Appendicitis: symptoms and causes
Appendicitis is an inflammation of the appendix, a finger-shaped sac protruding from the colon in the lower right abdomen
It is a disease that in most people causes pain that starts around the belly button and then moves to the lower right abdomen.
As the inflammation worsens, the pain usually increases and eventually becomes intense.
Although anyone can develop appendicitis, the disease most often affects individuals between the ages of 10 and 30. The standard treatment is surgical removal of the appendix.
Appendicitis, what it is
In medicine, the suffix ‘ite’ indicates the presence of inflammation.
And, in fact, appendicitis is an inflammatory disease involving the vermiform appendix.
The latter is a small, worm-shaped portion of lymphatic tissue (remember that the lymphatic system is responsible for protecting and defending the body) located in the first part of the colon, the large intestine.
The appendix resembles a small, short, blind (i.e. closed) tube: it is an area that is easily inflamed.
To better understand where the appendix is located, try to imagine making a cross centred on the navel that divides the abdomen into four quadrants: well, the appendix is located in the lower right quadrant of the abdomen.
However, this is not always the case: you should be aware, in fact, that some people, for anatomical reasons, have their appendix in other areas, for example higher up, below the liver (in this case we speak of a retrociecal appendix).
Signs and symptoms of appendicitis may include:
- sudden pain that starts on the right side of the lower abdomen or sudden pain that starts around the belly button and often moves into the lower right abdomen;
- pain that worsens if you cough, walk or make other movements;
- nausea and vomiting;
- loss of appetite;
- low-grade fever that may worsen as the disease progresses;
- constipation or diarrhoea;
- abdominal bloating;
- flatulence.
It should be known that the site of pain caused by appendix inflammation can vary, especially depending on the age of the patient and the position of the appendix itself.
For example, in pregnant women, the pain may seem to come from the upper abdomen because the appendix is usually higher during pregnancy.
Appendicitis, causes
The most likely cause of appendicitis is a ‘blockage’ (see next paragraph) in the lining of the appendix, which ends up causing an infection.
In such cases, bacteria tend to multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus.
If not treated promptly, the appendix can rupture.
It should be known that the appendix is lined with lymphatic tissue, which has the task of capturing microorganisms and harmful substances that are present in the body, including germs and bacteria.
This tissue is very abundant, so it can easily happen that bacteria, germs and pathogens (picked up by the lymphatic tissue) accumulate around the appendix, which can inflame the area.
The narrowness of the inner diameter of the appendix itself only encourages inflammation: all it takes is for a small foreign body (e.g. faecal waste, which is the most common cause) to get into the area, for the appendix to become obstructed, ulcerated or invaded by intestinal bacteria.
Other triggers may be the presence of foreign bodies (e.g. vegetable seeds), the length or angle of the appendix and the consumption of irritating foods.
Acute appendicitis
Appendicitis is essentially an acute disease.
It is quite common and is the condition that most commonly requires surgery in childhood.
In younger children, the differential diagnosis may be more laborious.
In the elderly, it may cause more nuanced symptoms, mainly due to fragile tissues and reduced immune defences.
In cases of acute appendicitis, it is often necessary to intervene surgically before it can complicate into peritonitis.
In some cases, microscopic analysis of the removed appendix may indicate the presence of chronic inflammatory tissue afterwards.
If painful abdominal complaints recur over time, it is important to exclude the presence of other chronic inflammatory diseases such as Crohn’s disease, gynaecological diseases, irritable bowel syndrome and abdominal abscesses.
Complications
If treated correctly, appendicitis is generally a disease of no concern.
However, it can be associated with two serious complications.
First, the appendix can perforate and, unfortunately, a perforation ends up spreading the infection throughout the abdomen, triggering peritonitis.
Potentially life-threatening, this condition requires immediate surgery to remove the appendix and clean out the abdominal cavity.
The second complication related to appendicitis is the formation of a pus sac in the abdomen.
If the appendix ruptures, an abscess may develop.
In such situations, in most cases, action is taken by draining the pocket of infection by inserting a tube into the abdominal wall, at the level of the abscess.
In combination, antibiotic drugs are administered to eliminate the infection.
When faced with the following symptoms, it is necessary to call for help and take the person to hospital:
- on palpation the wall of the abdomen puts up a tenacious resistance and the contraction, over time, becomes stronger and more extensive: there is a ‘wooden belly’;
- fever,
- nausea,
- vomiting.
While waiting for help, lie down, with the abdominal muscles as relaxed as possible.
Do not take purgatives, laxatives or analgesics to avoid altering the clinical picture during the doctor’s examination.
Caution: never put a hot water bottle on the painful part.
The heat, in fact, causes more blood to flow in, thereby increasing the pain sensation and inflammation.
If the diagnosis is uncertain, doctors may request investigations such as an abdominal ultrasound.
How appendicitis is treated
If appendicitis is present, surgery is usually performed to remove the inflamed appendix (technically referred to as an appendectomy).
Before surgery, it may be necessary to administer antibiotic drugs to treat the infection.
An appendectomy can be performed open, through an abdominal incision.
Alternatively, laparoscopic surgery, which involves several small abdominal incisions, may be used.
During a laparoscopic appendectomy, the surgeon inserts microscopic surgical instruments and a video camera into the abdomen to remove the appendix.
In general, laparoscopic surgery allows for faster recovery and healing with less pain and scarring.
But laparoscopic surgery is not suitable for everyone.
If the appendix has ruptured and infection has spread or if there is an abscess, you may need a larger incision, which allows the surgeon to better clean the abdominal cavity.
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