Appendicitis
The appendix is a thin, small tube measuring about 3 inches in length. The appendix is a wormlike structure located on the lower right of the abdomen. Appendixes are not known to have any function. The appendix does not appear to be essential for health or life. Its removal is unlikely to result in any complications. (1)
Appendicitis refers to inflammation of the appendix. Appendicitis is an inflammation of the appendix caused by infection or another cause. It is a relatively common condition that affects about 1 out of 25 people. In the United States, appendicitis is a condition that affects approximately 1 in 500 individuals each year. The condition is more common in men and whites compared to females or people of other races. Appendicitis is a condition that can affect anyone, but most often it occurs in those between 12 and 30 years of age.
Appendicitis has no known cause. Bacteria can enter the appendix via a hole in the wall, or through an opening at the junction of the appendix and the large intestine. Once inside the appendix, bacteria can multiply and produce toxins which cause inflammation. Appendicitis, if left untreated can lead to severe complications like peritonitis or sepsis.
Depending on the severity of appendicitis there are different treatment options. Mild cases might only need antibiotics and rest. In more severe cases, the appendix may need to be removed surgically. It can be done through open surgery, or through laparoscopy. Laparoscopy is a minimally invasive procedure that uses small instruments through tiny abdominal incisions. In the section on treatment, we will go into detail about the treatment.
Recent research has shown that antibiotics are not as effective in treating appendicitis. A team of surgeons from the University Of Washington School Of Medicine conducted a study that found patients who had surgery were twice as likely as those who only received antibiotics to be cured.
Nearly 200 patients were studied with appendicitis confirmed. About half of the patients had their appendix removed, and the other half were treated with antibiotics only. After one year, 88% of patients who underwent surgery were free of appendicitis. Only 47% of those who received antibiotics only were.
Pathophysiology
Appendix swelling occurs when bacteria in the appendiceal canal multiply. Appendix swelling and congestion are caused by increased intraluminal tension. Necrosis and gangrene are caused by an inflammatory response triggered by bacterial infections and ischemia. Appendixes can perforate if they become gangrenous. The obstruction usually progresses to perforation within 72 hours. (2)
One study found that appendiceal avulsion is more common among children than adults. Within 24 hours (7.7%) of the onset of symptoms, there was a significant perforation risk. The risk increased as the duration of the symptoms increased. Prehospital delays are associated with a significantly higher risk of perforation than in-hospital delays, even though symptoms duration is directly related to symptoms duration before surgery.
Appendicitis can cause only periumbilical discomfort in the early stages due to T10 innervating the appendix. As the inflammation progresses, an exudate will form on the serosal appendiceal surface. When the exudate contacts the parietal perineum, it causes intense pain.
Perforation causes a release of inflammatory fluids and bacteria into the abdominal cavity. Peritonitis is caused by inflammation of the peritoneal surfaces. Peritonitis can be localized or diffuse depending on the ability of the omentum to contain luminal spillage.
If the contents form an abscess, the pain and tenderness can be localized. If the contents do not wall off, and fluid is allowed to travel through the peritoneum, pain and tenderness can become more generalized.
