Appendicitis: A surgical emergency
by ranali perera
The appendix is a small, worm-like, blind-ending hollow organ found at the junction between the large and small intestines. It is usually 8-10 cm long (but can be as long as 20 cm) and has no major role to play in the human body functions. While it is a non-essential organ present within our body, it does however, very frequently give rise to a condition called appendicitis.
Appendicitis is the inflammation of the appendix. It is a common cause of sudden onset abdominal pain and is considered an emergency situation. It is frequent among children and young adults and shows a slight male predisposition. A diet devoid of fibre has been shown to be one risk factor for the development of this condition.
The appendix is commonly found in right lower abdomen. However, in certain people the appendix would be located differently. Some common locations are in the pelvic cavity, behind the large intestine and under the liver.
How does the appendix get inflamed?
The main reason for the onset of appendicitis seems to be obstruction. The appendix can get obstructed due to stools (especially in the elderly), infection by bacteria (common cause in children and young adults), worm infestations (in those living in Eastern countries) and foreign bodies.
Once the appendix gets obstructed, the intestinal bacteria present within it will continue to grow. The inflammation can lead to swelling and impingement of nearby nerves and structures leading to pain. The blood supply can get obstructed with the swelling and the ischaemic condition can lead to the death of tissues.
This will lead to eventual rupture of the appendix.
What symptoms point towards a diagnosis of appendicitis?
The typical presentation is an initial on and off pain near the belly button that is later increased in severity and becomes more constant and felt on the lower abdomen of the right hand side
The pain would increase on coughing and with movement
This pain would be preceded by loss of appetite
Vomiting may be present with the severe abdominal pain
Fever and malaise
Diarrhoea or constipation
A classical presentation, however, is seen only in 50% of the patients.
Most often a doctor would be able to diagnose appendicitis by the clinical presentation. If the diagnosis is unclear, you may be required to take certain tests to confirm the diagnosis.
Pregnancy test in women of childbearing age to exclude a pregnancy
Urine tests to exclude conditions like urine infection
What complications can arise with this condition?
The bacterial infection within the closed-off appendix can lead to abscess formation with collection of pus (yellowish liquid consisting of immune cells and cell debris)
As the appendix gets swollen due to inflammation, it can rupture. This is a life-threatening situation.
The appendix harbours bacteria that would then be released onto the abdominal cavity. This can give rise to a condition called peritonitis.
If the bacteria enters the blood stream, it can lead to sepsis, shock and death.
The infection can sometimes spread to the ovaries and fallopian tubes in women, and lead to scarring and infertility.
The pain may reduce as the appendix ruptures. However, it will come back more severely along with high fever if peritonitis develops. Other symptoms that can be present with peritonitis include increase in heart rate and rapid shallow breathing.
How can you treat appendicitis and avoid development of complications?
As I mentioned before, the appendix isn't a vital organ. Therefore, the mainstay of treatment is surgery. This surgical removal of the appendix is termed appendectomy or appendicectomy.
It can be done in two ways:
Laparoscopic surgery is the commonly practised method unless the appendix has ruptured or if the appendix is located elsewhere.
The surgery done laparoscopically is relatively risk-free but complications that may arise after surgery include:
Bleeding at the surgery sites
Infection at the wound sites
Hernia at the incision sites
Both types of surgeries are done under general anaesthesia, and the risks associated with that would be present as well.
Antibiotics are also be given along with the surgery in order to treat the infection. It is however, not yet proven to be effective when given alone.
What is the prognosis of appendicitis?
If surgery is done before rupture of the appendix occurs, the prognosis is very good. Though appendix rupture was fatal in the past, with improvement in healthcare now, it also has a better outcome provided proper treatment options are available in a timely manner.
Chronic appendicitis occur in 1% of the cases. This means that the symptoms persist for 3 weeks or more and is relieved by the removal of the appendix. Some may get recurrent appendicitis, with pain that settles before treatment is sought, only to recur again at a different time.
Ministry Secretaries should be appointed on Best interest of Public not Minister Lethargy blocking change
- ‘A prisoner in Indian jail on Eelam soil’
- Sagala vows to crush Aava group Police deployed in full strength
- Politico’s son-in-law in school frock drama Teacher threatened after student is reprimanded
- Lanka alarmed over increased smuggling of ‘KG’
- SC to hear Tangalle ASP assault case
- 656 kg Glyphosate nabbed
- FPTP opens gate for undesirables, warns Amunugama
- EC to issue nomination notice on 27th
- NPC Education Minister shuns national flag Sarveshwaran was Chief Guest at school event
- Geological changes in Jaffna – Academics
- Violence against children World Vision launches campaign
- Females from soldier families on SLPP list
- JO goes to CIABOC against five COPE members
- Warrant issued on Jaliya Wickramasuriya For failure to appear in court
- Appuhamy admits to communicating with Aloysius Denies wrongdoing
- Gota’s objections thrown out Avant Garde case to go ahead
- JVP to team up with the devil! Vows to defeat LG polls gazette case
- UNP and JO in ‘secret deal’ to tarnish SLFP – Dayasiri
- CID evidence on COPE members and Aloysius JO urges Speaker to investigate
- An Inconsistent US Assertive China and Asia’s Hobbesian Order
- Jorge Sharp and Citizen Movements:New Momentum for Chilean Left?
- Zimbabwe’s Tailspin: The Lessons for Africa
- Lankan family facing deportation due to MS diagnosis
- Malaysian security forces in SL Undergo sea combat training
- Customs nabs man with gold jewellery
- HNB clinch two titles
- Nadal wins defamation case
- One-legged footballer melts hearts
- Paine handed shock recall for Australia
- Italy's stars fall back to earth in Serie A
- 20th Army Para Athletic Meet 700 Servicemen and 5 Koreans in the fray 2 Korean Olympians provide international flavour
- 47 successful at AASL Technical Officers exam
- England’s May up to speed for Wallabies
- MCA Premier League 2018 MAS and DIMO into Semis
- 34th MBA Inter-Firm Team Badminton Championships 2017 McLarens Group are overall champions
- Fourteen teams for beach tag rugby
- CH in vigorous win over CR
- Havies up against tough Navy SC
- Pujara holds on as India struggle
- Waruna off to Finland
- Sevens players given SLR contracts 20 men and 16 women players will be signed on starting November
- ‘Singer Cup’ U-19 Cricket Sanjula gets 150 runs
- Lakmal rattles India on rain-hit day
- Curious case of Sri Lanka Winter Sports Association
- Inter Club Rugby League Tournament CR clash with arch rivals CH today
- Asian Markets Rise As Risk Appetite Improves
- Singapore suspends trade ties with North Korea
- House Republicans pass $1.4Tn Tax Overhaul bill
- The world’s largest automaker is putting big money into electric vehicles in China
- Emotional toll of diabetes 'needs more recognition'
- Could buying paintings make you rich?
- Walmart helps to lift US markets
- $7.5 million Schumacher Ferrari sets record: Sotheby's
- Norway's state fund ‘needs to drop oil and gas investments'
- Japan railway 'deeply sorry' after train leaves 20 seconds early
- Creditors rule Venezuela state oil firm PDVSA in default
- Asia Property Awards in Singapore Capital TRUST Residencies wins Best Condo in SL
- Lanka IOC reports losses for 3rd consecutive quarter
- Airtel and Google debut online purchasing in SL
- AIA Insurance Lanka revenue up 17% in Q3
- Full day of CSE trading from Disaster Recovery site
- Introducing Mars to agriculture
- How an oil giant came to dominate wheat
- Asian Shares Higher Ahead Of US Tax Vote
- Going green needs defined regulations to go forward
- Remembering ‘Dictionary Johnson’
- Budgetary design of blue green enterprise
- A Time of Gifts Different Perspectives
- We were forced to work like animals
- Enjoying the bounty and giving thanks
- BREXIT Impact on free movement of people
- Padmavati triggers stir in Bollywood
- Military burning houses Rohingya refugees flee to Bangladesh
- Rice Revolution Role of Dairy Centres
- Pollution in India: 2.5 million people killed in 2015
- There is no journey with the UNP
- Core values of the UNP are eroding - Pradeep Jayewardene
- UN compensation for Kuwait workers Rs 3.2 B on migrant worker welfare
- Professor Matteo Legrenzi says: Gulf States are not keen on all-out war
- I regret the inconvenience caused to the public
- An argument for a new Constitution
- ‘Otriachchi’, ‘Orumiththa Nadu’, ‘Aekeeya Rajya’ and unitary state
- A Constitutional Framework for Sri Lanka
- PAST LIFE AND RULING PLANETS IN KRISHNAMURTHI PADHDHATHI
- Astrological remedies for Agriculture
- Unintentional Murder and law
- An Idyl in South India
- GRANDMA’S HAIR GROWTH OIL
- INTERPRETING ASIAN CINEMA: CHALLENGES AHEAD
- How Sanskrit journalism is slowly hogging headlines
- ice manufacturing in South Asia
- CMSC’s season finale concert
- Two documentaries on Sri Lanka in Film South Asia 2017
- Politics of nostalgia
- Vibrancy of classical Sinhala poetry
- Gazing at the 'gems' of Sri Lanka
- Kite Surfing Lanka Kalpitiya An experience of a lifetime
- Ella and mini Adam’s Peak
- A cave of history -Ravana Cave
- Man who rebelled against the British
- Rohingya kids fill void of parents
- Looking back at Sri Lanka Police