Synonyms in a broader sense
- Appendicitis
- Appendicitis
- Appendicitis
- Appendicitis
- Pregnancy appendicitis
- Periappendicitis
Introduction
Appendicitis is an inflammation of the vermiform appendix of the appendix (caecum). The term appendicitis is therefore not medically correct, as it is not the appendix itself that is inflamed, but the appendix vermiformis. It would therefore be correct to speak of appendicitis.
The “appendicitis” presents itself with pain in the right lower abdomen, nausea, vomiting and fever. Even now, the diagnosis is still a challenge and a need for quick action for physicians in the form of surgical removal of the appendix (appendectomy). A dreaded and serious complication of appendicitis is the perforation of the appendix, which can be accompanied by a life-threatening peritonitis.
Frequency
7% of the population suffer from acute appendicitis once in their life. It occurs with a frequency of 100 cases per 100,000 inhabitants per year and is the most common cause of sudden onset of severe abdominal pain (acute abdomen), accounting for 50% of cases. The peak of appendicitis is between 10 and 30 years of age, but school children are the most frequently affected.
Infants and elderly people fall ill less frequently and often have an atypical course, so that the disease is diagnosed later and complications occur more frequently. In general, the mortality (lethality) of appendicitis is <1%. An appendicitis complicated by peritonitis has a significantly higher mortality rate of 6-10%. Early diagnosis is therefore of great importance.
Causes of appendicitis
The blueprint of the appendix is virtually predestined for the development of an inflammation. The appendix has a low swelling capacity and its small inner diameter (lumen) is predestined for constipation. The significance of the numerous lymphatic tissue found in the appendix has not yet been clarified.
Appendicitis can be caused by blockages in the appendix caused by hard faeces (excrement stones), kinking of the appendix, scar tissue (clamps) and external pressure (tumours and flatulence). Foreign bodies such as cherry, melon and grape seeds can also cause occlusion. Often local or general infections (viral, bacterial) can cause appendicitis to break out (local decompensation).
Examples are tonsillitis, influenza, measles, chickenpox or scarlet fever, which mostly affect children. In very rare cases, parasites such as roundworms can be the cause of appendicitis. The bacteria that cause a purulent inflammation in appendicitis are E-coli, preteus, enterococci and belong to the normal intestinal flora.
A stomach flu (gastroenteritis) can also be a possible cause. In very rare cases, Crohn’s disease can cause appendicitis. Appendicitis
Symptoms of appendicitis
There are various signs of appendicitis. These usually appear very quickly from full health and get worse. The easiest to recognise and the first sign of appendicitis is abdominal pain.
This usually severe pain typically begins around the navel or slightly above it on the right side, which is misinterpreted as stomach pain. In a short time this pain then shifts to the lower right side. This phenomenon is called “walking pain”.
Typical for the pain of appendicitis is the dependence on position. This means, for example, that the pain becomes worse when jumping, which is explained by the fact that the inflamed and irritated appendix also moves in the abdominal cavity (concussion pain). A side difference, i.e. a difference in the intensity of pain from right to left, also speaks in favour of appendicitis.
For the physician, there are some clinical signs that continue to point to appendicitis. One of them is the so-called relinquishing pain. If one presses with two fingers the abdominal wall on the left, i.e. the side opposite the appendix, deeply and releases abruptly, the patient suffers pain on the right side.
Also typical is the phenomenon known as psoas stretching pain. When the patient bends the right leg against resistance in the hip joint, this causes severe pain in the right lower abdomen. This is caused by the tension of the muscle that lifts the leg and has become very sensitive to pain due to the inflammation.
This is interesting for the layman, because the same principle causes pain during normal walking. For example, pain when walking in the right lower abdomen can indicate appendicitis. A sign that a relative or yourself can also see and feel is a tension of the abdominal muscles above the appendicitis (defence tension).
However, a non-existent sign does not rule out appendicitis, just as an existing sign does not indicate it with certainty. The signs must always be seen in the context of other symptoms and the patient’s information. Thus there are other signs indicating appendicitis.
Since appendicitis occurs in close proximity to the digestive organs stomach, small and large intestine, other important indications are nausea and vomiting. The inflammation and the messenger substances released in the process irritate neighbouring nerve fibres and trigger these symptoms. They occur virtually with every appendicitis in parallel with the pain.
This is accompanied by a loss of appetite in many patients. An objectively measurable sign of appendicitis is fever, which does not occur in digestive problems, for example, and indicates an inflammatory event. The temperature is often 39 degrees Celsius or higher.
When measuring fever in the context of appendicitis, a temperature difference between rectal and axillary temperature of more than 1 degree Celsius is often observed, which can also be a sign. In addition, an increased pulse rate can be measured (tachycardia). The fever is accompanied by increased, extremely heavy sweating, especially at night, which for outsiders can be the first sign of appendicitis.
It is important to know that almost every appendicitis in young people is associated with fever. However, it can happen that older people fall ill without having a fever. A possible stool retention can be interpreted as an additional sign of appendicitis.
The digestive tract is equipped with a widely ramified nervous system, which controls its processes relatively independently. It is affected by the inflammation and can thus lead to constipation. As a difference, the opposite is also possible, where the patient complains of diarrhoea.
Aggravating for the correct assessment of the signs is the fact that there can be anatomical variations from person to person in the position of the appendix in the abdominal cavity. Most of them are located in the right lower abdomen. However, the appendix can also lie in the middle or on the left side and even wander across the horizontal navel line.
This knowledge should be taken into account especially in pregnant patients. Pain that occurs will otherwise be misinterpreted because of the unusual position. All these typical signs, without which almost no appendicitis occurs in children and adolescents, are often seen in older patients only in an attenuated form.
Some do not occur at all. Appendicitis can occur at any age, but the main age at which the disease occurs is school age. A peak in frequency can be seen between the ages of five and twelve.
The younger the child is, the greater the risk of a breakthrough (perforation), so that a breakthrough often occurs in a small child as early as on admission to hospital. The classic course of symptoms of appendicitis with pain in the umbilical region, which in conjunction with nausea, vomiting and an increase in body temperature moves to the right lower abdomen within a few hours, can also occur in children. However, especially in children, many deviations from these classic symptoms are possible, which is why it is often more difficult for the examiner to make a reliable diagnosis.
In children, diarrhoea, high fever, an early deterioration of the general condition and loss of appetite are more common. As a matter of principle, a doctor should be consulted immediately if a child complains of cramp-like pain in the right lower abdomen that lasts longer than three hours, as a dangerous breakthrough can occur in the case of appendicitis. In some cases, however, the symptoms may start gradually in the child, so even severe pain is not a sure sign of acute appendicitis.
In addition to these clinical, palpable signs, suspected appendicitis is investigated using other methods. For example, when a blood sample is analysed in the laboratory, the inflammatory signs such as CRP and white blood cells are elevated. Fever is a reaction of the body to the presence of unwanted pathogens.
The body temperature is raised because the immune system is increasingly activated. In appendicitis, the occurrence of fever, especially in children and adolescents, is not uncommon. In older people, fever as well as other complaints, such as pain and vomiting, are less common in appendicitis.
Typically, the fever measured rectally is significantly higher than the temperature under the armpit. The difference in temperature is at least one degree Celsius. Rarely, however, is the fever higher than 39 degrees Celsius.
It can also lead to an increased pulse and night sweats. The signs of appendicitis can be quite different. The signs of acute appendicitis are not always characteristic of the disease, so it can sometimes be difficult to distinguish it from other causes of the symptoms.
In pregnant women, pain in the right upper abdomen can be a sign of appendicitis. In older people, the symptoms are often not very pronounced, making it difficult to diagnose appendicitis. Often there is also a co-infection of the ureter, which can lead to an erroneous diagnosis of isolated urethritis.
A major symptom of the disease is the clinical change of symptoms. Initially there is pain in the region of the navel (periumbilical) and in the stomach area. Within a few hours the localization of the pain changes to the right lower abdomen.
In many cases nausea and vomiting occur, and loss of appetite can also be a sign of appendicitis. In more advanced stages of the disease it can even lead to intestinal paralysis (paralytic ileus). As with any inflammation, appendicitis can also cause the body temperature to rise to as high as 39 degrees Celsius. Often there is a temperature difference between the measurement in the crook of the arm and the anus. As a result of the fever, there can be an increase in the pulse (increase in heart rate, tachycardia).
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