Treating appendicitis, the sooner the better

Symptoms of appendicitis may include sudden pain that begins on the right side of the lower abdomen. Net photo

Appendicitis, if not treated as soon as possible, can lead to death. Medical experts say that nausea, vomiting, loss of appetite, fever, constipation or diarrhoea, are signs that you need to see the doctor immediately.

Dr Joseph Ryarasa Nkurunziza, the chairperson of Heath Development Initiative, says that appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. Appendicitis can be acute or chronic.

He says, appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As the inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, often, it occurs in people between the ages of 10 and 30.

“Appendicitis pain may start off as mild cramping. However, it often becomes more intense. It may begin in your upper abdomen or bellybutton area, before moving to the lower right part of your abdomen,” states Dieudonne’ Bukaba, a nutritionist at Avega Clinic Remera.

A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture, Nkurunziza explains.

SIGNS AND SYMPTOMS

Nkurunziza enlightens that signs and symptoms of appendicitis may include sudden pain that begins on the right side of the lower abdomen, unexpected pain that begins around your navel and often shifts to your lower right abdomen.

He also says, pain that worsens if you cough, walk or make other quaking movements, nausea and vomiting, loss of appetite, low-grade fever that may worsen as the illness progresses, constipation or diarrhoea, abdominal bloating, flatulence, are signs that can’t be taken for granted.

“The site of your pain may vary, depending on your age and the position of your appendix. When you’re pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy,” he says.

COMPLICATIONS

If left untreated, appendicitis will gradually get worse as the inflammation leads to further complications. Pressure inside the appendix rises, restricting the amount of blood flowing through the walls of the appendix, thus starving the tissue from blood which starts to die, Bukaba notes.

For Nkurunziza, appendicitis can cause serious complications, such as a ruptured appendix; a rupture spreads infection throughout your abdomen (peritonitis). Perhaps life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.

He says there is a pocket of pus that forms in the abdomen, if your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you’re given antibiotics to clear the infection. Once the infection is clear, you will have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.

DIAGNOSIS

Nkurunziza also says, the doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests and procedures used to diagnose appendicitis include; physical exam to assess your pain.

Here, the doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signalling that the adjacent peritoneum is irritated, he adds.

He also says your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynaecological problems that could be causing the pain.

Other tests would be, blood tests, urine tests, imaging tests (an abdominal X-ray, an abdominal ultrasound, computerised tomography (CT) scan or magnetic resonance imaging (MRI) can be done to help confirm appendicitis or find other causes for your pain), he urges.

TREATMENT

Nkurunziza notes that appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.

He adds, an appendectomy can be performed as open surgery using one abdominal incision about two to four inches (five to ten centimetres) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.

Nkurunziza also says that in general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for older adults and people with obesity.

He warns that laparoscopic surgery isn’t appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.

Nkurunziza points out that if your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.

PREVENTION

Nkurunziza further says, there is no way to prevent appendicitis. However, appendicitis is less common in people who eat foods high in fibre, such as fresh vegetables and fruits. It may be that a high-fibre diet helps reduce the chances of developing appendicitis by creating softer stools are less likely to get trapped in the appendix.

RISK FACTORS

Bukaba notes that it is not easy to foretell who might get appendicitis, but scientists have discovered several risk factors for the condition, and some of these include; being a teenager or in your 20s, and having a long-lasting inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis.

editor@newtimesrwanda.com

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