Appendicitis

If your child (or you) ever has abdominal pain, always pay close attention. Abdominal pain can be a sign of a host of different health problems, many of them minor ones that will go away on their own. But, if junior’s bellyache is due to an infected appendix, this is one time you don’t want to be lax about quickly seeking intervention. We are not certain what the purpose of the appendix is, but we do know this: if it goes bad, it must be dealt with right away to avoid possible dire consequences.

What is Appendicitis?

In medical jargon, appendicitis officially means “inflammation of the appendix.” When this small organ becomes inflamed and a bacterial infection ensues, appendicitis has occurred. This is a medical emergency that must be dealt with promptly, because an infected appendix can quickly and easily burst, sending its toxins into the abdominal cavity and causing potentially life-threatening complications.

The next logical question might be: Just what is the appendix anyway? Well, it is a worm-shaped hollow organ that extends out from the cecum, which is the first part of the large intestine. The appendix is located on the lower right side of the abdomen. The official line in most medical school textbooks is that the appendix has no known purpose. However, this is not the whole story. Some research indicates that the appendix acts as a part of the immune system during the first few years of life. After that it appears to stop functioning, and does not seem to have any purpose after that point. However, even that is debatable. Some immunologists feel it does function as part of the immune system throughout one’s life, but that exactly how is not well understood as of yet. Saying an organ has no known function is simply a way of justifying the statement if a function is found in the future. If the appendix is removed, it does not have any negative effects (that we know of—gotta’ cover myself) on the immune system, digestive system, or on any other functions of the body. And it’s a good thing too, because the only treatment for appendicitis at this point in history is surgical removal of it (appendectomy). But if I were ever forced to have my appendix removed, I would do everything I could to bolster my immune system, just in case (which is a terrific way to avoid disease and foster a lifestyle that focuses on health anyway).

Appendicitis is the most common cause of all abdominal emergency surgeries amongst children and teens, and it strikes most often between the ages of ten and thirty. Approximately one in 15 individuals will develop appendicitis in their lifetime. Males from 10-14 are most likely to experience it, and females from 15-19. It is rarely found in children under two years old, or in the elderly, but is usually a more dangerous condition when it occurs in the very young or very old.

What Causes Appendicitis?

Sometimes the cause of an individual’s appendicitis is not clearly known, but there are several commonly found reasons that appendicitis occurs. Basically, something has to happen to cause the interior of the appendix to become filled up and swell. It could be mucus, stool, or even parasites in some cases.

• Often food waste or a fecal stone (hard piece of stool) is the culprit, becoming trapped in an orifice that runs the length of the appendix, and causing it to be obstructed.
• It has been discovered that sometimes appendix infections will follow gastrointestinal viral infections or other inflammatory conditions.
• Occasionally ulceration inside the interior of the appendix may cause an abnormal change to take place in the tissues, accompanied by the death of cells (gangrene).

Any of these conditions may lead to rapid bacterial invasion of the appendix, and the organ then becomes swollen and filled with pus. The pus is composed of white blood cells and dead tissue cells. If not attended to, the appendix can rupture within 48-72 hours.

What Are the Symptoms of Appendicitis?

Abdominal pain is associated with many illnesses, so diagnosing appendicitis can be difficult. The symptoms also tend to vary from person to person, and change over time as the infection develops. The typical signs are as follows:

• Pain centered on the navel, that many times will move toward the lower right abdomen.
• As the area becomes more inflamed, the infection may spread to other organs and tissues nearby (such as the inner lining of the abdomen called the peritoneum), causing the pain to sharpen and get worse.
• In most patients, the pain eventually is localized in an area known as “McBurney Point,” located about halfway between the top of your right pelvic bone and your navel.
• The pain increases with strain, such as coughing or any jarring movements.
• The affected area becomes more and more rigid and tender as the condition continues to worsen.
• If gentle pressure is applied to the area and then suddenly released, many patients will experience worse pain after the release. This phenomenon is called “rebound tenderness”.
• Sometimes the pain will lessen if you lie on your side in a fetal position, with legs pulled up towards your chest.
• You may or may not experience one or more of the following symptoms:
  • Nausea and/or vomiting
  • Decreased appetite
  • Constipation
  • Diarrhea
  • Low-grade fever
  • Abdominal swelling
  • Difficulty passing gas

Appendicitis can be hard to pin down even for an experienced health care provider, because the typical progression of symptoms (all of those listed above under common signs) only appears in about 50% of cases. Certain parts of the population can have particularly varied symptoms:

• Pregnant Women: Certain conditions that may occur during pregnancy can often produce signs that are similar to appendicitis, therefore making it harder to diagnose it if it does occur. This is critical, as you do not want to miss appendicitis if it is happening:
  • Ectopic pregnancy: Pain that is similar to appendicitis may occur when this condition exists. Ectopic pregnancy is when pregnancy occurs in a place other than the lining of the uterus.
  • Nausea and mild abdominal pain normally associated with pregnancy can be confused with appendicitis symptoms.
• Elderly Folks: The elderly generally experience a lesser degree of pain and tenderness than others with appendicitis, which may seem like a good thing, but it is a mixed blessing. It is often harder to diagnose early in them, and can more easily lead to a ruptured appendix. This is particularly dangerous for senior citizens, and a higher incidence of fatalities occur in the elderly when the appendix bursts.
• Children: Infants and young kids have unique challenges when it comes to identifying appendicitis. Their pain seems to move around more, and may settle in different spots due to their less developed bodies. They also often tend to have fever, vomiting, and diarrhea along with the abdominal pain.

What Complications Can Develop Due to Appendicitis?

The most serious possible complication from appendicitis is a ruptured appendix. That is why it is so important to diagnose appendicitis as soon as possible. Some warning signs of a ruptured appendix are:

• Ongoing symptoms for more than 24 hours.
• Fever
• Increased heart rate
• Elevated white blood cell count
• Increased thirst
• Decreased urine output
• Rarely the symptoms may disappear for a day or so, and then reappear, but this is an exception to the norm.
• Some patients actually feel better for a short time, maybe a few hours, after the appendix bursts. Then, shortly thereafter, the pain returns and may be felt throughout the entire abdomen, not just in a localized area.

A ruptured appendix usually leads to condition known as peritonitis, which is a serious infection or the inner lining of the abdomen. Even with timely and prompt treatment, peritonitis can be difficult to treat, and life-threatening in some patients. The elderly and young children are at increased risk of serious consequences. Kids have the highest incidence of ruptured appendices, so it is critical that parents take any abdominal symptoms as potentially serious.

Occasionally, the pus and other products of infection will leak from the appendix and form a pocket called an appendiceal abscess. These may range in size from as small as a walnut to as large as a grapefruit. If this occurs, the abscess must be surgically removed before it perforates and leads to peritonitis.

What Treatments Are Available for Appendicitis?

If you are afflicted with appendicitis, the only available treatment is the removal of the appendix (appendectomy). This is a medical emergency, and decisions must be made quickly. However, be aware that there are several options available. At times like this, it really pays off to have a doctor or surgeon that is part of the team of health care providers that you have been working with—someone who knows you, and you know them, so that you can trust that he or she is informed, and has your best concerns at heart. Surgical options include:

• Laparoscopic: This is by far the best and least invasive choice if it is available and appropriate for your situation. Laproscopic surgery involves one or more small incisions in the abdomen. A small device (laparoscope), equipped with its own light and video camera, is inserted into the abdomen through a hollow instrument (cannula) that is placed into one of the abdominal incisions. The surgeon can then look around inside the abdominal cavity and determine the situation. If the appendix has not ruptured, it can usually be removed during the procedure. Occasionally, it will be discovered that the appendix is healthy, and something else has caused the symptoms. Surgeons will often remove a healthy appendix anyway at this point, the rationale being to take it out since they have the opportunity, and therefore avoid future problems with the appendix. I would recommend you talk this over with your surgeon before hand to make your wishes known. It is a personal choice, but I am not too keen on removing a healthy organ from my body just because it’s purpose is not well understood.
• Traditional Appendectomy: Typical open surgery that uses one long abdominal incision to is to be avoided if possible. However, if the appendix has already burst, this is necessary in most cases in order to give the surgeon full access to the area so that all of the infected tissues can be removed. Sometimes if laparoscopic surgery was the first choice, the surgeon will have to switch to open surgery if a ruptured appendix is discovered. This is why it is so important to be working with health care professionals that you know and trust. A strong diagnosis based on a thorough knowledge of your health history can save unnecessary risks and procedures.