How do you know if you have appendicitis? 8 symptoms

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Appendicitis is a painful swelling of the appendix. The word appendicitis stems from Latin, meaning inflammation of the appendix. You can get appendicitis at any age, but it usually affects people aged between 10 and 30 years. Appendicitis is the most common reason for abdominal surgery. Missing appendicitis can have serious consequences. Unfortunately, appendicitis is often misdiagnosed because the symptoms are not always very obvious or specific.

What is the appendix?

The appendix is a small, thin pouch about 9-10 cm long with a diameter of about 6 mm located in the lower right portion of the abdomen. This pouch of intestinal tissue sticks out from the cecum (the first part of the large intestine near the end of the small intestine). Appendix is Latin for ‘appendage’ (something attached to something else). It has long been unclear what role the appendix has in the body but it is now thought to be involved primarily in immune functions. The appendix is not an essential organ in the body. In other words, you can easily live without it.

What are the symptoms of appendicitis?

  1. Appendicitis typically starts with a mild pain in the abdomen. The pain starts in the area around the belly button and then travels to the lower right-hand side where the appendix is located.
  1. Within a day, the pain becomes constant and severe.
  1. Applying pressure on the area increases the pain intensity.
  1. Coughing, sneezing, laughing, lifting or bending may also make the pain worse, as does driving over speed bumps. (The ‘speed bump sign’ is a tool in the diagnosis of acute appendicitis.)
  1. In approximately 75% of patients, appendicitis causes nausea and vomiting.
  1. Other possible symptoms are constipation or diarrhoea.
  1. Appendicitis usually causes a mild fever.
  1. Most patients notice that they feel generally unwell.

Acute and chronic appendicitis

Most cases of appendicitis are considered a medical emergency. Appendicitis that occurs suddenly and severely is known as acute appendicitis.

The symptoms of acute appendicitis and chronic appendicitis are very similar. With chronic appendicitis, the pain tends to subside within a day. The pain may also disappear and reappear after days, weeks or even months.

Appendicitis must be treated!

Appendicitis must be treated immediately. If the appendix ruptures, the infected contents can flow into the abdominal cavity. This can cause a much more serious medical emergency known as peritonitis, which can be life threatening. The risk of rupture (perforation) is higher in children who are under five years of age and in people above 65 years.

A ruptured appendix can lead to peritonitis, causing unbearable abdominal pain and very high fever. The pain in the abdomen gets more intense with motion or touch. In some cases, bacteria from the gastrointestinal tract enter the bloodstream and cause sepsis (blood poisoning). Sepsis is the body's extreme reaction to an infection. In general, symptoms of sepsis include chills, high fever, rapid heartbeat and rapid breathing. Without prompt treatment, the whole body can go into a kind of shock (septic shock) and patients lose consciousness. Septic shock is a medical emergency that must be treated in the intensive care unit.

Unlike acute appendicitis, chronic appendicitis is not considered a surgical emergency. The longer the infection lasts, the greater the chance of perforation.

What causes appendicitis?

It's unclear what causes appendicitis to develop. Usually the infection is caused by bacteria. The entrance of the appendix is very narrow and when it gets obstructed, bacteria build up in the appendix. This can cause the lymph node within the wall of the bowel to become swollen, closing off the entrance. Blockage can also be caused by, for example, a small, hard piece of poo (fecalith), causing inflammation and swelling in the appendix wall which develops into appendicitis.

Genetic factors may contribute to appendicitis. Eating high-fat and high-cholesterol foods have also been linked to an increased risk of appendicitis.

How is appendicitis diagnosed?

What are the signs of appendicitis that should not be ignored? Appendicitis is diagnosed based upon a patient's symptoms and various examinations and tests. In the case of acute appendicitis, the symptoms and a simple physical examination are usually enough to arrive at a diagnosis.

During the physical examination, the doctor listens to your abdomen and intestines using a stethoscope. Inspection consists of an external abdominal examination as well as a rectal or vaginal examination. Chronic appendicitis can be more difficult to diagnose because the symptoms may come and go, or they may be mild or unspecific.

Conditions with similar symptoms as appendicitis

When symptoms are unspecific, other possible causes must be ruled out. It can be difficult to diagnose appendicitis because its symptoms can be very similar to other conditions, such as an infection of the digestive system, bladder infection, food poisoning or gynaecological disorders like ovarian inflammation (oophoritis) or ectopic pregnancy. Appendicitis can even cause unspecific symptoms associated with normal pregnancy. Usually, appendicitis can be ruled out or diagnosed through additional testing.

The most common diagnostic tests for appendicitis are:

  1. Blood and urine test. A blood test is used to look for signs of infection (people with appendicitis have an elevated white blood cell count). A urine test looks at whether there are substances in the urine that don’t belong there, such as blood, protein, sugar and certain bacteria. For a urine test, the patient must hand in a sample bottle at the GP’s office, a laboratory or hospital.
  1. Ultrasound scan. An ultrasound scan is a procedure that uses high-frequency sound waves to create an image of part of the inside of the body. It allows the doctor to see if the appendix is swollen. In the case of peritonitis, the doctor will be able to see fluid in the belly or abdomen.
  1. CT scan. A CT scan of the abdomen may be performed if an ultrasound does not produce a clear image of the appendix.
  1. Laparoscopy. The doctor may recommend a laparoscopy to examine the appendix if the diagnosis is still uncertain. This procedure is also known as keyhole surgery or minimally invasive surgery. Laparoscopy is carried out under general anaesthetic. If laparoscopic exploration shows that the appendix is inflamed it will be removed right away.

How is appendicitis treated?

If you have appendicitis, your appendix will usually need to be removed as soon as possible. Removal of the appendix (appendicectomy) is carried out under general anaesthetic, most often using keyhole surgery. The operation involves making small cuts (incisions) in the abdomen. It is the preferred method of removing the appendix because recovery tends to be quicker than with open surgery. Most people can leave the hospital two to five days after the operation.

Sometimes an appendicectomy cannot be carried out. For instance, in the case of abdominal adhesions (scar tissue) around the appendix. In such case, the infection needs to clear before an operation can take place. This can take several weeks and requires a lot of rest.

In some cases, a course of antibiotics may be given to help combat the infection. Once the infection is clear, surgery to remove the appendix will be scheduled. In rare cases, appendicitis may spontaneously resolve when the infection goes away, in which case surgery is no longer necessary.

Preventing and curing peritonitis

Approximately 15% of all appendicectomies are unnecessary due to misdiagnosis of presumed appendicitis. However, delaying surgery until it is absolutely certain that the appendix is the cause of inflammation can have fatal consequences, as the appendix can rupture within 24 hours of the first symptoms. Peritonitis was a certain death sentence only half a century ago, now only a small percentage of patients with peritonitis die. It is thanks to modern surgery and antibiotics that many lives have been saved. However, it may take several operations and a long recovery period before a patient can get back to their daily routine.

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