Emergency Management of Appendicitis

Introduction

Appendicitis is a condition occurring in the appendix, which is a small pouch-like organ attached to the intestines. The inflammation of the appendix leads to appendicitis.

What Is Appendicitis?

Appendicitis is a condition that occurs when the appendix gets inflamed. For example, it could occur due to a blockage. Appendicitis can be of two types: acute and chronic.

The appendix lies in the lower right abdominal region. Bacterial multiplication in the appendix leads to pus formation. This causes inflammation, pain, and pressure in the lower abdominal area. Therefore, appendicitis needs timely treatment, or else the appendix can burst and lead to bacteria spilling inside the abdominal cavity; that is a severe condition and can be fatal.

What Are the Types of Appendicitis?

Acute Appendicitis - It is a severe and sudden case of appendicitis. This is most commonly seen in young children and adults, between 10 to 30 years of age, and in males than females. Pain develops and intensifies quickly within 24 hours. This condition requires immediate medical treatment. If not treated on time, it can cause a rupture of the appendix, which results in peritonitis (infection and inflammation of the abdominal lining called peritoneum). This is a severe condition and can be fatal sometimes. Acute appendicitis is more common than chronic appendicitis.

Chronic Appendicitis - Chronic appendicitis is less common than acute appendicitis. It occurs only in a few cases, usually that are already dealing with acute appendicitis. The symptoms of this appendicitis type are mild and so, it is difficult to diagnose this condition. Chronic appendicitis can be dangerous as well.

What Are the Symptoms of Appendicitis?

Appendicitis shows a range of symptoms starting with mild pain and tenderness in the upper abdominal or the belly button region and reaching to the right abdominal region, which gets severe while coughing and sneezing. This pain has the following characteristics:

• It elevates suddenly.

• It does not let a person sleep.

• It worsens within hours.

• It is different from other types of abdominal pain.

Some other symptoms of appendicitis are:

• Nausea.

• Vomiting.

• Loss of appetite.

• Improper digestion.

• Abdominal swelling.

• Mild fever can be present sometimes.

In addition to these problems, bowel problems can also be seen sometimes, such as,

• Constipation.

• Diarrhea

• The desire to pass a motion.

• Inability to pass gas.

In the case of appendicitis, if a person feels constipated, they should avoid taking laxatives (drugs that ease evacuation of bowels), as it could lead to the bursting of the appendix. However, it is noted that appendicitis has been found in some individuals who did not experience any symptoms at all, even in children.

What Are the Causes of Appendicitis?

Appendicitis can be caused due to more than one reason. In some cases, it may be identified clearly. The possible causes include the following:

• Enlargement of the appendix wall due to any infection of the digestive tract or involving some other part of the body.

• Inflammatory bowel disease.

• Hardened stool or growth that can block the opening inside the appendix.

• Abdominal injury or any trauma.

• Family history can be a possible cause.

How Is Appendicitis Diagnosed?

Appendicitis is diagnosed through different techniques, such as,

Physical Examination - The doctor asks for the patient's complete medical history including family history, signs, and symptoms of the disease, etc. He also performs a physical examination by looking for areas of pain and tenderness in the abdomen or the belly region.

Some tests are performed to check for signs of inflammation, blockage, or organ rupture. These tests include,

Blood Tests - Complete blood count or CBC is done to check for infection. Doctors also suggest a C-reactive protein test to check if the abdominal inflammation is associated with some other disease, such as an autoimmune disorder.

Imaging Scans:

• CT (Computed tomography) Scan - This can use a combination of X-rays and computer technology. It shows the cross-section of the body.

• Magnetic Resonance Imaging (MRI) - This technique uses magnetic waves for imaging. It shows a detailed picture of the abdominal organs.

• USG (Ultrasonography) - Abdominal ultrasound is performed to show images of the abdominal region.

What Is the Management of Appendicitis?

The treatment of appendicitis depends on the disease's age, type, and severity. The treatment is usually of two types.

Non-surgical Treatment - This can be done in cases of mild appendicitis. It is a treatment in which the patient is given antibiotics with the aim of avoiding surgery. In these patients, appendectomy (removal of the appendix) is suggested only when they do not respond to antibiotics and recurrence of appendicitis is seen. This option is chosen for patients with localized appendicitis without any evidence of peritonitis or large abscess. IV doses of Ceftriaxone in combination with Metronidazole are given. In the case of an oral regime, fluoroquinolones in combination with Metronidazole are suggested.

Surgical Treatment - Most people suffering from appendicitis need surgery which is called an appendectomy, which is the removal of the appendix. If the appendix is not ruptured yet, surgery prevents it from rupturing and spreading the infection.

Before starting the surgery, antibiotics are given to prevent infection. Most of the surgeries these days are done laparoscopically (a surgical procedure done through a small incision with a narrow tube). It is an easy procedure and recovery is fast. This minimally invasive procedure involves less pain and discomfort for the patient. The treatment protocol includes one or more of the following:

• Needle drainage or surgery to drain abscesses before the surgery if the appendix has not ruptured.

• IV fluids.

• Analgesics.

• Liquid diet.

• In case of ruptured appendicitis, a person needs a major abdominal surgery called a laparotomy.

Conclusion

Appendicitis is the inflammation of the appendix. It causes pain in the abdomen or the belly button area. The prevalence of appendicitis is more commonly seen in males. Its management requires surgery called an appendectomy, while in some rare and mild cases, it can be treated non-surgically with antibiotics. Open appendectomy was the only treatment for more than a century, while these days, laparoscopic procedures have helped a lot by providing faster recovery and less pain. If left untreated, complications of appendicitis are seen, such as abdominal abscess (a pocket full of pus in the abdomen), sepsis (bacteria from a ruptured appendix reaches into the bloodstream causing an infection), and peritonitis. Therefore, it requires timely treatment.