Appendicitis and its Management:
What is Appendix?
Small tube like structure with one blind end near the junction where small and large intestine connect.
Where is it located?
Right lower side of the abdomen
What causes Appendicitis?
- Blockage of outflow of sections from appendix by a small lump of fecal matter
- Gut infection
- Injury to abdomen
- Growth inside appendix lumen
These common factors cause swelling and infection leading on to the symptoms.
- Severe pain in Abdomen (initially near the belly button but more consistently near Rt lower region of abdomen)
- Pain is of varying severity, Worsened by movement, food consumption.
- Nausea and vomiting
- Diarrhea (or) constipation (passage of gas also affected later)
- Fever ( usually low grade unless associated with complications)
Commonly seen in young people although all age groups are affected.
- Physical examination severals typical findings suggestive of appendicitis.
- Blood counts: typically raised suggestive of infection
- Ultrasound abdomen: Effective in picking up signs of appendicitis but typically it shows features in only 65-70% of pts having an inflammation.
- CT scan abdomen: Effective in diagnosing in a majority of infections (most sensitive).
- MRI abdomen: Effective method to diagnose without radiation .
Most of the times people who have appendicitis are treated by removal of appendix called appendectomy.
- Very mild infection or obscure diagnosis: People are treated with Intravenous antibiotics under observation after admission to hospital.
- Almost all cases with appendicitis: Surgery is the treatment of choice
After admission a course of intravenous antibiotics is started for all patients, and assessment is done and then prepared to undergo surgical procedure.
- Laparoscopic Appendectomy: Minimally approach where a Laparoscope and instruments are passed into the abdomen to perform the surgery.
- Open surgery: in settings where expertise to perform laparoscopic surgery is not available.
- Laparotomy: Major abdominal surgery if complication like appendicular rupture and its associated conditions arise.
- Abdominal infections- Secondary to rupture can be treated laparoscopically or by laparotomy to treat the infection.
- Abscess: Pus collection around the appendix may be treated by surgery or by placing drainage tube & IV antibiotics .Once the infections settle these patients have to undergo surgery to remove appendix.
- Sepsis: Untreated /complicated appendicitis can lead into bacteria entering the blood stream. It is a serious condition can be fatal if untreated.
- Most patients undergoing laparoscopic surgery are discharged within 36 hours. (mostly in 24hrs)
- Most return to normal life in 2-3 weeks.
- Complications require longer hospitalisation and recovery is similarly prolonged sometimes > 3-6 weeks.