Acute Appendicitis – Knowing the Symptoms and Treatment
Appendicitis is one of the most common acute abdominal emergencies worldwide. Men are noted to be with greater risk than females and the incidence rises at the age of 15 to 19 years old and eventually falls after the age of 45. The cause of appendicitis is believed to be secondary to obstruction of the appendicial lumen by fecal material. After obstruction, bacteria in the appendix would multiply and invade the wall of the appendix eventually leading to gangrene and perforation if left untreated.
Symptoms of Acute Appendicitis
Abdominal Pain – the classic manifestation of appendicitis abdominal pain is it starts in your stomach (epigastric) area or periumbilical area and eventually transfers after a couple of hours to the right lower quadrant of your abdomen. Although this classic manifestation doesn’t happen to all patients, if its abdominal pain situated in the right lower quadrant of your stomach then think of appendicitis as a possible cause.
Anorexia (loss of appetite) – a decreased in appetite is seen among appendicitis patients probably secondary to the inflammation of the appendix. Having food intake would move the bowels which would eventually cause pain, leaving patients to refrain from eating to lessen the pain.
Nausea and Vomiting – these symptoms usually present among 50-60% of patients but is usually noted to be self-limiting.
Changes in Bowel Habits – changes in bowel habits is not diagnostic of appendicitis but it could present in some patients when the appendix is in a position in such a way it hits the sigmoid colon irritating it to produce diarrhea.
Fever – fever may not manifest in all patients, but if a patient has fever one might consider a perforation in the appendix.
Laboratory Findings in Acute Appendicitis
Elevated white blood cell count – an elevated white blood cell count or leukocytosis is usually present among appendicitis patients. However, a normal white blood cell count does not exclude the possibility of acute appendicitis.
Urinalysis – urinalysis is usually used to exclude other disease entities that could manifest as acute appendicitis like urinary tract infection, acute pyelonephritis, and urolithiasis or nephrolithiasis.
Radiographic Imaging – an x-ray of the abdomen are not routinely done in acute appendicitis unless other disease entities are entertained. Ultrasound imaging could report an enlarged appendix to establish the diagnosis. Abdominal Ct scan is far more accurate than the 2 radiographic imaging. It could clearly demonstrate a thickened appendix to clinch the diagnosis.
Treatment of Acute Appendicitis
Once the diagnosis is made for acute appendicitis or there is high suspicion of a possible acute appendicitis, the patient should be prepared for surgery. Appendectomy is the only treatment for acute appendicitis. Recent advancements showed that appendectomy can be done laparoscopically with good results.
“The diagnosis of appendicitis cannot be established unless tenderness can be elicited”
Harrisons Principles of Internal Medicine 18th ed