One of the most common medical emergencies of the abdomen is appendicitis. Oftentimes, this requires surgery. Almost 10% of the population develop appendicitis. Appendicitis in simple words is the inflammation of the appendix. The appendix is a finger-shaped pouch. Also, it is a little one-ended tube. The cecum of the large intestine lodges the appendix. The vermiform appendix is the other name of the appendix (vermiform = worm-like). So, this gives us a clear idea of how the appendix might look like.
An appendix is a 3 1/2 inch long tube. The definitive or clear function of the appendix is unknown. Further, certain theories suggest that an appendix is a safe place for the storage of gut flora. Moreover, some evidence suggests that the appendix plays an important role in the lymphatic and immune systems of the body. Also, a widely accepted theory is that the appendix is a vestigial or an additional useless organ which we have derived from our ancestors.
So, whatever the theory behind this organ might be, this organ is a menacing one in the sense that it’s really good at inflaming and causing abdominal pain through a condition called appendicitis.
WHAT CAUSES APPENDICITIS?
Appendicitis as we saw is the inflammation of the appendix. This develops and inflames almost all of a sudden with the least amount of warning. So, some of the reasons quoted for the development of this condition are,
OBSTRUCTION IN THE TUBE:
This could oftentimes be a fecalith or a faecal stone (a hardened lump of faecal material that finds its way into the lumen of the appendix and lodges itself comfortably). Apart from this culprit, stuff like undigested seeds from the fruits we consume, pinworm infestations and intestinal parasites could also cause inflammation.
GROWTH OF THE LYMPHOID FOLLICLE:
Further, an important cause of obstruction is lymphoid follicle growth or lymphoid hyperplasia in children and adolescents. It is nothing but a dense collection of lymphocytes (important cells of the immune system). These lymphoid follicles reach their maximum size in the appendix during adolescence. This growth can literally obstruct the tube pretty easily.
Further viral infections like measles, adenovirus are major causes. Even after immunization, the immune system ramps up and the follicles can grow well.
THE ACTUAL TROUBLE BEHIND DEVELOPING AN APPENDICTIS:
So, as we read the above-mentioned causes of appendicitis, whatever may be the reason behind developing it the actual pathway to the development of inflammation remains the same. So, the intestinal lumen along with the appendix always secretes mucus and fluids. The main reason behind the secretion of these fluids is to keep the pathogens away from entering into the bloodstream and also to keep the lining of the intestine moist and friction-free for effective and seamless functioning. The secretion never stops and keeps accumulating. When this keeps on happening continuously, this puts pressure on the appendix and it kinda fills up like a water balloon.
Further, the bigger it gets, it literally physically pushes the afferent visceral nerve fibres nearby, thus causing the classical symptom of acute abdominal pain. Further, the bacterial flora (like the E.Coli, Bacteroides fragilis) of the gut which was kept in check are now free to multiply. This makes the immune system of the body recruit white blood cells and pus to accumulate in the appendix.
SYMPTOMS OF APPENDICITIS:
The following are some of the presenting symptoms of appendicitis,
- Pain in the lower part of the abdomen (right side)
- Also, pain in the upper part of the abdomen and around the belly button
- Constipation or diarrhea
- Inability to pass gas
- Low grade fever
The activation of the immune system is exhibited as an increase in the white blood cells in the body. The lab investigations show this as increased white blood cells in the serum.
The affected person develops a fever as a result of infection. Along with the spike in the temperature, the patient develops acute and severe pain in Mcburney’s point (right lower quadrant of the abdomen where the appendix is located). Further, nausea and vomiting are classic symptoms.
Minimal physical investigations are more than enough for a physician to identify appendicitis. But in certain cases, imaging might be required to rule out other conditions before arriving at a diagnosis.
COMPLICATIONS OF APPENDICITIS:
In certain cases when the obstruction persists, the pressure on the appendix increases. When the pressure keeps growing and the swelling continues to grow up, this pushes and compresses the small blood vessels. It is a known fact that blood vessels carry blood and oxygen. Ischaemia sets in eventually. This causes the blood vessels in that portion to starve of blood and oxygen and eventually die.
As we already read, these cells are responsible for secreting mucus and keeping out the bacteria. When the gut flora is not kept in check, this starts to multiply freely. As more and more cells die due to the weakening of the abdominal wall, the appendix ruptures. Further, the rupture of the infected appendix promotes the escape of the contained bacteria into the abdominal cavity (peritoneum). This gives rise to peritonitis (mild inflammation of the abdominal cavity) and rebound tenderness (feeling pain when the pressure is taken off). McBurney’s point is the hub of this phenomenon.
RISK OF ABSCESS:
A common and important complication of a ruptured appendix is periappendiceal abscess. In simple words, the escaped pus and fluid from the appendix builds around the appendix. Also, subphrenic abscesses are common. These are tiny abscess that forms between the diaphragm and the liver and spleen.
TREATMENT FOR APPENDICITIS:
Surgical removal of the appendix also known as appendicectomy is the gold standard treatment procedure for the appendix. Antibiotics are mandatory in this condition.
A surgeon can perform appendicectomy through two common means. One is an open appendicectomy or laparotomy. The appendix is removed via an incision in the abdomen.
Secondly, laparoscopic appendicectomy can be used to remove the appendix. In this procedure, the appendix is visualized through a long, flexible tube that has a camera on one end. The appendix is then removed from the abdominal cavity through small cuts in the stomach.
In cases where the patient develops abscesses, the surgical draining of the abscesses is important. Removal of the appendix is totally safe and there are no known side effects of removing this vestigial organ. Moreover, in certain cases, when the surgeon performs an abdominal surgery for some other reason, they might as well remove the appendix to avoid the possible agony of appendicitis down the road. This procedure is a prophylactic appendicectomy. Further, incidental appendicectomy is the removal of the appendix when performing another surgery.