The appendix is a closed-ended, narrow tube that attaches to the cecum (the first part of the colon) like a worm. (The anatomical name for the appendix, vermiform appendix, means worm-like appendage.) The inner lining of the appendix produces a small amount of mucus that flows through the appendix and into the cecum. The wall of the appendix contains lymphatic tissue that is part of the immune system for making antibodies. Like the rest of the colon, the wall of the appendix also contains a layer of muscle
Q. What is appendicitis ?
Appendicitis is inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening.
This rock is called a fecalith (literally, a rock of stool). At other times, the lymphatic tissue in the appendix may swell and block the appendix. Bacteria which normally are found within the appendix then begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. (An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside the appendix..
The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue that line the wall of the appendix.)
If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a peri-appendiceal abscess).
Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the infection and accompanying inflammation do not spread throughout the abdomen. The inflammation, pain and symptoms may disappear. This is particularly true in elderly patients and when antibiotics are used. The patients then may come to the doctor long after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to the scarring that occurs during healing. This lump might raise the suspicion of cancer.
symptoms of appendicitis
Abdominal pain -- pain may begin in the upper-middle abdomen then develop to sharp localized pain
Abdominal pain may be worse when walking or coughing
Fever usually occurs within several hours
Loss of appetite
Nausea
Vomiting
Constipation
Rectal tenderness
Chills and shaking
Diagnosis
Before the operation, doctor should first perform several tests to make the right diagnosis. The examination must include a careful abdominal and rectal examination of the patient in which the localization of pain should be found.
A symptom commonly found in patients with appendicitis is that they move slowly and carefully, avoiding any sudden movements because they may cause irritation inside of the abdomen and pain.
There are also several other tests that should be done in order to make the right diagnosis : -
The white blood cells count : - In case of an infection, white blood cells count is always elevated. Problem with this test is that elevated white blood cells count doesn't have to be caused only by appendicitis but with almost all other conditions that include even the mildest inflammation
Urine analysis : - During the attack of acute appendicitis, the urine tests are usually quite normal which can also be very important diagnostic sign. Changes and abnormal urine tests suggests that there is a kidney or bladder problem.
Abdominal X-ray : - An abdominal X-ray should show the presence of an appendix stone called fecalith in the right lower area of the abdomen which blocks the opening of the appendix. A type of X-ray called Barium enema could also be helpful. During this procedure the colon is filled with liquid barium. This makes the X-ray visualization much better.
Ultrasound : - Ultrasound can identify an enlarged appendix or an abscess but not in all cases. It can be very helpful when the patients are females because it can rule out some other conditions such as inflammation of the ovaries, fallopian tubes and uterus
CT-scan : - Computed tomography scans play an important role in the diagnosis of appendicitis. CT may show an enlarged, swollen appendix but not in all cases.
The Surgical Procedure
For a standard appendix removal, the surgery is very straightforward and rarely presents any major problems. It can be performed in one of two ways - either as a traditional (open) surgical procedure or by having a laparoscopy. This is a form of procedure commonly referred to as 'keyhole surgery' and it is minimally invasive.
Whichever way the appendectomy is carried out you will be given a general anaesthetic which will mean that you will fall asleep and not feel or be aware of anything taking place. Should the surgeon decide that open surgery is more appropriate, for whatever reason, it will mean a relatively small incision into the abdomen, just between your navel and hip bone. This will then allow the surgeon to remove the appendix simply and quickly.
A laparoscopy is where no major incision as such is required and only a small hole is needed into which is inserted a kind of bendy microscope which not only allows the surgeon to see what's going on inside your abdomen but comes fully equipped to enable the surgeon to actually remove the appendix simply by using the scope and its related tools.
Where it's completely straightforward, it's obviously better to have the procedure carried out via this method and surgeons will opt to use it unless there is a clinical reason why only open surgery is possible.
Complications of the appendicitis
The infected appendix must be surgically removed during the operation called appendectomy because untreated appendix can lead to some serious complications. There are several complications of appendicitis which can occur in the first stadiums of the disease, but they mostly occur if the condition is left untreated. The most common complication of this condition is perforation.
Perforation can lead to a much more serious condition called peritonitis - an infection of the entire lining of the abdomen which can be lethal.
There are also some less common complications such as blockage of the intestine. This isn't really a blockage - the inflammation causes the intestinal muscle failure, and this prevents the intestinal contents from passing. Sepsis - the blood poisoning in which bacteria enters the blood stream may also occur and is an urgent condition too but luckily, this occurs very rarely.
The list of of Gastroenterology Hospitals in India is as follows : -
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For a standard appendix removal, the surgery is very straightforward and rarely presents any major problems. It can be performed in one of two ways - either as a traditional (open) surgical procedure or by having a laparoscopy. This is a form of procedure commonly referred to as 'keyhole surgery' and it is minimally invasive.
