What is Appendicitis?

The abdominal area contains many essential organs of the human body. Pain in the abdomen is one of those symptoms that may indicate something as harmless as simple indigestion or it may be an indicator of a more severe underlying disorder. In this blog, we’ll focus on appendicitis, a potentially serious cause of abdominal pain, to help you recognize when it’s time to seek medical attention and better understand what your body might be trying to tell you.

What is Appendicitis?

The appendix is a tube-like rudimentary organ that is attached to the lower part of the large intestine in human beings. The exact function and nature of an appendix in the human body is unknown. The infection and inflammation of the appendix is known as appendicitis. An appendicitis may be acute or chronic depending upon the cause.

Acute Appendicitis

Acute appendicitis is characterized by a sudden and severe infection of the appendix. The symptoms of appendicitis (acute) include pain in the abdomen associated with fever, nausea, and vomiting. This type of appendicitis requires urgent intervention and is a medical emergency.

Chronic Appendicitis

In chronic appendicitis, the infection/inflammation occurs gradually and the symptoms are less severe ranging from mild to moderate intensity. Although this condition is less urgent and the symptoms of appendicitis are mild in most cases, there is still a need for intervention eventually.

4 Stages of Appendicitis

An appendix infection/inflammation (appendicitis) may present in 4 stages:

1. Appendicitis - Early: The first stage in the 4 stages of appendicitis may present as mild and vague pain in the abdomen (around the belly button). It may be associated with nausea and a loss of appetite.

2. Appendicitis - Suppurative: The term suppurative refers to the formation or oozing of pus. Pus is composed of dead WBCs (white blood cells), pathogens, debris from tissues and cells, etc. It is produced when the immune response is triggered by an infection. A suppurative appendix is an indication for seeking immediate help. This stage is characterized by intense abdominal pain, nausea, vomiting, and sustained fever.

3. Appendicitis - Gangrenous: Gangrene refers to tissue death caused by a lack of adequate blood supply. Gangrenous appendicitis occurs when persistent infection/inflammation impacts the blood supply to the appendix. This stage is characterized by extreme pain and a high incidence of complications.

4. Appendicitis - Perforated: The last and the 4th stage of appendicitis is characterized by the rupture of the organ. This stage is very dangerous because it leads to the infection spreading to the abdomen (peritonitis). The symptoms of appendicitis at this stage include a rigid or hard abdomen, intense abdominal pain, high-grade fever, nausea, and vomiting.

Causes of Appendicitis

The appendix is attached to the lower end of the large intestine. This part of the intestine is the route of transportation for fecal matter and contains a large number of bacteria. The anatomical location of the appendix makes it easier for an obstruction or clogging to occur, leading to appendicitis. Common causes for appendicitis are as follows:

• Fecaliths (Calcified fecal deposits or fecal stones)

• Infections (E.g. Gastroenteritis)

• Inflammation of the colon (Colitis)

• Swelling of lymphatic tissue (Lymphoid Hyperplasia)

• Parasitic infections

• Tumors or growths

• Cystic fibrosis

Symptoms and Signs of Appendicitis

Typical signs and symptoms of appendicitis include abdominal pain (middle, near the navel), fever, nausea, and vomiting. As the condition progresses, the pain moves to the lower abdomen and keeps increasing in intensity.

Acute Appendicitis Symptoms

The symptoms of acute appendicitis include:

• Abdominal pain (starting at the navel and moving to the lower abdomen later)

• Fever

• Lack of appetite

• Nausea, vomiting

• Lack of bowel movement

• Unable to pass gas

The signs of acute appendicitis are as follows:

• Mcburney’s sign: Pain when the right side of the lower abdomen is pressed.

• Blumberg’s sign or Rebound tenderness: Pain on releasing the abdomen after pressing.

• Rovsing’s sign: Compressing the lower left abdomen elicits pain in the lower right abdomen.

• Guarding: Involuntary tightening of the abdomen when it is touched.

• High-grade fever

• Higher than normal heart rate

• Dunphy’s sign: Pain on movement/coughing.

• Malaise

• Urgency

Chronic Appendicitis Symptoms

The chronic appendicitis symptoms include:

• Mild but recurring abdominal pain

• Lack of or decreased appetite

• Nausea

• Abdominal pain/cramps/discomfort

• Fluctuating bowel movements

• Lethargy

The signs of chronic appendicitis are as follows:

• Abdomen is mildly tender to touch

• Mild abdominal swelling

• Recurrent, low-grade fever

• An elevated WBC count (occasionally)

How Appendicitis is Diagnosed?

The diagnosis of appendicitis is made based on a detailed history and physical examination. Appendicitis is confirmed if there is a typical presentation and signs such as rebound tenderness, guarding, etc., are present. For vague signs and symptoms, confirmatory investigations are performed, including:

• Complete blood count

• Abdominal ultrasound

• CT scan abdomen

Treatment for Appendicitis

Appendicitis is treated with a combination of antibiotics, pain medication, and surgical intervention. Acute appendicitis is a medical emergency and once a diagnosis is confirmed, it is treated by surgical removal. Even for chronic appendicitis treatment, antibiotics are given as a stop-gap measure. This is because it is common for symptoms to recur. Surgical removal of the appendix is the final treatment for both acute and chronic appendicitis.

Appendicitis Surgery

The surgical removal of the appendix is known as an appendectomy. It is performed for acute and chronic appendicitis and to treat any complications. There are two types of appendicitis surgery:

• Laparoscopic: A laparoscopic appendectomy is less invasive, has a smaller incision, and a quicker recovery.

• Open: An open appendectomy is performed in case of complications or rupture. It has a larger incision and a longer recovery duration.

Recovering from Appendicitis

A complete recovery from appendicitis requires the removal of the organ. Since the appendix is rudimentary and has no known function in the body, its removal has no anatomical or physiological consequences. The recovery after the removal of the appendix depends on whether the surgery was laparoscopic or open.

In the case of a laparoscopic appendectomy, patients can go home without any hospital stay. For appendicitis complications requiring an open appendectomy under general anesthesia, a hospital stay and monitoring are usually necessary. Most patients can go home with medications for pain relief after that. Full recovery may take up to six weeks.