APPENDICITIS: SIGNS, SYMPTOMS & TREATMENT

Appendicitis is a condition when the appendix becomes inflamed and filled with pus, causing pain and discomfort for patients.
 

The main cause of appendicitis is the blockage of the inside of the appendix usually due to the buildup of hardened stool. In addition, enlarged lymphoid tissues, vegetables, fruit seeds, or intestinal worms are also found as less common causes of the blockage of the appendix.
 

Common signs of appendicitis may include:
 

- Abdominal pain: This is the first sign of acute appendicitis that causes discomfort to patients. A typical symptom includes the pain starting in the upper abdomen and bellybutton area. The pain is moderate and steady, and there are contractions sometimes. After 1 to 12 hours (normally 4 to 6 hours), the pain moves into the right lower abdomen. In some cases, the pain may start and persist in the right lower abdomen.
 

- Loss of appetite (anorexia): This is a common sign of appendicitis.
 

- Nausea and vomiting: This symptom occurs in about 58% of cases but is not typical and persisting. Most patients vomit only once or twice.
 

- Fever: Patients may develop a mild fever (usually below 39o C) as a sign of appendicitis. A high fever may indicate a ruptured appendix.
 

A sequence of symptoms can help diminish the difficulties of recognizing appendicitis and distinguishing it from other diseases. In 95% of the patients with acute appendicitis, the sequence usually starts with anorexia, followed by abdominal pain, then vomiting (if any).
 

Patients should seek medical attention for the right diagnosis when experiencing these signs.
 

How to diagnose appendicitis:
 

- Physical examination is important in the diagnosis. Doctors will examine patients’ abdomen by gently pressing the right lower abdomen to assess the pain. The pain level may depend on how serious the appendicitis is.
 

- Further tests could be ordered to diagnose appendicitis include blood test and abdominal ultrasound. In some complicated cases, doctors may indicate a CT scan to help confirm appendicitis.
 

Appendicitis requires prompt treatment, otherwise the appendix may rupture and release the infection into the abdomen, which can threaten patient’s life.
 

In case of ruptured appendix, the patient may develop focal peritonitis, generalized peritonitis or appendiceal abscess, making more complications and difficulty to treatment. Therefore, patients need to seek medical attention as soon as possible once suspecting any signs of appendicitis.
 

Removal of the appendix (appendectomy) remains the main curative treatment of appendicitis. Appendectomy can be performed through the 2 following forms of surgery:
 

- Open surgery: Except for very few complicated cases, open surgery is rarely performed.
 

- Laparoscopic surgery: Laparoscopic appendectomy is usually the preferred method of removing the appendix at almost every phases of appendicitis, except for very few complex circumstances.
 

How is the postoperative prognosis?
 

For laparoscopic surgery, recovery is faster. Patients just need 1 – 3 days of hospital stay and may get back to work after 1 week. During this time, patients may still have a little pain at the surgical area and need to be prescribed some medicine.
 

For patients in later phases of appendicitis such as peritonitis or appendiceal abscess, longer hospital stay is recommended (about 1 week), and they can get back to work after 10 – 14 days.
 

Patients don’t need to make changes to their diet and can get back to their normal routine after surgery. It is suggested that patients should limit some physical activities such as playing sports for about 4 weeks.