Appendicitis

Definition

Appendicitis is an inflammation of the appendix, which is the worm-shaped pouch attached to the cecum, the beginning of the large intestine. The appendix has no known function in the body, but it can become diseased. Appendicitis is a medical emergency, and if it is left untreated, the appendix may rupture and cause a potentially fatal infection.

Description

Appendicitis is the one of the most common abdominal emergencies found in the United States. More males than females develop appendicitis. It is rare in the elderly and in children under the age of two. The hallmark symptom of appendicitis is increasingly severe abdominal pain. Since many different conditions can cause abdominal pain, an accurate diagnosis of appendicitis can be difficult. Other conditions can have symptoms similar to appendicitis, especially in women. These include pelvic inflammatory disease , ruptured ovarian follicles, ruptured ovarian cysts , tubal pregnancies, and endometriosis. Various forms of stomach upset and bowel inflammation may also mimic appendicitis.

A timely diagnosis of appendicitis is important, because a delay can result in perforation, or rupture, of the appendix. When this happens, the infected contents of the appendix spill into the abdomen, potentially causing a serious infection of the abdomen called peritonitis. Very rarely, the inflammation and symptoms of appendicitis may disappear but recur again later. If appendicitis is suspected, the following activities should be avoid, as they may cause the appendix to rupture:

• consuming food or drink
• taking pain medication, laxatives, or antacids
• the use of a heating pad on the affected area

Causes & symptoms

The causes of appendicitis are not totally understood, but are believed to occur as a result of blockage of the appendix. This blockage may be due to fecal matter, a foreign body in the large intestine, cancerous tumors, a parasite infestation, or swelling from an infection.

The distinguishing symptom of appendicitis is the migration of pain to the lower right corner of the abdomen. The abdomen often becomes rigid and tender to the touch. The patient may bend the knees in reaction to the pain. Increased rigidity and tenderness indicate an increased likelihood of perforation and peritonitis. Loss of appetite is very common, accompanied by a low-grade fever, and occasionally there is constipation or diarrhea, as well as nausea. Unfortunately, these signs and symptoms may vary widely. Atypical symptoms are particularly present in pregnant women, the elderly, and young children.

If bacteria multiply unchecked within the appendix, it will become swollen and filled with pus, and may eventually rupture. This produces an inflammation of the lining of the abdominal wall, or peritonitis, which is a medical emergency. Signs of rupture include the presence of symptoms for more than 24 hours, a high fever, a distended abdomen, a high white blood cell count, and an increased heart rate.

Diagnosis

A careful examination is the best way to diagnose appendicitis. It is often difficult even for experienced physicians to distinguish the symptoms of appendicitis from those of other abdominal disorders. The physician will ask questions regarding the nature and history of the pain, as well doing an abdominal exam to feel for inflammation, tenderness, and rigidity. Bowel sounds will be decreased or absent. A blood test will be given, because an increased white cell count may help confirm a diagnosis of appendicitis. Urinalysis may help to rule out a urinary tract infection that can mimic appendicitis. In cases with a questionable diagnosis, other tests, such as a computed tomography scan (CT) or ultrasound may be performed to help with diagnosis without resorting to surgery. Abdominal x rays, however, are not of much value except when the appendix has ruptured.

Patients whose symptoms and physical examination are compatible with a diagnosis of appendicitis are usually hospitalized and a surgical exploration of the abdomen, called a laparotomy, is done immediately to confirm the diagnosis. A normal appendix is discovered in about 10-20% of patients who undergo laparotomy. Because of the potential for a life-threatening ruptured appendix, persons suspected of having appendicitis are often taken to surgery before the diagnosis is certain. If the symptoms are not clear, surgery may be postponed until they progress enough to confirm a diagnosis. Sometimes the surgeon will remove a normal appendix as a safeguard against appendicitis in the future.

Treatment

Appendicitis must be treated by a surgeon in a hospital setting. However, acupressure can be helpful for recuperation. One dose of homeopathic phosphorus 30c can be taken before surgery to help reduce nausea, lightheadedness, and disorientation due to anesthesia. Phosphorus 6c can be also taken two to three times in the hours following surgery. Other appropriate remedies may include Aconite napellus 30c, Arnica montana 30c, Gelsemium 6c, and Staphysagria 30c.

Allopathic treatment

The treatment for sudden, severe appendicitis is surgery to remove the appendix, called an appendectomy. An appendectomy may be done by opening the abdomen in the standard operating technique, or through laparoscopy, in which a small incision is made through the navel. Recovery may be faster with a laparoscopy than with an ordinary appendectomy. An appendectomy should be performed within 48 hours of the first appearance of symptoms, to avoid a rupture of the appendix and peritonitis. Antibiotics are given before surgery in case peritonitis has already taken hold. If peritonitis is discovered, the abdomen must also be irrigated and drained of pus, and then treated with multiple antibiotics for 7-14 days.

Expected results

Appendicitis is usually treated successfully by appendectomy. Unless there are complications, the patient should recover without further problems. The mortality rate in cases without complications is less than 0.1%. When an appendix has ruptured, or a severe infection has developed, the likelihood is higher for complications, with slower recovery, or death from disease. There are higher rates of perforation and mortality among children and the elderly.

Prevention

Appendicitis is probably not preventable, although there is some indication that a diet high in leafy green vegetables may help prevent appendicitis.

Key Terms

Pus

A fluid formed in infected tissue, consisting of while blood cells and cellular debris.

Laparotomy

Surgical incision into the loin, between the ribs and the pelvis, which offers surgeons a view inside the abdominal cavity.

Further Reading

For Your Information

Books

• The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Virginia: Time-Life, Inc., 1996.
• Lininger, D.C., Skye, editor-in-chief, et al. The Natural Pharmacy. California: Prima Health, 1998.
• Yamada, Tadataka, ed. et al. Textbook of Gastroenterology. Philadelphia: J.B. Lippincott, 1995.

Periodicals

• Van Der Meer, Antonia. "Do You Know the Warning Signs of Appendicitis?" Parents Magazine (April 1997).
• Wagner J.M., et al. "Does This Patient Have Appendicitis?" JAMA: The Journal of the American Medical Association 276 (1996).

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.