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Appendicitis

Symptoms and treatment

Although it's probably the most common surgical emergency, the signs and symptoms of appendicitis can be difficult to interpret. Even in the hands of an experienced clinician, this can sometimes result in a delay in diagnosis and treatment.

The appendix is a small, tube-shaped extension of the large intestine. It is located in the right side of the lower abdomen, known medically as the right iliac fossa. When the lumen of the appendix becomes blocked, the appendix becomes inflamed and then infected. If treatment is delayed, the appendix tissue will die and can burst, leading to widespread infection in the abdominal cavity. If this process occurs rapidly, it is referred to as acute appendicitis. A more insidious course, where the lumen is perhaps only partly obstructed, tends to result in less severe symptoms and is referred to as chronic appendicitis.

Symptoms

The symptoms of acute appendicitis:

  1. Abdominal pain
  2. Loss of appetite
  3. Nausea
  4. General tiredness and fatigue

The abdominal pain tends to be a generalized, colicky pain in the early stages. However, as the condition advances, pain tends to become localized to the right iliac fossa. Pain may be worse on movement, prompting the patient to lie still. Pain may be felt in other areas if the appendix is located somewhere else in the abdomen. For example, it may be located higher in a pregnant woman, because it's been pushed upwards by the developing baby.

The signs of acute appendicitis:

  1. Fever and flushed face
  2. Raised heart rate
  3. Furred tongue and an odor to the breath
  4. Tenderness in the right iliac fossa
  5. Tenderness on internal examination

On pushing the abdomen, the clinician may provoke tenderness, which may be more severe when the clinician removes his hand. This is known medically as rebound tenderness. The abdomen may also feel tense; known medically as guarding.

The clinician may ask to perform internal examinations of the rectum and vagina. This may, in some cases of acute appendicitis, be the only examination that results in tenderness being experienced.

If you are experiencing any of the symptoms listed above, you should consult with your clinician to allow prompt diagnosis and treatment. Diagnosis of acute appendicitis tends to be a clinical one; this means that although some tests may be ordered, it's the story of your symptoms and the clinician's physical examination that allow him to make the diagnosis. Tests that are commonly requested include a urine test (looking for signs of infection), and in female patients, a pregnancy test. In some circumstances, an ultrasound examination or CT scan may be requested.

Treatment

Treatment of acute appendicitis is surgical; the appendix needs to be removed. This can be done by making a small incision in the lower abdomen, or in some cases by keyhole procedures. While awaiting surgery, patients are kept nil by mouth, meaning they are not able to eat or drink. They may be given intravenous fluids and antibiotics, which may also continue after the operation.

In some instances where the diagnosis is uncertain, the clinician may opt to wait and see what happens, either with or without commencing treatment with antibiotics. In instances of chronic appendicitis, this may allow symptoms to settle, although removal of the appendix at a later date may still be needed.

By Sarah Staples

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