The appendix is a small outgrowth of tissue forming a tube shaped sac attached to the lower end of the large intestine. Inflammation of the appendix presents itself in acute and chronic forms and affects both the sexes equally. Appendicitis is a painful swelling and infection of the appendix. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure problems with blood flow and inflammation. If the blockage is not treated, the appendix can break open and leak infection into the body.

This disease accounts for about half the acute abdominal emergencies occurring between the age of ten and thirty.

Causes

Appendicitis is initiated by the presence of an excessive amount of poisonous waste material in the caecum. As a result, the appendix gets irritated and inflamed.

Inflammation and infection are caused by certain germs which are usually present in the intestinal tract.

The sources that cause obstruction are:

• Feces, parasites or growths that block the appendiceal lumen.

• Any infection in the gastrointestinal tract causes enlarged lymph tissue in the wall of the appendix.

• Inflammatory bowel disease

• Trauma to the abdomen

The appendicitis, when diagnosed properly should be removed immediately, as it may burst and spread infection throughout the abdomen and create a potentially dangerous condition such as the peritonitis.

Symptoms

The commonly seen symptoms of appendicitis include pain in the abdomen, loss of appetite, nausea and vomiting, constipation or diarrhea, inability to pass gas and low fever. Gradually, the pain shifts to the lower right side and is usually accompanied by a fever varying from 38 degree Celsius to 39 degree Celsius. These symptoms need not be present necessarily in all appendicitis patients. Nausea is common and the patient may vomit once or twice.

In the chronic state of appendicitis, the patient may suffer from recurrent pain in the right lower abdomen, constipation, loss of appetite and nausea.

Appendicitis is initiated by the presence of an excessive amount of poisonous waste material in the caecum. As a result, the appendix gets irritated and inflamed.

Inflammation and infection are caused by certain germs which are usually present in the intestinal tract.

Surgery is the treatment for appendicitis. Removal of this organ does not affect the patient’s health.

The history and sequence of symptoms are among the most important diagnostic features of appendicitis. The initial symptom is almost abdominal pain of the visceral type.

There is often an accompanying urge to defecate or pass the flatus, neither of which relieves the distress.

This visceral pain is mild, often cramping and rarely catastrophic in nature, usually lasting 4 to 6 hours, but it may not be noted by stoic individuals or by some patients during sleep.

As the inflammation spreads to the parietal peritoneal surfaces, the pain becomes somatic, steady and more severe, aggravated by motion or cough, and usually located in the right lower quadrant.

• Anorexia is so frequent that the presence of hunger should arouse serious suspicion of the diagnosis of acute appendicitis. Nausea and vomiting occur in 50 to 60 percent of cases, but vomiting is rarely profuse and protracted. The development of nausea and vomiting before the onset of pain is extremely rare.

Urinary frequency and dysuria occur if the appendix is adjacent to the urinary bladder.

The typical sequence of symptoms (poorly localized periumbilical pain followed by nausea and vomiting with subsequent shift of pain to the right lower quadrant) occurs in only 50 to 60 percent of patients and some variations are considered below.

Physical findings vary with time after onset of the illness and according to the location of the appendix, which may be situated deep in the pelvic cul-de-sac, in the right lower quadrant in any relation to the peritoneum, caecum, and small intestine, in the right upper quadrant (especially during pregnancy), or even in the left lower quadrant. The diagnosis cannot be established unless tenderness can be elicited.

While tenderness is sometimes absent in the early visceral stage of the disease, it ultimately always develops and is found in any location corresponding to the position of the appendix.

Abdominal tenderness may be completely absent if a retrocecal or pelvic appendix is present, in which case the sole physical finding may be tenderness in the flank or on rectal or pelvic examination. Percussion, rebound tenderness and referred rebound tenderness are often, but not invariably, present; they are most likely to be absent early in the illness.

The temperature is usually normal or slightly elevated, but a temperature above 38.3 degree Celsius should always suggest the presence of perforation. Tachycardia is common with the elevation of temperature.

Rigidity and tenderness is more marked as the disease progresses to perforation and localized or diffuse peritonitis. Distension is rare unless severe diffuse peritonitis has developed. The alleged disappearance of pain and tenderness just prior to perforation is extremely unusual. A mass may develop if localized perforation has occurred but usually will not be detectable before 3 days after onset of the disease.

In case of blood test, presence of moderate leukocytosis is seen. However, absence of leukocytosis does not eliminate the possibility of acute appendicitis. However, a high value should alert the Clinician to the probability of perforation. Anemia and blood in the stool suggest a primary diagnosis of carcinoma of caecum, especially in the elderly individuals. The urine may contain a few white or red blood cells without bacteria if the appendix lies close to the right ureters or bladder.

X-rays are rarely of value except when an opaque fecaltih (5 percent of patients) is observed in the right lower quadrant (especially in children) together with other clinical findings consistent with appendicitis. Consequently, there is no routine need to obtain films of abdomen unless there is a possibility of other conditions such as intestinal obstruction or ureteral calculus.

Diet and other measures

When the first symptoms of pain, vomiting and fever occur, the patient must be put to bed immediately as rest is of the utmost importance. The patient of appendicitis should adopt all measures to eradicate constipation. Once the waste matter in the caecum has moved into the colon and is then eliminated, the irritation and inflammation in the appendix will subside and surgical removal of the appendix may not be necessary.