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Appendicitis Overview
The appendix is a narrow tubular pouch that is attached to the intestines. When the appendix is
blocked, it becomes inflamed and results in the condition known as appendicitis. If the blockage
continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of
blood supply, which finally results in the appendix bursting.
Appendicitis is a common condition that affects 6% of the population. It most commonly occurs
among those !"#! years of age, though it can occur at any age. Increased $igilance in
recogni%ing and treating potential cases of appendicitis is re&uired for the $ery young and old
who ha$e a higher rate of complications.
Appendicitis Causes
There is no clear cause of appendicitis. 'ecal material has been thought to be one possible
obstructing ob(ect. It also appears that appendicitis is not hereditary or transmittable from person
to person.
Appendicitis Symptoms
Appendicitis typically begins with a $ague pain in the middle of the abdomen often near the
umbilicus )na$el or *belly button*+. The pain slowly mo$es to the right lower abdomen )toward
the right hip+ o$er ,- hours. In the classic description, abdominal pain is accompanied with
nausea, $omiting, lack of appetite, and fe$er. All of these symptoms, howe$er, occur in fewer
than half of people who de$elop appendicitis. .ore commonly, people with appendicitis often
ha$e any combination of these symptoms.
Symptoms of appendicitis may take 4-48 hours to develop. During this time,
someone developing this condition may have varying degrees of loss of
appetite, vomiting, and abdominal pain. Some may have constipation,
diarrhea, or no change in bowel habits.
Early symptoms are often hard to separate from other conditions including
gastroenteritis an in!ammation of the stomach and intestines". #any people
admitted to the hospital for suspected appendicitis leave the hospital with a
diagnosis of gastroenteritis$ true appendicitis is often mis-diagnosed as
gastroenteritis initially.
%hildren and the elderly often have fewer symptoms, which makes their
diagnosis less obvious and the incidence of complications more fre&uent.
When to Seek Medical Care
/all the doctor if there are acute symptoms of middle0lower or right0lower abdominal pain with
fe$er and0or $omiting.
If symptoms of abdominal pain continue for more than four hours, then an urgent medical
e$aluation should be done at the doctor1s office or the hospital1s emergency department.
Exams and Tests
Lab work 'lthough no blood test can con(rm appendicitis, a blood sample
is sent for laboratory analysis to check the white blood cell count, which is
typically elevated in an individual with the condition. )owever, normal levels
are often present with appendicitis, and elevated levels can be seen with
other conditions. ' urine test may be performed to e*clude urinary tract
infection or pregnancy in females" as the cause of the symptoms.
!ma"in" tests 'ppendicitis is diagnosed by the classic symptoms and the
physical e*am the doctor+s e*amination of your abdomen". ,maging tests are
used when the diagnosis is not readily apparent. #ost medical centers now
use a %- scan of the abdomen and pelvis to help evaluate abdominal pain
suspected of being caused by appendicitis. .ltrasound scanning is currently
commonly used in small children to test for appendicitis.
Appendicitis Treatment
Sel#$Care at %ome
There is no home care for appendicitis. If the condition is suspected, contact your doctor or go to
an emergency department. A$oid eating or drinking as this may complicate or delay surgery. If
you are thirsty, you may rinse your mouth with water. 2o not take )or gi$e your child+ laxati$es,
antibiotics, or pain medications because they may cause delay in diagnosis and risk rupture of the
appendix or mask the symptoms, which would make diagnosis more difficult.
The best treatment for appendicitis re&uires surgery to remo$e the appendix )the operation is
called an appendectomy+ 3 before the appendix opens or ruptures. While awaiting surgery, you
will be gi$en I4 fluids to keep hydrated. 5ou will not be allowed to eat or drink because doing so
may cause complications with the anesthesia during surgery.
6urgery is commonly done laparoscopically )through small incisions using a camera in the
abdominal ca$ity+. 7owe$er, in some cases it may be necessary to do an open abdominal
procedure to take your appendix out.
&ext Steps
After an uncomplicated appendectomy, you may gradually resume a normal diet with a
restriction in physical acti$ity for at least two to four weeks. The doctor will check the incision
the following week to look for possible wound infection.
There is no way of predicting when appendicitis will occur. It cannot be pre$ented.
/ith uncomplicated appendicitis, most people recover with no long-term
,f the appendi* ruptures, there is a greater than ten times risk of
complications, including death. -his increase in risk generally is found in the
very young, elderly, and those with weakened immune systems, including
people with diabetes.
/hether a perforated appendi* is a signi(cant risk for infertility has not been
well established. Some e*perts recommend that this be considered in young
women who might be at risk.
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An appendicectomy )or appendectomy+ is the surgical remo$al of the $ermiform appendix.
This procedure is normally performed as an emergency procedure, when the patient is suffering
from acute appendicitis. In the absence of surgical facilities, intra$enous antibiotics are used to
delay or a$oid the onset of sepsis8 it is now recogni%ed that many cases will resol$e when treated
non"operati$ely. In some cases the appendicitis resol$es completely8 more often, an
inflammatory mass forms around the appendix. This is a relati$e contraindication to surgery.
Appendicectomy may be performed laparoscopically or as an open operation. 9aparoscopy is
often used if the diagnosis is in doubt, or if it is desirable to hide the scars in the umbilicus or in
the pubic hair line. :eco$ery may be a little &uicker with laparoscopic surgery8 the procedure is
more expensi$e and resource"intensi$e than open surgery and generally takes a little longer, with
the )low in most patients+ additional risks associated with pneumoperitoneum )inflating the
abdomen with gas+. Ad$anced pel$ic sepsis occasionally re&uires a lower midline laparotomy.
In general terms, the procedure for an open appendicectomy is as follows.
Antibiotics are gi$en immediately if there are signs of sepsis, otherwise a single dose of
prophylactic intra$enous antibiotics is gi$en immediately prior to surgery.
;eneral anaesthesia is induced, with endotracheal intubation and full muscle relaxation, and the
patient is positioned supine.
The abdomen is prepared and draped and is examined under anaesthesia. If a mass is present, the
incision is made o$er the mass8
<citation needed=
otherwise, the incision is made o$er .c>urney1s point,
one third of the way from the anterior superior iliac spine )A6I6+ and the umbilicus8 this
represents the position of the base of the appendix )the position of the tip is $ariable+. The
$arious layers of the abdominal wall are then opened. The appendix is identified, mobili%ed and
then ligated and di$ided at its base. 6ome surgeons choose to bury the stump of the appendix by
in$erting it so it points into the caecum. ?ach layer of the abdominal wall is then closed in turn
?mergency appendicectomy
, @rophylactic appendicectomy
# @regnancy
- :eco$ery
A :eferences
6 ?xternal links
Emergency appendicectomy
'n in!amed appendi* can be life-threatening, particularly if the patient is out of
reach of medical care. )istorical records show a number of appendicectomies
carried out by unskilled ad hoc surgeons, communicating with a base hospital by
telephone or even telegraph.
3citation needed4
Prophylactic appendicectomy
To find the cause of unexplained abdominal pain, exploratory surgery is sometimes performed. If
the appendix is not the cause of symptoms, the surgeon will thoroughly check the other
abdominal organs and remo$e the appendix anyway, to pre$ent it from becoming a problem in
the future.
When abdominal surgery is performed for an entirely different reason )e.g. hysterectomy or
bowel resection+, the surgeon sometimes decides to perform an appendicectomy in addition to
the intended procedure, to eliminate the possible need of a future surgery (ust to remo$e the
appendix. 7owe$er, recent findings on the possible usefulness of the appendix has led to an
abatement of this practice.
,f appendicitis develops in a pregnant woman, an appendicectomy is usually
performed and should not harm the fetus.
-he risk of fetal death in the
perioperative period after an appendectomy for early acute appendicitis is 67 to
87. -he risk of fetal death is 9:7 in perforated appendicitis.
;ecovery time from the operation varies from person to person. Some will take up
to three weeks before being completely active$ for others it can be a matter of days.
,n the case of a laparoscopic operation, the patient will have three stapled scars of
about an inch in length, between the navel and pubic hair line. /hen a laparotomy
has been performed the patient will have a 9-6 inch scar, which will initially be
heavily bruised.
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