Appendicitis: Symptoms

Appendicitis is inflammation of the appendix, a blind pouch arising from the cecum. The cecum is situated in the right lower quadrant of the abdomen. That's way most of the time acute appendicitis is associated with pain and tenderness over this part of the abdomen. However, most patients with acute appendicitis tend to have their pain starting at the upper mid-line of the abdomen or the per-umbilical region. This is related to the fact that anatomically the large bowel originated from the mid-line structures during men's embryonic stage. In time, the pain shifts to the right lower quadrant. Bedside physical examination by a doctor will elicit right lower quadrant tenderness, and at times "rebound tenderness" and "guarding". Rebound tenderness describes the sign that when the hand pressing on the abdominal wall is suddenly removed, pain or tenderness is elicited by the sudden movement of the abdominal wall. "Guarding" refers to involuntary tensing of the abdominal wall muscles when the abdomen is being pressed. Some common symptoms associated with appendicitis include: nausea, anorexia, fever and vomiting.

Appendicitis: Treatment

1. Open appendectomy

This procedure is centuries old. It is one of the most commonly practiced surgical procedures. The surgeon makes a small wound over the right lower quadrant of the patient's abdomen and takes out the inflamed appendix. The procedure is effective and safe. Only minor discomfort is associated.

2. Laparoscopic appendectomy

This procedure is a modified version of open appendectomy. The main difference is that minimal incisions are used instead. These incisions cannot admit fingers of the surgeon. Only slim instruments can be used through them. An endoscope to visualized the inside of the abdominal cavity (called a laparoscope) is used to provide the visual input and monitoring.In experienced hands, equal efficacy and safety as is open appendectomy is achieved. Patient acceptance of the treatment is higher than in open appendectomy as less pain and quicker recovery is often achieved.

3. Conservative treatment

In exceptional situations where surgery is not available or not a practical option ( e.g. on board of an ocean liner in the middle of the ocean and days away from shore), conservative treatment is given. This takes the form of intravenous fluid support and intravenous antibiotics. However, complete control of the infection is only achieved in a fraction of patients. Treatment failure tends to give rise to significant complications including generalized peritonitis, intra-abdominal abscesses, or even death. In general, a search for surgical treatment is also initiated as a salvage procedure at the same time.