APPENDICITIS

ACUTE APPENDICITIS

THE APPENDIX:  The appendix is a thin tail, tube or appendage growing out of the caecum, which is part of the large intestine located on the lower right side of the abdomen.

Nobody knows exactly what the appendix does, but removing it’s not harmful.

APPENDICITIS: Appendicitis is a painful swelling of the appendix.

SYMPTOMS:

Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go.

Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe.

Pressing on this area, coughing or walking may make the pain worse.

If you have appendicitis, you may also have other symptoms, including:

feeling sick (nausea)

being sick

loss of appetite

constipation or diarrhoea

a high temperature and a flushed face.

WHEN TO GET MEDICAL HELP:

If you have abdominal pain that’s gradually getting worse, contact your surgeon immediately.

Appendicitis can easily be confused with something else, such as:

gastroenteritis

severe irritable bowel syndrome (IBS)

constipation

bladder or urine infections

Crohn’s disease

a pelvic infection

In women, symptoms similar to those of appendicitis can sometimes have a gynaecological cause, such as an ectopic pregnancy, menstrual pain or pelvic inflammatory disease (PID).

But any condition that causes constant abdominal pain requires urgent medical attention.

♦♦

Call Emergency Services to ask for an ambulance if you have pain that suddenly gets worse and spreads across your abdomen, or if your pain temporarily improves before getting worse again.

If your pain eases for a while but then gets worse, your appendix may have burst.

A burst appendix can cause peritonitis, which is a serious infection of the inner lining of the abdomen.  ♦♦

DIAGNOSIS:</>

You may have:

a blood test to look for signs of infection

a pregnancy test for women

a urine test to rule out other conditions, such as a bladder infection

an ultrasound scan to see if the appendix is swollen

a CT scan.

TREATMENT:

Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.

OPEN APPENDECTOMY:

Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 cms) long laparotomy.

LAPAROSCOPIC APPENDECTOMY:
Laparoscopy is usually the preferred method of removing the appendix because the recovery tends to be quicker than with open surgery.

The operation involves making 3 or 4 small cuts (incisions) in your tummy (abdomen).

Special instruments are inserted, including:

a tube that gas is pumped through to inflate your abdomen – this allows the surgeon to see your appendix more clearly and gives them more room to work

a laparoscope – a small tube with a light and a camera, which relays images of the inside of the abdomen to a television monitor

small surgical tools used to remove the appendix

After your appendix has been removed, dissolvable stitches may be used to close the incisions.

In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity.

EXCEPTIONS

But laparoscopic surgery isn’t appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.

Expect to spend one or two days in the hospital after your appendectomy.

Draining an abscess before appendix surgery

If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.

Alternatives to emergency surgery

In some cases, appendicitis can cause a lump called an appendix mass to form on the appendix.

The lump is made of appendix and fatty tissue and is the body’s way of trying to deal with the problem and heal itself.

If an appendix mass is found during an examination, your doctor may decide it’s not necessary to operate immediately.

Instead, you’ll be given a course of antibiotics and an appointment to have an operation a few weeks later, when the mass has settled.

There’s not enough clear evidence to suggest that antibiotics could be used to treat appendicitis as an alternative to surgery.

POST OPERATIVE CARE

Lifestyle and home remedies

Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal:

• Avoid strenuous activity at first.If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities after surgery.
• Support your abdomen when you cough.Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain.
• Call your doctor if your pain medications aren’t helping.Being in pain puts extra stress on your body and slows the healing process. If you’re still in pain despite your pain medications, call your doctor.
• Get up and move when you’re ready.Start slowly and increase your activity as you feel up to it. Start with short walks.
• Sleep when tired.As your body heals, you may find that you feel sleepier than usual. Take it easy and rest when you need to.
• Discuss returning to work or school with your doctor.You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to four weeks to resume strenuous activity, such as gym classes or sports.

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