Abdominal pain is a common symptom of many conditions. While the pain can be
severe, it is not necessarily life threatening. This is why many people, when
experiencing severe abdominal pain, may choose to stay home instead of seeking
medical treatment. In some cases, this can be a fatal mistake. Acute
appendicitis is likely the most common surgical emergency worldwide. In 2019,
it was estimated that there were 17.7 million cases of acute appendicitis
internationally and 33,400 cases resulted in death. As such, people should be
aware of who is at risk, as well as the signs, symptoms, and causes of
appendicitis.
اضافة اعلان
Our gastrointestinal tract is the path that food
follows from the mouth to the rectum. Along this tract, the small intestine
meets with the large intestine at the lower right side of the abdomen. Here,
there is a roughly 10cm tube known as the appendix. While it was historically
believed to be a vestigial organ, the exact function of the appendix remains
unknown. Research is currently underway which may show the role it plays in
good health. Since it has long been believed that this organ does not provide
any use to the body, many people have undergone surgery to remove it in a
preventive measure — a procedure called a prophylactic appendectomy. Although
the number of preventative appendectomies has decreased in recent years, they
are still performed.
What is appendicitis?
In simple terms,
appendicitis is inflammation of the appendix. It can be caused by a number of
conditions but almost all relate to a blockage. Furthermore, appendicitis can
be broadly categorized into two types: acute and chronic.
Acute appendicitis has a severe and sudden onset
with pain that develops and intensifies rapidly over the course of 24 hours. It
is most common in those between the ages of 10–30, but it can occur in anyone
at any age. Additionally, acute appendicitis is more common in men than in
women. It is also more common than chronic appendicitis, and if left untreated
it can result in fatal complications.
Chronic appendicitis, on the other hand, has more
mild symptoms and occurs over a longer period of time. It is not uncommon for
symptoms to disappear and reappear over a period of weeks, months, or even
years. Although more mild, chronic appendicitis can still be a health concern
since it has the potential to develop into acute appendicitis.
When the appendix becomes blocked, it can serve as a
breeding ground for bacteria, which increases significantly the chances of pus
formation and swelling. As the appendix swells, pressure builds up in the
abdomen and blood flow may be obstructed in the surrounding area. The blockage
can be caused by a number of factors, but the treatment is, in most all cases,
an appendectomy. Causes for appendix blockage can include a buildup of hardened
stool, intestinal worms, traumatic injury, and tumors.
Acute appendicitis occurs rapidly and typically
follows a set path. It usually begins as mild cramping of the upper abdomen or
navel area. The pain will then begin to migrate towards the lower right
quadrant of the abdomen, with the pain growing in intensity over the course of
a few hours. Many describe it as the worst abdominal pain they have experienced
and has been known to rouse people from sleep. Other, more non-distinct,
symptoms may include a loss of appetite, indigestion, nausea, vomiting,
abdominal swelling, and low-grade fever (37.5–38.3°C).
Complications
Acute appendicitis on its
own is not inherently dangerous. The high risk of perforated appendicitis, when
the appendix ruptures, can be deadly. This is when a tear forms in the wall of
the appendix and fecal matter, along with accumulated bacteria, leak into the
abdominal space. An estimated 20–30 percent of acute appendicitis cases develop
into perforated appendicitis. The likelihood of a perforation increases with
age — between 32 and 72 percent of cases in those over the age of 60 involve a
rupture. There are a host of subsequent complications that have a high
likelihood of being fatal.
Acute appendicitis has a severe and sudden onset with pain that develops and intensifies rapidly over the course of 24 hours.
When the appendix ruptures, bacteria leak into the
abdominal cavity. These can cause infection and inflammation known as
peritonitis, which can be very serious and even fatal. Symptoms of peritonitis
include tachycardia (fast heart rate), high fever, shortness of breath, and
severe and continuous abdominal pain.
In some cases, the body will try to save itself by
trying to isolate the appendix. In these cases, the body forms a sac around the
rupture known as an abscess. This is the body’s way of preventing the bacteria
from entering the abdominal cavity. The abscess fills with white blood cells
that further help fight the infection but will likely need to be drained prior
to surgery.
In rare cases, the bacteria can make its way into
bloodstream and to other parts of the body. This condition is known as sepsis
and is extremely serious and life-threatening. Sepsis has a mortality rate of
approximately 33 percent and requires intensive care. Symptoms of sepsis
include high or low body temperature, confusion, severe drowsiness, shortness
of breath, and loss of consciousness.
Prevention
There is no definitive way
to prevent appendicitis and more research is still needed on the subject. What
studies do exist seem to suggest that countries with fiber-rich diets seem to
have lower rates of appendicitis. As a result, it may be beneficial to
incorporate fiber into your diet. Foods that are high in fiber include fruits,
vegetables, lentils, beans, and a variety of wheat products. Although
prevention is generally centered on preventing a blockage, it should be noted
that laxatives and enemas for the sole purpose of prevention should be avoided.
This is especially true if you suspect that you have appendicitis. Using such
treatments while having appendicitis can increase the risk of developing
perforated appendicitis without any real benefits.
Although preventive surgery is a controversial
topic, it is still practiced in many places. The idea is that by removing the
appendix, you avoid the potential of developing appendicitis later in life. The
practice was popular for travelers and is still common practice for astronauts,
where medical care would be more difficult. However, for the average person,
medical care is more readily available, and the controversy lies within the
balance of risk and benefits. Despite appendectomies being done via
laparoscopy, surgery still carries risk of complications and cost. Some
research suggests that those who are at higher risk of developing appendicitis
(e.g., those with a family history) could benefit from the procedure.
Regardless of the surgery performed, whether it be open or laparoscopic, the
risks are similar. These include bleeding, wound infection, bowel obstruction,
and injury to nearby organs.
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