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Appendicitis.

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VOL: 101, ISSUE: 48, PAGE NO: 21

What is it?

 

What is it?
- Appendicitis is an inflammation of the appendix.

 

 

- It is a medical emergency that usually leads to removal of the appendix before it can rupture, as this can cause infection and even death.

 

 

- Surgically removing the appendix appears to have no effect on the digestive system.

 

 

- Appendicitis can occur at any age but usually affects children and young adults.

 

 

Incidence
- The incidence of acute appendicitis is falling, although the reasons are not known. There are approximately 60,000 cases of appendicitis each year in England and Wales (Simpson and Speake, 2005).

 

 

- Appendicitis is the most common emergency condition to necessitate surgery.

 

 

Causes
- The exact causes are not clear, but it usually involves a blockage of the lumen of the appendix (leading to increased pressure and impaired bloodflow, which results in inflammation).

 

 

- This is usually caused by faeces, but bacterial or viral infections in the digestive tract can lead to swelling of lymph nodes (lymphoid hyperplasia), which puts pressure on the appendix and causes obstruction.

 

 

- Untreated, the appendix can become gangrenous or rupture. If it ruptures, the infection may be released into the abdomen.

 

 

Symptoms
- These include:

 

 

- Abdominal pain, first in the centre of the stomach, then spreading out to the lower right area;

 

 

- Nausea;

 

 

- Loss of appetite;

 

 

- Fever;

 

 

- Gastrointestinal problems including constipation or diarrhoea;

 

 

- Vomiting;

 

 

- Inability to pass flatus;

 

 

- Abdominal swelling.

 

 

- Not all patients will have all these symptoms.

 

 

- Patients may also experience tenesmus - feeling the need to empty the bowel, accompanied by pain, cramping and involuntary straining to little effect. Laxatives and painkillers should not be taken.

 

 

Diagnosis
- Diagnosis can be difficult as symptoms differ between individuals. There is no definitive test for appendicitis: diagnosis is usually based on judgement.

 

 

- If there is pain in the lower right-hand side of the abdomen accompanied by nausea, appendicitis should be suspected. The patient’s temperature should be taken and the abdomen examined for tenderness.

 

 

- The rectum or vagina may be examined for tenderness around the appendix.

 

 

- If examination does not confirm the diagnosis, blood or urine tests or an ultrasound scan may be needed to exclude other possible conditions such as food poisoning or irritable bowel syndrome.

 

 

Treatment
- The usual treatment is appendectomy.

 

 

- The operation can be performed by laparoscopy.

 

 

- Occasionally, appendiceal perforation can be contained within an abscess.

 

 

- The abscess can be drained over several weeks. An appendectomy may be scheduled after the abscess has been drained.

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