Appendicitis is one of the commonest abdominal emergencies seen anywhere in the world. It is more common in women than in men and it used to be thought of as a cosmopolitan disease, but in the last two decades or so, evidence has suggested that this is not necessarily true.
Indeed, there is no hospital, large or small that does not have to deal with this condition in all parts of Nigeria, whether in the urban or rural areas. The appendix is a small, thin pouch about 5-10 cm long. It is connected to the large intestine where faeces (stool) are formed. No one knows exactly why we have an appendix and removing it is not harmful.
Appendicitis is a painful swelling of the appendix, which causes pain in the abdomen. There are four types of appendicitis: acute appendicitis, sub-acute appendicitis, recurrent appendicitis and chronic appendicitis.
Acute appendicitis is the commonest surgical condition of the abdomen. Acute appendicitis may occur at all ages, while sub-acute appendicitis may resolve with medications.
Symptoms of Appendicitis
Appendicitis typically starts with a pain in the middle of the abdomen (tummy). The pain may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe.
Other symptoms are unexplained weight loss, nausea and low grade fever. Pressing on this area, coughing or walking may all make the pain worse. The patient may lose appetite, feel sick and occasionally experience diarrhoea.
The single most important physical finding by the doctor is right lower abdominal pain on palpitation of the abdomen. Other findings include low-grade fever, peritoneal signs and guardedness.
Causes Of Appendicitis
It’s not exactly clear what the causes of appendicitis are, although most cases are thought to occur when something, usually a small piece of seed, stone, faeces (stool) or a swollen lymph node within the wall of the bowel blocks the entrance of the appendix. This obstruction leads to development of inflammation and swelling.
Diagnosis of Appendicitis
The overall diagnostic accuracy achieved by history, physical examination and laboratory tests has been approximately 80 per cent. The ease and accuracy of diagnosis varies with the patient’s sex and age. It is more difficult in women, children, elderly persons and women of childbearing age because acute gynaecologic conditions (e.g., pelvic inflammatory disease) may cause symptoms similar to appendicitis.
If the diagnosis of appendicitis is clear from the patient’s history and physical examination, no further testing is needed and prompt surgical referral is warranted. When the diagnosis of appendicitis is not clear, management options for suspected appendicitis include observation in a hospital, diagnostic imaging to clarify the diagnosis, laporoscopy and appendectomy.
In typical cases, ultrasonography and computed tomography (CT) may help lower the rate of false-negative appendicitis diagnoses and reduce morbidity from perforation.
It may rupture with the escape of faecal material and various bacteria into the abdomen, thus causing a more severe disease called peritonitis.
An abscess cavity forms around the appendix, with tge development of severe illness, high-grade fever and considerable discomfort. A mass is formed by a combination of certain structures within the abdomen, the intestines and the appendix itself, called an appendix mass.
As the causes are not fully understood, there’s no guaranteed way of preventing appendicitis. The risk of the disease may be reduced by increasing the consumption of high fibre diets and vegetables, since such foods make bowel movements regular and shorten the digestion transit time.
Source: The Punch, Monday, October 9, 2017.
Written by Rotimi Adesanya, Child and public Health Physician