Appendicitis: How to recognize the symptoms

Appendicitis: How to recognize the symptoms

Appendicitis, or appendicitis, is inflammation of the vermiform appendix, a small appendage attached to the appendix. While commonly used, the name appendicitis could be more accurate because the inflammation is limited to the appendix, which is connected to the beginning of the appendix. Here, you can find out what causes inflammation in this appendix, how to recognize the symptoms of appendicitis, and what to do when the first signs appear.

Causes of appendicitis

The appendix hangs like a worm on the appendix and has a diameter of about one centimetre. Due to the narrowness in the muzzle area, mechanical occlusion by foreign objects can quickly occur, for example:

  • Fecal stones (hardened chunks of stool)
  • Cherry pits and other pits or foreign bodies
  • worms
  • old scars
  • kinks in adhesions

But even with an inflammation of the rest of the intestine, tonsillitisflumeasles or scarlet fever, bacteria can enter the appendix via the blood.

Its mouth then closes due to the swelling of the tissue. As a result, secretions build up, and the accumulation of bacteria from the large intestine leads to a violent reaction since the appendix is ​​not used for digestion like the rest of the intestine but is an organ of defence against infection.


Appendicitis: Recognizing Symptoms

Appendicitis often causes typical symptoms, but since these do not always occur, the inflammation is usually not easy to recognize.

Symptoms develop within 12 to 24 hours. Classically, the process is as follows:

  • First, there is pain in the area of ​​the navel or above, which is usually the first sign.
  • This abdominal pain shifts to the right lower abdomen within a few hours, and the abdominal wall is tense.
  • Pain when walking often causes those affected to pull their right leg up a little.
  • Hopping on the right leg or raising the right leg against resistance causes pain—this can often serve as a first test.
  • There is also nausea, which is often accompanied by vomiting and loss of appetite.
  • At the so-called Mac-Burney point (between the navel and the iliac crest on the right), there are signs of local peritonitis with defensive tension, local pressure and percussion pain. Even a light touch is excruciating.
  • Fever is also familiar with appendicitis.
  • Sometimes, the intestinal activity is restricted.

What to do if you suspect appendicitis?

If appendicitis is suspected, you should immediately consult a doctor or go to the hospital. Because, in many cases, a quick operation is required. It would help if you did not eat anything more than this until further clarification, as this could aggravate the symptoms.


diagnosis of appendicitis

Diagnosis of acute appendicitis is based on medical history and physical examination. While the “classic” course described above can often provide clear indications of appendicitis, deviations from this course can occur, especially in children, pregnant women and older people affected. Even for the experienced doctor, it is sometimes challenging to identify appendicitis with certainty.

The following signs can often be identified during the examination by the doctor:

  • The bowel sounds heard with a stethoscope are quieter than usual in appendicitis.
  • There is also a fever with a temperature difference of more than 0.8 °C between the armpit and anus.
  • When palpating the abdomen and often during the rectal examination, tenderness can be detected. Pressure pain usually occurs when pressure is applied to a specific point in the lower left abdomen.
  • The blood count also often shows signs of inflammation, such as the white blood cells or the C-reactive protein ( CRP ).
  • The inflamed appendix is ​​often visible during an ultrasound examination, and computed tomography (CT) may also be necessary in individual cases.
  • Children may have diarrhoea, high fever, loss of appetite, and an early deterioration in general well-being.
  • The symptoms can be weakened in older patients but are associated with a more rapid course.
  • During pregnancy, the position of the appendix changes so that the pain can express itself in an atypical way.

With these examinations, the doctor can usually determine whether it is appendicitis or, for example, a (harmless) appendicitis.

exclusion of other diseases

Other diseases with symptoms similar to appendicitis are gastroenteritis with diarrhoea, inflammation of the gallbladder in stone disease (biliary colic), Crohn’s disease and renal colic.

In women, symptoms similar to appendicitis can be caused by inflammation of the fallopian tubes, ectopic or ectopic pregnancy, pedunculated ovarian cyst, and pain at the time of ovulation. Therefore, the gynaecological disease should be excluded in women through appropriate examinations.

In children, inflammatory swelling of the lymph nodes in the abdomen or pneumonia near the diaphragm can mimic appendicitis.

Rupture of the appendix as a complication

The most important complication of appendicitis is the breakthrough of the purulent secretion from the appendix into the free abdominal cavity; one speaks of an appendix perforation. At the moment of breakthrough, the affected person can feel relief due to lifting the accumulation of secretion, but the pain quickly increases again. The spread of the bacteria in the abdomen can lead to peritonitis, and the life of the person affected can be acutely threatened. Preventing this complication with timely treatment (usually an operation) is essential.

After a breakthrough, encapsulation and demarcation by sticking to the mesh apron and surrounding loops of the small intestine with pus deposits is also possible ( abscess ). These abscesses can affect bowel movements and sometimes cause bowel paralysis.


Treatment primarily by appendix surgery

Any finding in which appendicitis cannot be ruled out after several hours of observation should be operated on. In the case of advanced inflammation, treatment with antibiotics and intravenous fluids is sometimes initiated first to combat the inflammation before the operation can occur.

The operation to remove the appendix (appendectomy) is done by opening the abdominal wall with a small incision on the lower right abdomen. Suppose the affected person is very overweight, or the diagnosis is unclear. In that case, the incision is made more prominent along the middle of the lower abdomen since the surgeon has a better overview. This procedure is known as an open appendectomy.

In the so-called laparoscopic appendectomy, optical instruments, i.e. cameras (endoscopy), are used, which means that only three small incisions are required. In the past, this method was only used for planned interventions, such as the removal of chronic appendicitis or after repeated mild inflammation in a symptom-free period. This technique is now also used in emergencies.

In both cases, general anaesthesia is required. To be sure about the cause of the inflammation, the removed appendix is ​​always examined histologically.

The patient can usually be discharged from the hospital four to five days after the operation, provided their intestines are functioning normally again, and their general condition allows it. After that, he should take it easy at first. Usually, there is a sick note for two to three weeks.

Therapy with antibiotics

Conservative treatment without surgery can be used for subacute appendicitis, i.e. mild appendicitis. For those affected, this means bed rest, fasting (abstaining from food), administration of antibiotics, laboratory control and repeated examinations.

Treatment with antibiotics and painkillers is also often used in children. If this does not show the desired success, an operation is required.

Although surgical removal of the appendix is ​​the standard treatment for appendicitis, initial studies suggest that antibiotics may be sufficient in many cases. However, more detailed investigations are still pending.

Complications after appendicitis

The uncomplicated appendicitis healed after the operation. In some cases, however, a few years after the appendectomy, adhesions can form in the area of ​​the removal site, which can then lead to a mechanical intestinal obstruction.

An abscess, i.e. a collection of pus in the abdominal wall (abdominal wall abscess) or the abdominal cavity (Douglas abscess), can also occur a few days after the operation.

If appendicitis has not been treated and has subsided on its own, scarring and adhesions can develop as a result, which can promote renewed inflammation of the appendix or even cause an intestinal blockage.

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