Appendicitis: Definition | Symptoms | Treatment

Acute appendicitis is inflammation of the vermiform appendix, it is a potentially life threatening medical condition when treatment is delayed. The only definitive treatment for appendicitis is appendectomy, removal of the appendix.

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It is the most common surgical emergency and is one of the most common causes of acute abdominal pain. Appendicitis can occur at any age but it’s commonly seen between 10 to 20 years. It is rare to see appendicitis in children below 2 years of age because it is still cone shaped

Vermiform appendix (or simple appendix) is a small worm-like extension of the cecum, the first part of large intestines. Its average length is 8 to 10cm long. Its location regionally is right lower part of the abdomen.

What causes appendicitis?

Appendicitis is caused by appendix lumen blockade, this is mainly due to:

• Infections
• Fecal matter stasis
• Inflammation  caused by Irritable Bowel Disease (IBD)

Gut microorganisms, bacteria, viruses and sometimes filarial worms invade the wall of the obstructed appendix leading to edema, ischemia and in later stages, Necrosis and perforation. Perforated appendix is an emergency that can kill in few hours if no surgical intervention is done.

Symptoms

Acute appendicitis symptoms start as periumbilical abdominal pain that later migrates to right iliac fossa (RIF).

It is accompanied by:

• Nausea
• Vomiting
• Fever
• Poor appetite
• Diarrhea

Signs of Appendicitis

Objective physical examination findings of a person with acute appendicitis are:

1. Right Iliac Fossa (RIF) tenderness
2. Rovsing’s sign: pain felt more on right lower quadrant (RLQ) when pressing left lower side
3. Psoas sign: extension of the right hip causes pain on Right Lower Quadrant with the patient lying on the left side.
4. Rebound tenderness on RIF indicate local peritonitis
5. Signs of inflammation such as increased pulse rate and increased body temperature (fever).

When Appendix is ruptured or perforated, the whole abdomen becomes tender with additional signs like:

• Low Blood Pressure
• Generalized abdominal guarding
• Shock

Diagnosis of appendicitis is based on history and physical examination, there is no time to do scans and other blood tests. If access to quick laboratory results is available, Alvorado Score can be used to assist in determining the likelihood of appendicitis.

Ultrasound does reveal inflamed appendix if available in the facility but is not necessary to make the diagnosis.

Alvarado Score

 Alvarado score tool help to determine how likely is appendicitis if you have signs and symptoms of it. It was created by Dr Alfred Alvarado.

Interpretation

Treatment of Appendicitis

As mentioned earlier, the only definitive treatment or management of acute appendicitis is surgical removal of the appendix as soon as possible.

When laparoscopy is done, even if appendix is not inflamed or the diagnosis is missed, it is removed. This is simple because there is no function of the appendix in the body.

Intravenous (IV) antibiotics are given prior to surgery and continued after surgery to prevent surgical wound infection. Cefazolin and Metronidazole IV can be used, in some places Piperacillin/Tozabactam is used.

Complications

1. Perforation
2. Appendix Mass
3. Appendix Abscess

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