Definition

Acute appendicitis is an emergency condition caused by inflammation of the appendix. The appendix is located ​​in the lower right quadrant of the abdomen. A person with acute appendicitis feels moderate to severe pain in the lower right abdomen. Initially, the discomfort manifests in the umbilical area. As the inflammation progresses, the pain moves to the lower right abdomen. It commonly worsens within twenty-four hours. As one of the most common causes of acute abdominal pain, appendicitis requires immediate treatment.

Appendicitis is most prevalent between the ages of 5 and 45, affecting 233 per 100,000 individuals. Acute appendicitis is reported to be more prevalent in men than in women. Approximately 1 in 20 individuals in the United States will experience appendicitis during their lifetime.

Causes

Appendicitis can be classified into two types: acute and chronic. Acute appendicitis develops rapidly and presents noticeable symptoms. Chronic refers to a condition that persists for an extended period with minimal manifestation of symptoms.

Acute appendicitis is more prevalent than chronic appendicitis and needs prompt medical intervention. An obstruction in the appendix is what causes acute appendicitis. Infections, lymphoid hyperplasia (an enlargement of the lymph nodes), hard feces, and appendix tumors are just a few causes of this obstruction.

An obstruction within the appendix can lead to elevated intra-appendix pressure, consequently impeding the circulation of blood and mucous secreted from the appendix. The obstruction of the appendix results in its accumulation of secretions and subsequent stretching, which provides an optimal environment for bacterial proliferation. All of these elements contribute to acute inflammation in the appendix, which ultimately results in necrosis of the affected tissue. Irritation of the appendix and a bacterial infection are the etiologies of acute appendicitis.

Risk factor

Potential risk factors for acute appendicitis include:

• Age. The incidence of acute appendicitis is higher among those under the age of 20.
• Gender. Acute appendicitis is more prevalent among males.
• Family history. The presence of a familial history of acute appendicitis can elevate the risk of acute appendicitis.

Symptoms

The following are symptoms of acute appendicitis:

• Acute pain in the lower right abdomen
• Abdominal pain originates in the navel and subsequently migrates to the lower right abdomen.
• Experiencing exacerbated pain with coughing, walking, or quick movements.
• Vomiting
• Anorexia
• Fever
• Gastrointestinal disorders such as constipation or diarrhea
• Bloating
• Flatulence

The location of the pain may vary depending on your age and the anatomical position of your appendix. The symptoms will progressively intensify within a time frame of 12 to 24 hours following the onset of the initial symptoms. Complications, such as appendix rupture (perforation), may occur 48 hours after the initial symptoms appear. Pregnant women may have discomfort in the upper right abdomen. During pregnancy, the appendix is displaced higher as a result of the expansion of the uterus.

Diagnosis

During your consultation, the doctor will inquire about your chief complaint, the onset of the symptoms, and any additional symptoms that may be present. The diagnosis of acute appendicitis needs a comprehensive physical examination to identify typical signs of appendicitis. These signs are observed during the physical examination of the abdomen. Gynaecology and rectal examinations may be conducted to rule out other diagnoses.

The doctor can also conduct additional examinations to confirm the diagnosis, such as:

• Complete blood count: This test may detect elevated WBC levels in acute appendicitis, which are indicative of inflammation.
• A urine test is performed to rule out inflammation of the appendix as the potential cause of abdominal discomfort, such as in the case of a kidney stone infection.
• Radiological examinations using ultrasound or CT scan
• Pregnancy test. Ectopic pregnancy, also known as extrauterine pregnancy, shows symptoms that closely resemble those of appendicitis.

Management

Appendicitis is treated by removing the inflamed appendix, known as appendectomy.  Prior to an appendectomy, the doctor will prescribe antibiotics to treat the infection, analgesics for pain relief, intravenous (IV) fluids for hydration, and a liquid diet for post-surgery. A liquid diet is the intake of liquid food and water to facilitate the body's absorption of nutrients without leaving any residue inside the digestive system.

An appendectomy can be performed with a single 5–10 cm incision (laparotomy) or through multiple small incisions (laparoscopy). Your surgeon will implant a camera and surgical equipment during a laparoscopic appendectomy in order to remove the inflamed appendix. Laparoscopic procedures, in general, will provide you with a faster recovery with fewer scars. Laparoscopy, however, is not always an option. If your appendix has ruptured and the infection has spread to other regions of your body, your surgeon will conduct an open laparotomy to clean your abdominal cavity.

Self-Care

The duration of the healing process will vary based on the occurrence of the disease, the therapy received, and your overall health state, including the presence of other comorbidities and age. Factors that may enhance your recovery are:

• Limit your activities. After laparoscopic surgery, limit your activities for the next 3–5 days. For laparotomy appendectomy, limit your activities to 10–14 days. Ask your doctor about the limits of the activities you can do and when you can do your usual activities after surgery.
• Place a pillow on your stomach when you cough. This can help reduce pressure when coughing, laughing, or moving
• Move carefully
• Consult your doctor if pain medication is not effective. Pain can add stress to your body and slow down the healing process. Consult your doctor if the analgesic is less effective.
• Go back to school or work.
• Return to work once you feel better. Children can also return to school within 1 week after surgery, but it takes 2 to 4 weeks to be able to do physical activities, for example, sports classes.
• Keep your surgical wound dry and clean

Complications

Untreated acute appendicitis can lead to severe consequences, such as:

• Appendiceal rupture

An appendiceal rupture can cause infection throughout the stomach, causing peritonitis. This condition can be life-threatening. Peritonitis requires surgery immediately to remove the appendix and clean out your abdominal cavity.

• Appendiceal abscess

The inflamed appendix will form a pocket filled with pus as a result of the inflammation and infection, called an abscess. In most cases, your surgeon will try to drain the pus from the sac by placing a tube in the abdominal wall (abscess drainage) for two weeks, along with antibiotics consumption. Once the infection has diminished, the appendix will be removed.

Prevention

There is no specific prevention for appendicitis. However, by consuming foods high in fiber, such as fruits, vegetables, whole cereals, oatmeal, brown rice, and nuts, the risk of developing appendicitis can be reduced. Your doctor may prescribe you a fiber supplement to prevent constipation.

When to see a doctor?

If you experience the symptoms above, see your doctor immediately. Acute appendicitis requires appropriate and fast treatment to prevent more severe complications.

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