Appendicitis

When your appendix, a finger-shaped tube at the right lower part of abdomen, is inflamed, you may have appendicitis.

You will feel the abdominal pain at the lower right side. In most cases, patients feel the pain around the navel and the pain moves. The pain becomes more intense and severe as the inflammation gets worse.

Appendicitis can happen to anyone but it is often found in people aged 10-30. Appendix removal is a standard treatment option.

Symptoms
You may have appendicitis if you experience:

• Sharp pain at the lower right side of your abdomen
• Sharp pain starts at your epigastrium or around the navel and later on move to the lower right side of your abdomen
• Pain aggravated by coughing, walking or making jarring movements
• Vomiting and nausea
• No desire to eat
• Low-grade fever as appendicitis gets worse
• Diarrhea or constipation
• Flatulence or abdominal bloating

The location of the pain depends on the location of your appendix. In pregnant women, the pain may be around right upper abdomen due to the relocation of appendix by the gravid uterus.

When to see a doctor
Consult your doctor if you have signs or symptoms indicating appendicitis. Seek immediate medical care if you have increasing pain in your abdomen.

Causes
Appendicitis tends to occur when there is blockage of the lumen of the appendix leading to infection. The infection of appendix is due to a rapid bacteria reproduction.  Rupture of appendix can occur if prompt treatment is not given.

Complications

• Appendiceal rupture: The perforation of appendix can spread infection throughout your abdomen, leading to peritonitis. Surgical removal of appendix and abdominal washout is urgently required.
• Abscess: If there is rupture of appendix, abscess may develop. A tube will be inserted through your abdomen and left there for a fortnight to drain this pocket of infection. Antibiotics will be prescribed to clear up the infection. An appendectomy can be performed after the infection is clear. Once the abscess drainage is completed, an immediate surgical removal may be performed in some patients.

Diagnosis
You will be questioned regarding previous signs and symptoms and your abdomen will be examined to make the diagnosis of appendicitis. Appendicitis tests and diagnostic studies include:

• Physical examination
  Your doctor will gently press on the area you feel the pain. If the abdominal pain aggravates when your doctor releases the pressure, it indicates presence of peritonitis. Your doctor will also evaluate signs of abdominal rigidity and guarding. Digital rectal exam may be performed by your doctor. In women of child bearing age, a pelvic exam may be performed to evaluate gynecological conditions that may possibly cause the pain.
• Blood test
  If there is an infection, the level of your white blood cells would rise.
• Urinalysis
  To assess if the abdominal pain is the result of a kidney stone or urinary tract infection.
• Imaging studies
  These can be an X-ray, ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) of your abdomen. Imaging studies can help pinpoint appendicitis or detect other possible cause of abdominal pain.

Treatment
The treatment for appendicitis is a surgical removal. Prior to surgical removal, antibiotics may be administered to treat the infection.

• Appendectomy
  To remove your inflamed appendix, your surgeon may perform a laparotomy which is an open surgery involving a surgical abdominal incision of 5-10-centimeter or 2-4 inches long. Another option is laparoscopic surgery which involves a couple of smaller abdominal incisions and the use of special surgical instrument and a video camera for appendix removal.
  A laparoscopic surgery allows for faster postoperative recovery and smaller scars. This is a recommended option for people of older ages or with obesity. However, this type of surgery is not for everyone. A laparotomy is usually performed in case of appendix rupture or abscess buildup because your abdominal cavity can be better cleaned. 1-2 days of hospital stay is usually required afterwards.
• Abscess drainage prior to appendectomy
  If an abscess builds up after appendix rupture, abscess drainage is necessary. A tube will be inserted through abdominal wall into the abscess for pus drainage. Many weeks after the infection is resolved, appendectomy can be safely performed.

Home treatment and lifestyle modification
Postoperative recovery may take a couple of weeks or longer in case of appendix rupture. To enhance the healing process:

• Refrain from doing vigorously activities after surgery
  • After laparoscopic surgery, avoid strenuous activities for 3-5 days.
  • After an open appendectomy, avoid strenuous activities for 10-14 days.
    Consult your doctor what activities you should avoid and when you can resume your normal daily activities.
• When coughing, laughing or moving, put a pillow or pressure over your surgical incisional wound for additional support to minimize pain.
• Contact your doctor if your medications do not relieve the pain
  The postoperative pain should improve day by day. Contact your doctor if you are in pain even though you are taking medications.
• Move around when possible
  Try to move around by starting with a short stroll and increase daily activities slowly when you feel ready.
• Rest
  During recovery, you may feel like sleeping more often. Take a nap and relax when needed.
• Consult your doctor regarding going to work or school
  Once you feel strong enough, you can go back to work. It is possible for children to go to school within a week. However, active activities such as sports or PE class should be avoided up until 2-4 weeks.

Complementary and alternative medicine
To relieve your postoperative pain, medications will be prescribed. Complementary and alternative medicine, along with conventional medicine, can also help lessen the pain.

Consult your doctors for recommended treatments such as:

• Distraction: Activities which distract you from the pain can be chatting with friends or listening to music. Children can take their mind off the pain when they are distracted.
• Guided imagery like imagining where you’d like to be or your favorite spot.

Preparing for your appointment
When you start to feel the pain in your abdomen, it is recommended to go see your doctor. If the pain is due to appendicitis, hospital admission and appendix removal are necessary.

What you can do
Prior to your doctor appointment, please check if there are anything such as fasting you should do and take a note of:

• Symptoms you experience whether they are related or unrelated to appendicitis
• Your family medical record, recent stressful events or life changes
• Medications or dietary supplement you have been taking as well as the dose
• Questions you may have

Take someone along so he/she can help you taking note of what your doctor informs you.
Samples of question you may want to ask your doctor

• Are my symptoms due to appendicitis?
• Are there any tests I should take?
• What are other possible causes of my abdominal pain?
• Is surgery necessary? When should I have it?
• Are there any risks regarding surgical removal?
• After appendix removal, do I have to stay in the hospital?
• How long is the recovery?
• When can I return to work?
• Has my appendix burst?
• Ask any other questions you may have

What to expect from your doctor
Sample of questions that you may be asked:

• When was the symptom onset?
• Where do you first feel the pain?
• Does the pain move?
• How serious is the pain?
• What aggravate your abdominal pain?
• What relieve your abdominal pain?
• Are your symptoms accompanied by fever?
• Do you experience nausea or vomiting?
• Are there any other symptoms you experience?