Acute Appendicitis
An Overview

Its definite function is not known. It was thought to be a vestigial organ in human. Current evidence however suggests that the appendix is indeed a very important organ that helps in the immune functions of the bowel. It is believed to house "good bacteria" and releases same to the bowel to aid the normal balance and function of gut.

The appendix, located in the lower right side of the abdomen, is a redundant worm like organ, whose function in man is not known.

Like other parts of the bowel, it has a lumen. On the wall of the lumen, we have some lymph glands like the glands in the neck which become swollen when we have cold or flu. The cells on the wall of the appendix also secret mucus to keep the appendix lubricated inside. Appendicitis occurs if the lumen of the appendix becomes blocked and bugs (bacteria) then multiply and infects the wall of the appendix.

Blockade leads to reduction of the blood supply to the part of the appendix below the level of the obstruction. Once the blood supply of any part of the body is reduced, bacteria tend to grow fast there, and colonize the tissue. This is understandable because the blood provides nutrients as well as regular supply of white blood cell which act to curtail infection.

Is appendicitis contagious? No Appendicitis is not spread by touching some one or coming in contact with an infection of any type.

What Is Appendicitis Pain Like?

• A dull to severe lower right side abdominal pain.

• The pain may originally start around the umbilicus or navel (belly button), and then move to the right lower abdomen.

• The pain is often constant and last for 2 to 3 days, and if not diagnosed by then, could lead to a ruptured appendix (what some have called a burst appendics). Does appendicitis pain come and go? No. It's usually constant, though staying still or taking pain killers could take the edge off the pain, but the pain would come back again on movement or pressing on the right lower abdomen.

• The abdominal pain is often associated with fever, nausea, vomiting (only after the pain has commenced) and poor or loss of appetite. There may also be a mild diarrhoea or constipation.

It is a very common cause of right side abdominal pain in all age groups, especially in the first three decades of life.

It is a common surgical problem world wide. About 70,000 appendix operation is done in the UK yearly.

In the US, it is said that 1 in every ten (10%) persons will come down with appendicitis. The incidence of this disease is falling in the industrialized world, but sharply rising in developing countries.

Inflammation of the appendix is one and a half times commoner in men than in women. Women on the other hand are more likely to have "unnecessary" operation for a presumed appendicitis because of diagnostic difficulties.

In pregnancy, the diagnosis of an inflamed appendix may also be difficult due to the rising uterus pushing the appendix up, and altering the traditional position of the pain in appendicitis.

Appendicitis can occur in a child of any age, and a high index of suspicion is needed to avoid missing the diagnosis

It is commoner within the first and second decades of life (20 – 30 yrs of age).

Because it is not frequently seen in extremes of life, those in this group who develop the problem are often not diagnosed on time and frequently end up with severe complications (rupture or perforation of the appendix), as the case of an acute attack below shows

What Are The Causes of Appendicitis?

• Blockade caused by small piece of hard faeces (faecoliths)

• Parasitic worms

• Spread of infection to the appendix following gut infection

• Presence of benign tumour of the appendix

Appendicitis Tests & Diagnosis

Diagnosis is mainly based on a good history or story from the patient, a thorough physical examination of the patient and use of ancillary blood test.

Blood tests for appendicitis include the Full blood count, also called complete blood count. The White Blood Cells (WBC) count and the neutrophils (a type of white blood cell) are the most important. It is said that the presence of more than 10,000 WBC and not more than 20,000, makes appendicitis very likely, if occurring with other symptoms of this disease.

While ultra sound scan and a CT -Scan can help to further give weight to a suspected case, laparoscopy or endoscopy provides the most convincing evidence of the presence of an inflamed appendix.

The Alvarado Score scoring system for appendicitis is a very reliable way of predicting the presence of appendicitis. It adds up a number of common signs and symptoms of appendicitis, as well as laboratory findings to award a score of 0 to 10.

You can add up the presence or absence the symptoms and findings, and reach an Alvarado score as follows:

• Presence of Pain In Right Lower Abdomen (scores 2)
• Pain moved from the upper abdomen to the lower right abdomen (scores 1)

• Presence of loss of appetite (scores 1)

• Feeling sick or vomiting (scores 1)

• Worsening of pain when thr right lower abdomen is pressed and released - rebound tenderness) - scores 1

• Presence of a temperature more than 37.3 degrees centigrade (scores 1)

• Presence of raised white blood cells (WBC) in blood test more than 10,000 scores 2

• Neutrophils shift to the left on blood test (scores 1).

If you have a score of 1 to 4, appendicitis is unlikely, a score of 5-6 makes the presence of an inflamed appendix likely, a score of 7 to 8 means the diagnosis of this condition is most likely and a score of 9 to 10 makes this diagnosis almost certain.

Claire is 15. She woke up with a dull central abdominal pain.

At lunch time, the pain has worsened, and she could barely eat. By bed time she felt sick and actually vomited. She started feeling cold, and when she saw her GP by the next morning, the pain has become much more severe, and moved over to the lower right abdomen. She refused breakfast.

She had a single episode of loose bowel motion. Temperature was 37.6 degree centigrade.

She was referred to the local district hospital’s emergency department. The pain has subsided once she got to the hospital, lying still in bed, waiting to be seen by a doctor.

She was assessed and thought to have had food poisoning, and sent home, with advice to come back if pain does not resolve after two days.

By the next day, Claire was brought back to the hospital, now unable to walk straight, with intense pain and very unwell.

A diagnosis of acute appendicitis attack was made, and Claire was taken to theatre within minutes of arrival.

At operation, the appendix was found ruptured, spilling faces all over the abdomen.

She was hospitalized for four weeks, dealing with one complication after the other.

Claire was eventually discharged.

Acute inflammation of the appendix is common and can be confused with a host of other causes of abdominal pain. See a list of the differential diagnosis of appendicitis here

Treatment Options

1. Surgical Treatment or Appendicectomy (appendectomy)
2. Medical Treatment with antibiotics
3. Do nothing.

The last option is not recommended, and could lead to very serious consequences, even death.

The best treatment option for acute appendicitis is to surgically operate to remove the appendix.

Even though medical treatment is strongly frowned against, and never advocated, in very special cases, medical treatment can be tried. This involves the use of antibiotic combination like a metronidazole and augmentin or cefuroxime intravenously.

Sources & References:

• American College of Emergency Physicians (ACEP) Care Guideline. Published in Annals of Emergency Medicine, January 2010, Vol. 55(1), p.71-116.

• Journal of Theoretical BiologyVolume 249, Issue 4, 21 December 2007, Pages 826-831

• Emergency Imaging of the Acutely Ill or Injured Child

  Leonard E. SwischukLippincott Williams & Wilkins, 2000 - Medical - Pages 177 to 195

Appendicitis? - Have Your Say!

Do you or your loved one have symptoms suggestive of acute appendicitis? Have a query relating to surgery for this condition - before or after appendicectomy operation? Or just want to "air" your views on this subject? Share it here!

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