Appendicitis or appendicitis is an inflammation of the appendix or appendix. Typical signs of appendicitis is severe abdominal pain or lower abdominal pain when you tighten your legs, jump or apply pressure.
What is appendicitis?
Infographic showing the anatomy and location of appendicitis. Click image to enlarge. Appendicitis is an inflammation of the appendix caused by bacteria. In particular, bacterial inflammation occurs in the area of the appendix. The appendix itself, is about the length of the thumb and ends in the large intestine like a cul-de-sac. In the case of appendicitis, this two to twenty centimeter long appendix (also appendicitis) is inflamed here. There are a large number of lymph nodes in the area of the appendix. If a bacterial infection or inflammation now occurs, these lymph nodes swell and the appendix enlarges enormously. Appendicitis is relatively common and in the Middle Ages was hardly curable, so that sufferers not infrequently died from it. Today, about seven percent of the German population suffers from appendicitis. Children and young adults (between the ages of ten and thirty) in particular can develop an infection of the appendix. However, it is also not uncommon for pregnant women to contract appendicitis.
Causes
The causes of appendicitis are varied. The most common cause is obstruction of the appendix (vermiform appendix). Especially if the feces or stool is hard and coarse, this can cause obstruction of the appendix. The heavy feces can also cause the appendix to collapse and thus become inflamed in the long term. Another cause is worms or parasites. Although these are less common, they quickly cause inflammation of the appendix. Equally rare are adhesions to the intestinal walls. As already noted, foreign bodies of any form in particular come into consideration as a cause. These include the well-known and typical cherry pits and other pits of pome fruits. Lastly, inflammation by various bacteria should be mentioned as a cause. Known for this are enterococci, coliform bacteria or proteus bacteria. They inflame the appendix without causing obstruction or kinking. Very rare are also intestinal inflammations in Crohn’s disease, in which appendicitis can occur as well as a consequence.
Symptoms, complaints, and signs
The first signs in appendicitis are usually nonspecific pain in the stomach and belly button area. Somewhat later, they become increasingly stabbing or pulling in the lower right abdomen. Typically, appendicitis causes pain when walking or hopping, which is why doctors have patients hop on their right leg to diagnose it. To relieve the pain, sufferers tend to pull their right leg toward their abdomen, which doctors call a “Schonhinken. Due to the pain and inflammation, the abdominal wall is tense and responds to pressure with severe pain. In addition to the pain, there is an increase in body temperature to cica 39 degrees C, sometimes an increased pulse and sweating. Typical in appendicitis are serious temperature differences between measurements in the armpit and the anus. The pain may be accompanied by lack of appetite, nausea and vomiting. In children, the symptoms may be more severe than in adults. They usually feel severe nausea and the pain extends throughout the abdomen. In older people, symptoms may be weaker and therefore are not easily recognized. They rarely have a fever. In pregnant women, due to the circumference of the abdomen, the pain often occurs in unusual areas, sometimes even in the back. This makes diagnosis more difficult.
Course
The course of appendicitis depends on whether it is recognized and treated in time. If acute appendicitis is not treated, it can even lead to death. Nevertheless, almost all cases are treated in the hospital, so that serious complications can almost never be assumed. If appendicitis is not treated or if the appendix is not operated on, life-threatening complications can occur:
- Rupture of the intestine or appendix. If the appendix bursts, a condition called perforation occurs.The fecal residues are distributed into the abdominal cavity, which can then cause further inflammation or poisoning. Likewise, it can also ENflammation of the peritoneum and massive pus formation (abscesses).
- In the case of prolonged intestinal obstruction, intestinal paralysis may set in. If the stool or feces then can not be excreted with further food intake, there is likewise intestinal perforation.
Complications
Appendicitis or inflammation of the appendix (appendicitis) can carry serious complications. Bacterial inflammation of the appendix can cause it to become very red and swollen. In addition, a lot of pus accumulates. If this is not removed, there is a risk that it will burst open and break through (perforation). In this case, the pus pours into the abdominal cavity and can cause infection of other abdominal organs such as the peritoneum (peritonitis). In addition, abscesses can form in the abdominal cavity, causing severe abdominal pain and discomfort. Furthermore, paralysis of the intestine can occur, the intestinal muscles no longer function properly and the food content is no longer transported further, resulting in intestinal obstruction (paralytic ileus). If left untreated, this can lead to a rupture of the intestinal wall, which can subsequently also become inflamed. The increased pressure in the intestine also compresses vessels. This leads to a lack of supply to the intestinal segment, which can die. In addition, the lungs can be compressed, which disturbs breathing. Metabolism is also disturbed, so that the body loses a lot of fluid and electrolytes. In patients with inflammatory bowel disease (Crohn’s disease), appendicitis can cause connections to form between the appendix and other parts of the intestine, called fistulas, making surgery difficult.
When should you see a doctor?
At the first suspicion of appendicitis, a medical professional should be consulted immediately, as there is a danger to life. As soon as affected persons notice loss of appetite, nausea as well as vomiting, action is inevitable. Appendicitis is often accompanied by diarrhea and vomiting. Accompanied by colicky abdominal pain, these symptoms should be clarified in any case. Furthermore, a doctor should be contacted if there is a clogged tongue and a high fever. Especially in children and older persons it is recommended to react immediately if appendicitis is suspected. In these patients, the symptoms are usually weaker and cannot be assessed precisely. Pregnant women should consult a physician directly, since the appendix shifts due to pregnancy and makes diagnosis more difficult. The pain is first noticeable in the area around the belly button. Over the next twelve hours, the discomfort spreads to the lower right abdomen. A medical professional should be contacted at the latest after these symptoms. Anyone who additionally notices concussion pain when running and hopping should not dither further with a visit to the medical professional.
Treatment and therapy
If the typical symptoms of appendicitis (severe abdominal pain, abdominal pain when tightening the legs and after pressure) occur, a doctor should be consulted immediately. In acute cases, calling an emergency physician should not be shied away from. If the suspicion of appendicitis remains, the affected person will be admitted to a hospital. During this time, the patient will not be allowed to eat anything, otherwise complications may arise during the operation under general anesthesia. During the appendectomy, the inflamed appendix is then removed. The earlier this is done the faster healing or recovery is possible. In the past, this appendectomy was performed with the help of an abdominal incision. It was not uncommon for wound infections to occur. Today, the appendectomy is increasingly being performed using an invasive surgical method. This involves inserting an endoscope through a tiny incision or opening near the appendix. This keyhole surgery has the advantage of finding the cause of appendicitis more quickly and does not create large wounds. In addition, further investigations or differential diagnoses can be performed during this procedure.
Outlook and prognosis
Operations on the appendix represent a routine procedure for many physicians.Therefore, only the time of diagnosis determines whether the course of appendicitis is potentially harmless or threatening. If the inflamed appendix is completely removed, there is usually no significant subsequent damage. However, if the actual cause is recognized too late, serious complications may occur. If intestinal perforation occurs, feces, bacteria and pus pass through the fragile intestinal segment into the surrounding abdominal cavity. As a direct consequence, this leads to an extremely painful and rapid inflammation of the peritoneum (peritonitis). The abdominal wall hardens shortly after the prolapse and a flat pain sensation over the entire abdominal area occurs. The life-threatening condition is considered an acute emergency and the patient’s demise can only be prevented by prompt intervention. Even without a perforation, deposits in the form of abscesses can form in more distant sections of the intestine at an advanced stage. Long-term inflammation and restricted or even blocked bowel activity then massively complicate the course of recovery. In some cases, pain in the right lower abdomen subsides on its own without medical treatment. Mild appendicitis, however, leaves scarred tissue and protrusions in affected areas. This change in the surface of the intestine can provoke the development of new inflammations if unfavorable and also cause functional disorders. After successful removal of the appendix, antibiotic treatment kills residual germs, depending on the severity of the appendicitis. Patients are usually able to resume drinking and eating solid food within a day of completing treatment. However, the so-called Douglas abscess may require draining of newly formed pus a week after surgery.
Aftercare
To be on the safe side, a mild appendicitis or irritation should be marked as healed or as not requiring surgery by a follow-up examination. In most cases, however, acute appendicitis will undergo a different type of follow-up. If the inflammation is already far advanced, the inflamed appendix must be surgically removed. Since acute appendicitis can lead to rupture of the appendix and emptying of its contents, including pus, into the abdominal cavity, surgery is usually unavoidable in advanced stages. In the postoperative follow-up, not only wound care is ensured. Laporoscopically performed operations can also cause painful sequelae such as bruising in the abdominal cavity. The attending physician must keep an eye on larger bruises. In addition, the inflammation may have already progressed. It must be ensured that it has not also affected surrounding tissue. The scar pain after an inflamed and removed appendix can initially be considerable due to severed abdominal muscles. The newly operated patient should therefore be made aware that he will have to take it easy for a longer period of time. As a rule, he will be put on sick leave. Follow-up care ensures that neither wound infections nor internal inflammatory processes occur. There are also certain follow-up risks. There may be subsequent ectopic pregnancies, increased risk of colon cancer, or postoperative bowel obstruction as a result of surgical removal of the appendix.
Here’s what you can do yourself
Regarding the following self-help measures, it is explicitly stated that appendicitis can be a medical emergency and must be treated by a physician. But the discomfort can be reduced by self-help measures. Castor oil applied as a poultice can relieve an existing blockage and prevent inflammatory processes. Oral ingestion can bring about a stimulation of intestinal movements and accompanying indigestion can be alleviated. The gingerols contained in ginger are considered to have a strong anti-inflammatory effect. In addition, ginger can reduce any existing nausea and improve appetite. Freshly brewed ginger should be drunk two to three times a day. Prepare freshly and let it steep for about 10 minutes. In addition, rub the abdomen with ginger oil. The accumulation of intestinal waste and excess mucus can be prevented by fenugreek seeds. These seeds can have preventive and acute anti-inflammatory effects. In addition, they can relieve the existing pain.For a decoction, boil two teaspoons of fenugreek seeds with one cup of water and simmer for about 10 to 15 minutes. Then strain and drink lukewarm once daily.
