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Appendix Surgery Medical Overview
Appendicitis is a condition where the appendix is inflamed and infected. The appendix is a finger-like pouch that is attached to the first portion of the large intestines. It has no real function.
Appendicitis occurs whenever there is blockage of the appendix from a foreign body, a tumor or a fecolith, a ball of hard stool. Infection and inflammation build up behind the appendix, which can enlarge, become inflamed and become infected.
The symptoms of appendicitis usually begin with mid to lower central abdominal pain associated with a low grade fever and sometimes nausea and vomiting. The pain begins gradually and worsens over time. It gradually drifts to the right lower quadrant and becomes sharper. A poor appetite is common and the fever tends to increase to around 100-101 degrees but not much higher. The location of the appendicitis pain is called the McBurney's point. If there is rupture of the appendix, you will feel temporarily better and the pain begins to worsen from the peritonitis that occurs secondary to rupture of the appendix and the spread of bacteria in the abdominal cavity.
Later symptoms of appendicitis include pain worse with walking or coughing and chills, diarrhea, constipation, loss of appetite, nausea, vomiting and chills.
In order to diagnose appendicitis, the doctor needs to begin with a physical exam. He or she can press on the appendix area and release suddenly. If pain occurs when doing this, there may be peritonitis or severe appendicitis. There may be spasm of the abdominal muscles in peritonitis. A rectal exam can show tenderness on the right side of the rectum. There are imaging studies that help show appendicitis. These include an abdominal CT scan, an ultrasound of the abdomen focused on the right lower quadrant of the abdomen. Diagnostic laparoscopy can be done to show the presence of inflammation of the appendix.
The treatment of appendicitis involves a surgery known as the appendectomy. It can be done using an open technique or, more commonly, a laparoscopic technique. Small incisions are made and the appendix is removed using instruments. We don't need our appendix so that surgery to remove it is not going to cause any harm.
In some cases, an appendectomy removes a normal appendix. This is because the diagnosis of appendicitis is not clear cut and sometimes the diagnosis appears to be appendicitis but is not. This is not uncommon and is a necessary side effect of having appendicitis surgery. The doctor, upon finding the normal appendix, will explore the rest of the abdomen for other causes of your pain. If the CT scan reveals an abscess of the right lower quadrant, it needs to be removed surgically and antibiotics must be used to treat the infection in the abdomen.
The prognosis of appendicitis is much better if you have the surgery before the appendix ruptures. Your prognosis is excellent with an unruptured appendix but if you have a ruptured appendix, you may suffer from peritonitis and extensive infection, such as sepsis. The recovery time is slower if you wait until the appendix ruptures.
Complications of appendicitis include fistulae, which are abnormal connections between two abdominal organs or between an abdominal organ and the skin. An abscess can form if the appendix ruptures. Infection of the surgical wound is also possible. Peritonitis and sepsis can form if the appendix ruptures and bacteria spread to the abdominal cavity. There is a higher likelihood of death if there is peritonitis and sepsis.
See an emergency room doctor if you have severe or sudden pain, fever that is associated with abdominal pain, vomiting of blood or bloody diarrhea, a hard, rigid or tender abdomen, or cannot pass stool.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here