A persistent pain on the right side of her stomach had become part of Uwimana’s life. She often complained about it, but her brothers would dismiss it as ‘women’s issues’ and tell her to ‘handle it like a real African woman.’ It was only after she collapsed under the pain did everyone realise that there was more to her pain. Her appendix had ruptured.
Appendicitis is a medical emergency that requires immediate care. Swift diagnosis and treatment reduces the chances the appendix will burst and improves recovery time.
The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen. Scientists are not sure what the appendix does, if anything, but removing it does not appear to affect a person’s health.
The inside of the appendix is called the appendiceal lumen. Mucus created by the appendix travels through the appendiceal lumen and empties into the large intestine.
Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected.
Sources of obstruction include; feces, parasites and growths that clog the appendiceal lumen. Enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body can also cause appendicitis.
Other possible causes of appendix lumen obstruction can be inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.
The most worrying factor to mention here is that once an inflamed appendix is not treated early or removed surgically, it is likely to burst.
Bursting spreads infection throughout the abdomen and can potentially be dangerous causing a condition called peritonitis. Once the patient suffer from peritonitis, he or she is likely to suffer a severe abdominal pain that in most cases leads to death.
Also worth noting is that appendicitis commonly leads to more emergency abdominal surgeries than any other abdominal health problems.
Anyone can get appendicitis, but mainly depends on the life style of a person. Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain.
The abdominal pain usually occurs suddenly, often causing a person to wake up at night and always occur before other symptoms.
The pain for this infection normally begins near the belly button and then moves lower and to the right, it gets worse in a matter of hours and worsens when moving around, taking deep breaths, coughing or sneezing.
Other symptoms of appendicitis may include; loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, a low-grade fever that follows other symptoms and abdominal swelling.
Diagnosis of the disease
A doctor can diagnose most cases of appendicitis by taking a person’s medical history and performing a physical examination. If a person shows classic symptoms, a doctor may suggest surgery right away to remove the appendix before it bursts.
Doctors may use laboratory and imaging tests to confirm appendicitis if a person does not have classic symptoms. Tests may also help diagnose appendicitis in people who cannot adequately describe their symptoms, such as children or the mentally impaired.
In most cases, patients help doctors by giving them a clear history of their problem. The doctor will ask specific questions about symptoms and health history. Answers to these questions will help rule out other conditions.
The doctor will want to know when the pain began and its exact location and severity. Knowing when other symptoms appeared relative to the pain is also helpful.
The doctor will ask questions about other medical conditions, previous illnesses and surgeries, and use of medications, alcohol, or illegal drugs.
Women of childbearing age may be asked to undergo a pelvic exam to rule out gynecological conditions, which sometimes cause abdominal pain similar to appendicitis.
The doctor may also examine the rectum, which can be tender from appendicitis. Blood tests are used to check for signs of infection. Such tests include a high white blood cell count.
Blood tests may also show dehydration or fluid and electrolyte imbalances. Urine analysis is used to rule out a urinary tract infection.
Computerized tomography (CT) scans, which create cross-sectional images of the body, can help diagnose appendicitis and other sources of abdominal pain.
Ultrasound is sometimes used to look for signs of appendicitis, especially in people who are thin or young. An abdominal X-ray is rarely helpful in diagnosing appendicitis but can be used to look for other sources of abdominal pain.
Women of childbearing age should have a pregnancy test before undergoing x rays or CT scanning. Both use radiation and can be harmful to a developing fetus. Ultrasound does not use radiation and is not harmful to a fetus.
Typically, appendicitis is treated by removing the appendix. If appendicitis is suspected, a doctor will often suggest surgery without conducting extensive diagnostic testing. Prompt surgery decreases the likelihood the appendix will burst.
Surgery to remove the appendix is called appendectomy. Today laparoscopic surgery that uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix is commonly used.
Laparoscopic surgery leads to fewer complications such as hospital related infections, and has a shorter recovery time. Sometimes an abscess forms around a burst appendix called an appendiceal abscess.
An abscess is a pus-filled mass that results from the body’s attempt to keep an infection from spreading. An abscess may be addressed during surgery or, more commonly, drained before surgery. To drain an abscess, a tube is placed in the abscess through the abdominal wall.
CT is used to help find the abscess. The drainage tube is left in place for about 2 weeks while antibiotics are given to treat infection. Six to 8 weeks later, when infection and inflammation are under control, surgery is performed to remove what remains of the burst appendix.
Non-surgical treatment may be used if surgery is not available, if a person is not well enough to undergo surgery, or if the diagnosis is unclear. Some research suggests that appendicitis can get better without surgery.
Non-surgical treatment includes antibiotics to treat infection and a liquid or soft diet until the infection subsides. A soft diet is low in fiber and easily breaks down in the gastrointestinal tract.
The writer is a medical practitioner