Overview
The Appendix is a small, finger-shaped pouch of intestinal tissue extending from the cecum, which is the first part of the large intestine. The appendix is located in the lower right portion of the abdomen, it has no known function. Removal of the appendix appears to cause no change in digestive function.Blockage of the opening of the appendix into the bowel by a hard small stool fragment (fecalith) is believed to be a frequent cause of appendicitis.
The infected appendix must be surgically removed (emergency appendectomy), because if it becomes perforated (leaks), this can lead to infection of the entire abdominal space (peritonitis), which can be fatal.
Diagnosis
- Clinical Diagnosis : - appendicitis remains a clinical diagnosis primarily. There is no set of invariably ocurring signs and symptoms. The two most common are anorexia (loss of appetite) and pain, although there are many cases of appendicitis that have neither of these. Other signs and symptoms included pain around the umbilicus that "moves" to the right lower quadrant, fever, nausea, vomiting, diarrhea, rigid and board-like abdomen, and worsening pain on walking. Appendicitis is most difficult to clinically diagnose in the very young and very old and in patients who are diabetic or on steroids.
- Radiographic Diagnosis : - - there are three radiographic studies that are commonly used to help diagnose appendicits, although in clear-cut clinical cases none is absolutely required. The most widely used is computed tomography (CT) of the abdomen and pelvis with 5 mm cuts. For best results this should be performed with intravenous dye, dye given by mouth (or PO), and dye given per rectum (although this is often not done as it is uncomfortable for the patient and radiology technician both.) Findings consistent with appendicitis are stranding in the mesentery, non-visualization of the appendix lumen, fluid in the pelvis, and an enlarged and thickened appendix, especially if it is seen in cross-section.
It must be noted that a normal CT does not rule appendicitis. Studies have shown that a CT can miss appendicitis, especially in the early stages, in up to 10% of cases.
Treatment
Laparoscopic Appendectomy is a much less invasive procedure for patients who have been diagnosed with an acute appendicitis than is traditional surgery.
The surgery can be completed in less than an hour in most cases. The appendix is a small, finger-shaped pouch that projects out from your colon on the right-hand side. The appendix has no known purpose. Every year about 7 percent of Americans develop appendicitis - a condition in which the appendix becomes inflamed and filled with pus.
The main symptom of appendicitis is pain that begins around the navel and then shifts to the lower-right abdomen. The pain usually increases over a period of 12 to 24 hours, and eventually may be very severe. Anyone can develop appendicitis, but it most often strikes people between the ages of 10 and 30 and is one of the most common reasons for emergency abdominal surgery in children.
The standard treatment for appendicitis is surgical removal of the appendix (appendectomy). In many cases the surgery is straightforward and you recover quickly. But if your appendix has ruptured, the surgery may be more complicated and you'll take longer to heal. A ruptured appendix that's not promptly treated can lead to serious complications such as an infection of the abdominal lining (peritonitis) or a walled-off area of infection (an abscess). In rare instances a ruptured appendix may be fatal.
Symptoms
The first sign is usually a pain or discomfort in the centre of the abdomen. The pain usually begins near the umbilicus and moves down and to the right. This pain comes and goes in waves and increases on movement.
Pain is often thought at first to be a simple stomach upset :.
- Nausea
- Vomiting
- Constipation
- Diarrhoea
- Inability to pass gas
- Low fever that begins after other symptoms
- Abdominal swelling
- Anorexia
Complications
- Superficial Wound Infection- this is a risk with all surgical incisions and is increased if the skin edges are closed in the setting of late appendicitis or rupture.
- Intraperitoneal Abscess - this is fortunately unusual but can complicate up to 10% of cases of ruptured appendicitis.
- Other - as with all surgeries there is always a risk of blood clots, pulmonary embolism, stroke, heart attack, and death.
In most cases, the specific reason for the inflammation is not known but it is due to blocking of the opening connecting the large intestine and appendix. In many cases it is caused by small pieces of hardened stool (faecaliths) that get stuck in the appendix.
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