Appendicitis: Diagnosis and Treatment

What is appendix?
The appendix is narrow tube attached to large intestine (colon), located in the lower right portion of the abdomen. It has no known function.

Removal of the appendix appears to cause no change in digestive function.

What is appendicitis?

Appendicitis is an inflammation of the appendix. It must be surgically removed as there is no effective medical therapy (emergency appendicectomy). If delayed appendix can burst (Perforation), causing spread of infection into abdomen (Peritonitis) and even death.

Occasionally after appendix rupture infection is localized, walled of and appendicular abscess is formed.

What is the cause of appendicitis?

The cause of appendicitis relates to blockage of the inside of the appendix, most commonly because of feces or parasites . Inflammatory disease, traumatic injury and genetic may be responsible in small number of cases.

What are the Symptoms of appendicitis?

Pain in the abdomen, first around the belly button (Umbilicus), then moving to the lower right abdomen, pain worsens on moving/coughing,deep breathing

Loss of appetite/ nausea/ vomiting
Constipation or diarrhea
Abdominal swelling
Inability to pass gas
Not everyone has all the symptoms and Symptoms vary widely among children, elderly and pregnant women.

How is appendicitis Diagnosed?

It is essentially clinical diagnosis. Asking questions and careful physical examination of abdomen are key to the diagnosis.

Location of the pain and tenderness in the abdomen is important.

Pain is a symptom described by the patient tenderness is response of the patient on being touched.

Rebound tenderness is when patient feels more pain when doctor releases pressure on the abdomen than when it is applied.

Guarding is when muscles become tensed in response to touch.

Rebound tenderness and guarding are two important signs suggesting that abdominal lining (peritoneum) is inflamed.

No blood test can confirm appendicitis; it is done to check for signs of infection, such as a high white blood cell count.

Urine analysis is used to rule out pregnancy in women of child bearing age and UTI (urinary tract infection)

USG and CT scan has more than 90% accuracy but it may be negative. It may show appendix inflammation and rule out gall bladder disease and pregnancy. Diagnostic

Diagnostic laparoscopy is done in cases of doubtful diagnosis.

How appendicitis is treated?

Ideal treatment is surgical removal of appendix (Emergency appendicectomy).

Mild appendicitis may sometimes be treated with antibiotics but removal at a later date is done (Interval appendicectomy).

If an appendicular abscess is present, it may be drained by placing a tube through the skin. Appendectomy can be performed several weeks later after the infection is under control.

Appendicectomy may be performed through a standard open or laparoscopic operation.

Laparoscopic surgery isn’t appropriate for everyone. If appendix has ruptured or if an abscess is present, an open appendectomy may be required.

 What is Laparoscopic, Key hole or minimally invasive Appendicectomy?

Laparoscopic Appendectomy involves removing appendix through tiny incisions in the abdomen. A laparoscope with attached camera is inserted into the abdomen through a small cut, allowing doctors to see the internal organs on a high resolution monitor. Surgery can then be performed through special laparoscopic instruments.

Benefits of laparoscopic surgery

Smaller incision,
Less pain
Faster recovery
Shorter hospital stay

Preparation for Laparoscopic Appendicectomy

Give detail of any allergy or medical condition along with medicine you are taking.
One should not eat or drink 6 hours prior to surgery.
Procedure will be done on impatient basis under general anesthesia.
A family member must accompany you for surgery.

Post operative what to expect?

You will be kept fasting for 6 hours after surgery.
Depending upon your bowel movement as judged by your surgeon your diet will be resumed slowly.
You will receive pain killers and antibiotics.
Recovery from Laparoscopic appendectomy is generally faster, but limiting
Strenuous activity may still be necessary for 4 to 6 weeks after surgery.

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