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Appendicitis

DEFINITION

Appendicitis is a painful abdominal condition caused by an inflamed appendix. Appendicitis usually causes acute abdominal pain and is a surgical emergency. The appendix is a small structure which branches off the small intestine and is what scientists call “vestigial” (meaning it once had a purpose in for other animals throughout evolution, but doesn’t for humans). The cause of appendicitis is the obstruction of its opening to the intestines causing backup of mucus in its pockets and rapid swelling. Sometimes the obstruction will spontaneously resolve but, more often, the increasing pressure in the appendix leads the appendix to burst if it is not removed from the body. Often, a small clot will form in the blood supply to the appendix, leading to death of the tissue. Bacteria then leaks through the wall of the appendix causing the collection of pus around the appendix. Ultimately, this pus bursts into the surrounding abdominal cavity, a condition called peritonitis. Peritonitis is extremely dangerous and can lead to a severe bacterial infection called sepsis and even death. Even if you had your appendix removed, it is possible to have recurrent appendicitis in the leftover stump of your appendix after surgery.

SYMPTOMS
Severe abdominal pain, nausea, vomiting, loss of appetite, fever

DIAGNOSIS
Diagnosis of appendicitis begins with a history and physical exam. Appendicitis needs to be handled in an emergency fashion, so you will be sent to the Emergency Room if you’re not already there. A surgeon will see you as soon as appendicitis is suspected. If you are a woman, you will have a test to see if you are pregnant. You will have a series of blood tests done to look for infection and at your liver, but the most important testing is imaging. Pictures of your appendix will be taken with either an ultrasound (sonogram) or CT scan. Neither of these exams is terribly painful, but you will likely already be in a lot of pain. If a swollen or burst appendix is seen on imaging, you will need surgery emergently.

TREATMENT
Treatment of appendicitis begins with not eating or drinking anything to give the bowel rest. You will be given pain medication to help with your symptoms. You will likely get IV fluids. You will likely be started on antibiotics through your vein (IV antibiotics). The only definitive treatment for appendicitis is surgery. Surgery can either be done with tiny scopes placed in the abdomen (laparoscopy) or with an open surgery of the abdomen (laparotomy). Depending on whether the appendix has burst, you may also have a washout of the abdomen with liquid antibiotics. Complications after the procedure are more frequent if your appendix has burst. If the appendix has not burst, recovery time can be fairly easy. Generally, recovery time is between one to three weeks depending on the severity of the appendicitis. Even with optimal treatment, appendicitis can cause very serious infections and death.

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