The appendix is a hollow wormlike projection from the first part of the large intestine called the cecum. In less than 10% of individuals, the appendix can become inflamed. The result is appendicitis, a clinical emergency that can have grave consequences if treatment is delayed.
Causes and Pathophysiology
The factor that triggers appendicitis is obstruction of the appendix. This can occur with fecal matter hardened into stones (fecaliths), foreign bodies, tumors, or swelling of lymphoid tissue in the appendix (lymphoid hyperplasia) in response to Crohn's disease or certain infections. Whatever the cause may be, this obstructed appendix cannot move secreted mucus and fluids out into the large intestine. Furthermore, bacteria within the appendix multiply significantly.
The pressure within the appendix increases until it cuts off the blood supply to the appendix (ischemia). If this inflamed appendix is not removed, it becomes gangrenous, allowing the bacteria within to infect the abdominal cavity. Such an infection can result in inflammation of the membrane lining the abdominal cavity (peritonitis) and/or a collection of bacteria and fluid that is isolated from surrounding tissues by immune processes (abscess). Either way, the infection is a serious complication that can possibly lead to death.
Diagnosis and Treatment
A patient with appendicitis experiences abdominal pain. In general, the pain starts as a dull pain around the belly button (periumbilical pain) and becomes a sharp pain in the right lower quadrant of the abdomen. This pain may be relieved by lying down with the knees brought close to the abdomen. Other symptoms include loss of appetite (anorexia), nausea, and vomiting.
The diagnosis of appendicitis requires a physical examination that carefully explores the nature of the abdominal pain and a computed tomography (CT) scan to image the inflamed appendix. The physician should also rule out other causes of abdominal pain, particularly in women who might have lower abdominal pain originating from the reproductive organs.
The treatment of appendicitis is surgical removal of the appendix (appendectomy), which can be done either as an open technique or with the aid of a camera in the abdominal cavity (laparoscopic appendectomy). Medications are also given to control infection, pain, nausea, and vomiting. Most patients do very well afterwards and are able to return to their normal diet and level of activity.
Final Words
Appendicitis is like many conditions where the consequences are serious without treatment but preventable with treatment. By knowing the warning signs of appendicitis, one is more likely to seek prompt medical attention when it occurs.
