What Is Appendicitis?

It is defined as a disorder in which there is an inflammation of the appendix. It is a condition of emergency. The inflamed part of appendix must be removed with the help of laparoscope. If this condition is not treated properly it can lead to the death of individual. It occurs due to the shock. This condition was first described by the R Fitz in year 1886. He divided it into two parts as acute and chronic. This condition is one of the most common causes of pain in abdomen. It leads to sharp pain. There is a non acute form of this condition which is known as rumbling appendicitis.

What are the signs and symptoms of appendicitis?
It includes the different signs known as rovsings sign, psoas sign, obturator and Blumberg sign. The rovsings sign includes the non stopping deep palpation which starts from the left side of ileum and goes upwards. It pushes the bowl contents towards the valve present in ileocaecal area and increases the pressure over there.

The psoas sign includes the pain in lower right area. It occurs when the patient lies on the left side and extends its hips. The extension increases the pain and the patient lieswith the flexing of right hip so that he can get relieve from the pain.

The obturator sign includes the contact of inflamed appendix with a muscle known as obturator internus. It is done by flexing and middle side rotation of the hip. It may lead to pain in the area below the gastrium. Most of the conditions cause appendicitis and the inflammation of appendix can be controlled. It can occur with the help of antibiotics.

The blumberg sign includes the palpation of left part of fossa in which there is a pain which is bound to happen again.

All the signs are present on the right side of ileum fossa. The wall of abdomen becomes quite sensitive to little bit pressure known as palpation. There is a pain in this region which happens again and again. If the appendix is of retro cecal area there is no pain even if the pressure is applied properly. If the appendix is present in the pelvis area there is no rigidity in the abdomen. The coughing helps to locate a painful point in this area which is known as Mc Burney’s point. The inflamed appendix can be localized by this way.

How appendicitis can be treated?
It includes the treatment into two parts one before and other after the surgery. Before the surgery the patient must avoid any eating or drinking stuff. He is given fluids intra venous so that the hydration can be maintained. Antibiotics are given to kill thebacteria and decrease the chances of infection. It can even prevent the complications. In an empty stomach general anesthesia is used. The preparation for the operation takes two hours. The doctor explains to the patient how surgery is done. The risks which are linked with the surgery must be told to patient in advance. The appendix must not break and if it breaks the complications after the surgery arises. It can lead to bleeding or occurrence of the pneumonia.

1. The doctor must tell to patient about the recovery time. If the patient is male, than the hair in abdomen are removed and it helps to prevent the complications. One can also experience nausea as well as vomiting before the surgery. Pain killers along with the antibiotics must be given before the surgery.

2. It is important to control the pain during appendicitis. One must go for narcotics to control the pain. They must be given before the surgery and includes mainly the morphine. It is given in the adults as well as children.

3. The pain killer must be given as soon as possible. The surgical procedure done to remove the inflamed appendix is known as appendicectomy. It can be done with the help of laparoscope. In this there are multiple incisions and can see the appendix with the help of camera. If there is a rupture or a formation of abscess one can go for laparotomy. It is done at the point where there is maximum pain known as Mc Burney’s point. The laparoscopic procedures are considered to be better than the other procedures. The chances of infection are quite less in this case. The stay in hospital is less and one can return to the daily activities early. But this is a costly procedure. The young females are going to be benefit more from the laparoscopic procedures as compared to the other age groups. The start of antibiotic therapy and the delay in surgery does not increase the chances of perforation. The surgeries which are done during the day have better results as the staff is adequate and the doctor is not tired. The chances of complications are quite less. The most common complication linked with the surgery is perforation. The duration of surgery in patient varies from half an hour to few hours.

4. The traditional type of surgery used to treat this disorder is laparotomy. In this a single incision is given to remove the infected appendix in the lower right part of abdomen. The general anesthesia is given to patient to keep his muscle relaxed. The patient remains unconscious. After the incision the infected tissue is removed and the doctor helps to get an idea about the surrounding tissues which are damage or infected. After that he can close the incision. It must be covered with a bandage which is sterile so that infection must not occur.

5. The new method to treat this disorder is laparoscopic surgery in which multiple incisions are given. A special equipment known as laparoscope is used and it is connected to a monitor which is present outside the body of patient. It helps the surgeon to give a view of the tissues and the infected area. It also requires the use of general anesthesia.

6. After the surgery the stay in hospital ranges from one to few days. It can extend to few weeks if any complications arise. The recovery after the surgery depends on the condition whether the appendix has ruptured or not. The recovery of appendix surgery is quite fast as compared to the ruptured appendix. The patient must follow the advice of a doctor and must act accordingly. He must limit the physical activity as the tissues can heal quite fast if the physical activity is limited. The diet must not be changed and so is the life style.

7. After the surgery he patient is moved to the intensive care unit so that he can be checked. One can also give medicines to control the pain. When the patient becomes conscious he is moved to the hospital room so that he can recover. After the surgery the individuals are given liquid diet which is followed by the regular diet. It occurs as the intestines are able to work properly. The patient must sit up and walk few steps so that the blood circulation becomes proper. One must move and take medicines as prescribed by the doctor. The full recovery from the surgery takes few weeks and it can extend if the rupture is found.

How appendicitis can be diagnosed?
It includes the use of ultra sound, computed tomography and a combination of both. One can also take help from the Alvarado score and other data. The differential diagnosis is also helpful. It is mainly based on the patient symptoms and signs. It includes the different signs such as rovsings sign, psoas sign, obturator and Blumberg sign along with a physical examination. It shows increase in the white blood cells mainly neutrophils. The history of patient can be typical or atypical. The typical symptoms involve the pain in abdomen along with the nausea as well as vomiting. The pain starts in the lower left part of the abdomen and moves towards the right part. The atypical symptoms involve the pain in lower right part of abdomen in early stages. Prior to the surgery a pregnancy test must be done in the child age bearing women. The pain in women must be evaluated.

The diagnosis with the ultra sound helps in the detection of this disorder mainly in children. In few cases the ultra sonography of iliac fossa does not tell us about any problems. It cannot detect appendicitis. This is quite true in case of appendicitis present in the early stages. When it increases in size and stage it makes difficult for the appendix to be located as there is a large amount of fat and a gas in the bowel.

The diagnosis with the computed tomography helps in the diagnosis of this disorder in case of adults. It is done in those cases where the diagnosis is in a mis match with the history and physical features. But in this case radiations are used which can limit its use. Its use is limited in case of children and the females which are pregnant. A properly done CT gives good results. The Inflammation caused by this disorder leads to a peritoneal fat formation. In the thin patients the diagnosis becomes more difficult. It is also difficult to detect in case of children as they do not have enough fat in the abdomen.

The diagnosis with the help of ultra sound as well as CT scan is much better than the ultra sound alone.

The diagnosis with the Alvarado score helps in the diagnosis with the help of symptoms. The score 1 denotes to the anorexia, nausea, vomiting and pain in the right abdominal region. The signs 1 denotes to the fever and a pain which occurs from one point to other.The signs 2 denotes to the leucocytosis as well as pain in the right abdomen.

If the score is less than 5 it denotes to the life threatening condition.
The diagnosis with the differential diagnosis helps to know about the cause of the disease.

What are the causes of appendicitis?
It is caused mainly due to the obstruction in lumen of the appendix. After the blockage the appendix is filled with the mucus and it increases in the size. It increases the pressure and results in blockage of the small vessels which results in the stoppage of lymphatic fluid. The recovery is difficult to occur at this point. As the condition progresses the appendix loses the blood supply and becomes prone to infection caused by the bacteria. The pus is formed within the appendix which may lead to the death of individual.

The other agents which can causes appendicitis includes the trauma, foreign bodies, worms in the intestine and deposits formed as a result of calcium deposition. In developed countries the chances of appendicitis are more as compared with the developing countries. The acute appendicitis may lead to the cancer of colon as well as rectum. The diet which is not rich in fiber may lead to this condition.