Appendicitis

Inflammatory and Immune System

Appendicitis is inflammation of the appendix – a small finger-like shaped organ attached where the small intestine meets the large intestine in the lower abdomen. In the past, it was thought that the appendix served no function in the human body. However, new research suggests that the appendix functions as a secondary immune organ and stores healthy gut bacteria for the lower intestinal tract. The inflammation of the appendix occurs usually due to a blockage of some sort that causes the bacteria inside the small tube to multiply and cause pressure to build on the abdomen. The condition can be very painful and seriously life-threatening if the appendix ruptures. Appendicitis is the most common abdominal emergency needing surgical intervention with more than 10,000 people requiring treatment each year. Teenagers and people in their 20s commonly suffer from appendicitis, but it can happen at any age.

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Symptoms

At first, the symptoms of appendicitis may be mistaken for other conditions. Constipation, ulcerative colitis, stomach lesions, Crohn’s disease, inflammatory bowel disease  (IBD), and a host of other stomach maladies all have similar symptoms. These include:

  • Pain, sometimes sharp in the area of the lower right side of the abdomen
  • Reduced appetite
  • Nausea and vomiting
  • Swelling in the abdomen
  • Fever ranging from 99.0° F to 102.0° F
  • No passing of gas or bowel movement
  • Pain in the rectum
  • Pain with urination
  • Cramping
  • Constipation
  • Diarrhea

Infants and children can have different symptoms with appendicitis. They may not complain of pain in a specific area but may be tender throughout their body. In older adults and pregnant women, the stomach pain may not be as severe nor as localized (that is, the lower right side of the abdomen). Pregnant women can also have back or flank pain with the pain shifting upward (on the right side) after the first trimester.Remember, any form of severe abdominal pain should be evaluated in the emergency room right away.

Remember, any form of severe abdominal pain should be evaluated in the emergency room right away.

Types

Appendicitis can be acute, recurrent, or acute depending on the symptoms. All types are resolved with an appendectomy.

Acute appendicitis. Relatively rare in infants and senior patients. The obstruction causes mild pain in the upper abdominal region and a low-grade fever. This is followed by severe pain, building pressure within the appendix, and vomiting.

Recurrent appendicitis. Characterized by episodes of severe abdominal pain that come and go.

Chronic appendicitis. Inflammation of the appendix causes severe unremittent pain lasting for weeks.

Risk Factors

Risk factors for appendicitis include:

  • Between 10 years and 30 years of age
  • Family history of appendicitis
  • Male gende
  • History of cystic fibrosis

Diagnosis

If you or someone you care for has symptoms of appendicitis, medical evaluation is needed right away. Doctors will look at the following:

Physical signs. After taking a medical history of your symptoms, the doctor will check different parts of the abdomen for pain. Often when doing this, removal of the hands causes sharp pain. Your abdomen will also be checked for firmness and stiffness. You may also need a rectal or pelvic examination.

Lab tests. A complete blood count is obtained to check for high white blood cells. This shows inflammation/infection. A urine test is done to make sure pain is not coming from kidney stones or a bladder infection.

CT scan or ultrasound. These are done to check the size of the appendix or to rule out another reason for the abdominal pain.

Treatments

If you are diagnosed with appendicitis, the usual treatment is surgery. This is done right away to prevent the appendix from rupturing and causing further issues. The only time surgery is not performed right away is if there is an abscess. This is a pus-filled sac that forms outside of the appendix and seals itself off. The abscess must be drained first. Then an appendectomy (surgical removal of the appendix) is done a few weeks later.

Patients are put on intravenous antibiotics as soon as they are diagnosed in the case that any bacteria has leaked into the system. Even if there was no bacterial leakage before surgery, sometimes the appendix can rupture during surgery, so the antibiotics will have you covered!

An appendectomy is usually performed via laparoscopy, which makes very small incisions in the abdomen. You can be up and around just a few hours after your surgery and can even go home the same day if there are no complications. In severe appendicitis or in the case of rupture, traditional open surgery may be performed.

Alternative Treatments and Home Remedies

Appendicitis is a medical emergency and should be evaluated and treated by a physician. If the doctor does decide to watch and wait, there are a few natural remedies you can use to help cleanse the appendix. While they are not a cure, they may help while you are waiting for surgery:

Turmeric and ginger. Take ½ teaspoon of turmeric powder and mix in ginger juice and honey. You can take these two times a day to help relieve inflammation and pain.

Increase in fiber. Whether you have surgery or not, increasing fiber from fresh fruits and vegetables can help with constipation and bowel cleansing.

Buttermilk. Anything with natural probiotics can help keep the bacterial levels down in the appendix.

Basil tea. This can help to reduce the fever that comes with appendicitis.

Prevention

There is no surefire way to prevent appendicitis from happening. You can take precautions to keep your bowels moving regularly and prevent fecal build-up. This includes eating healthy and drinking plenty of fluids.

Some studies in other countries have shown that people who eat less meat, processed foods, and sugar have less chance of developing appendicitis. This includes a diet that is high in fiber-rich foods such as wheat germ, bran, fresh fruits, and vegetables.

Lifestyle Changes

After surgery for appendicitis, the following lifestyle changes may need to be made to help the recovery period go faster.

Take it easy the first few days after surgery and avoid heavy lifting. If a laparoscopic procedure was done, about 3 to 5 days recovery time is needed while an open procedure requires 10 to 14 days. Rest as much as your body tells you to. Sleep is restorative and helps you heal faster. Lay down when you feel tired.

Use a pillow on your abdomen to cough. This will help relieve any pain. Increase activity as tolerated. A little walking is good to get your bowels moving and help you pass gas. Only walk until you feel tired and then rest.

Drink plenty of fluids. This will help your body heal and prevent constipation, which can be common after bowel surgery.

References

Healthline. Everything you need to know about appendicitis. Retrieved from Healthline: https://www.healthline.com/health/appendicitis#ultrasound

Hopkins Medicine. What is appendicitis? Retrieved from Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendicitis

Luo, E. K. (2017, September 25). Appendicitis: What you need to know. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/312123

Medline Plus. (2019, March 18). Appendicitis. Retrieved from Medline Plus: https://medlineplus.gov/appendicitis.html

Petroianu, A., & Villar Barroso, T. V. (2016, April 29). Pathophysiology of acute appendicitis. JSM Gastroenterology and Hepatology, 4(3). Retrieved from https://www.jscimedcentral.com/Gastroenterology/gastroenterology-4-1062.pdf

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