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What is Appendicitis?

  Appendicitis is inflammation of the appendix. It may be acute or chronic.

What causes appendicitis?

  In many cases, the cause for appendicitis is unknown. There can also be multiple causes for any one case of appendicitis. Doctors believe that one cause of this condition an obstruction in the appendix. Obstruction may be either partial or complete. Complete obstruction is a cause for emergency surgery.

Obstruction is often due to an accumulation of fecal matter. It can also be the result of:
  • enlarged lymphoid follicles
• worms
• trauma
• tumors

When there's an obstruction in your appendix, bacteria can multiply inside the organ. This leads to the formation of pus. The increased pressure can be painful. It can also compress local blood vessels. A lack of blood flow to the appendix may cause gangrene.

If the appendix ruptures, fecal matter can fill the abdomen. This is a medical emergency.

Peritonitis is one possible consequence of a ruptured appendix. It's an inflammation of the tissue that lines the abdominal wall. Other organs can also become inflamed after a rupture. Affected organs may include the cecum, bladder, and sigmoid colon.

If the infected appendix leaks instead of ruptures, it can form an abscess. This confines the infection to a small walled off area. However, an abscess can still be dangerous.
  What are the symptoms of appendicitis?
  Symptoms of appendicitis include:

• pain around the bellybutton
• lower right side abdominal pain
• loss of appetite
• nausea
• vomiting
• diarrhea
• constipation
• inability to pass gas
• abdominal swelling
• low grade fever
• a sense you might feel better after passing stool

You may experience one or more of these symptoms.

Appendicitis pain may start off as mild cramping. It often becomes more steady and severe with time. You won't necessarily notice changes in your bowel habits. However, sometimes appendicitis can affect urination.

If you have right side tenderness along with any of these other symptoms, talk to a doctor. Appendicitis can quickly become a medical emergency. Rupture rarely happens within the first 24 hours of symptoms.

A perforated appendix can be fatal. The risk of death is highest in infants and the elderly.
  How is appendicitis diagnosed?
  Your doctor will begin by performing a physical exam. A physical exam for appendicitis looks for tenderness in the lower right quadrant of your abdomen. Majority of the cases can be diagnosed clinically only but in doubtful cases imaging study like USG Or CT scan of abdomen can be useful

If you're pregnant, the pain may be higher. If perforation occurs, your stomach may become hard and swollen.
A swollen, rigid belly is a symptom that should be discussed with a doctor right away.

In addition to looking for tenderness, your doctor will perform several tests for appendicitis:

• Urinalysis can rule out a urinary tract infection or kidney stone.

• Pelvic exams can make certain that women don't have reproductive problems. They can also rule out other pelvic    infections.

• Pregnancy tests can rule out a suspected ectopic pregnancy.

• Abdominal imaging can determine if you have an abscess or other complications. This may be done with an X-ray,
ultrasound, or CT scan.

• Chest X-ray can rule out right lower lobe pneumonia. This sometimes has symptoms similar to appendicitis.
  What are the treatment options for appendicitis?
  • Treatment for appendicitis varies.

• In rare cases, appendicitis may get better without surgery. Treatment might involve only antibiotics and a liquid    diet.
  Antibiotics first?
  Everyone with appendicitis, even those on their way to surgery, gets antibiotics. These drugs treat the infection inside the appendix and reduce the risk of widespread infection if it bursts or has already burst.

Antibiotics first means giving antibiotics to someone with appendicitis and then watching to see what happens. If the drugs treat the infection and the appendicitis fades away, surgery isn’t needed. If a course of antibiotics doesn't work, then an appendectomy will follow.

This idea was first tested unintentionally - and successfully - in Navy personnel who developed appendicitis while at sea, and out of reach of an operating room.

The idea of antibiotics-first has piqued interest because some evidence suggests that appendicitis doesn’t always lead to a burst appendix. And a 2014 study in JAMA Surgery showed no association between the amount of time adults with appendicitis spent in the hospital before having an appendectomy and the risk of the appendix bursting. So while appendicitis is still an urgent problem, it may not be quite as urgent as we thought.

Randomized clinical trials comparing antibiotics first to appendectomy first haven't made the case for delaying surgery. On the plus side, antibiotics first does not appear to increase complications, including burst appendix, compared to immediate appendectomy. On the negative side, up to one-third of people assigned to antibiotics first still end up having an appendectomy, either within 48 hours or within the next year.

• Diagnosing appendicitis isn't always easy. Conditions like inflammatory bowel disease can look like appendicitis. And young children often can't describe their symptoms accurately enough to rule out other causes for their stomach pain. "Giving antibiotics to a patient with an uncertain diagnosis and then watching them carefully is a reasonable course of action in some cases" says Dr. Suradkar "But appendectomy is still the standard of care for appendicitis."

• In most cases, however, surgery will be necessary. The type of surgery will depend on the details of your case.

• If you have an abscess that hasn't ruptured, you may receive antibiotics first. Your doctor will then drain your abscess using a tube placed through your skin. Surgery will remove your appendix after you've received treatment for the infection.

• If you have a ruptured abscess or appendix, surgery may be necessary right away. Surgery to remove the appendix is known as an appendectomy.

• A doctor can perform this procedure as open surgery or through a laparoscopy. Laparoscopy is less invasive, making the recovery time shorter. However, open surgery may be necessary if you have an abscess or peritonitis.
  How can I prevent appendicitis?
  • You can't prevent appendicitis, but there are steps you can take to lower your risk. It's less common in people who have diets high in fiber. Eating a healthy diet that contains lots of fresh fruits and vegetables increases your fiber intake.

• Seek medical attention immediately if you think you have appendicitis. Untreated appendicitis can become a medical emergency.
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