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Sunday, August 13, 2017

Basic Idea of Appendicitis

 Appendicitis


Definition

Is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock.

First described acute and chronic appendicitis in 1886, and it has been recognized as one of the most common causes of severe acute abdominal pain worldwide. A correctly diagnosed non-acute form of appendicitis is known as "rumbling appendicitis".

Appendicitis is a condition in which the appendix becomes swollen, inflamed, filled with pus. The appendix is a small pouch shaped like a small finger. It is on the right side of the abdomen, connected to the colon.

Signs and Symptoms

Later symptoms include:
· Chills
· Constipation
· Diarrhea
· Fever
· Nausea
· Shaking
· Vomiting
· Progressively worsening pain
· Coughing or sneezing is painful
· Nausea
· Vomiting
· Diarrhea
· Inability to pass gas (break wind, fart)
· Fever
· Constipation
· Loss of appetite

Causes

· Acute appendicitis seems to be the end result of a primary obstruction of the appendix lumen. Once this obstruction occurs, the appendix subsequently becomes filled with mucus and swells, increasing pressures within the lumen and the walls of the appendix, occlusion of the small vessels. As the former progresses, the appendix becomes ischemic and then necrotic. As bacteria begin to leak out through the dying walls, pus forms within and around the appendix .The end result of this cascade is appendiceal rupture (a 'burst appendix') causing peritonitis, which may lead to septicemia and eventually death.

· Infection - a stomach infection may have found its way to the appendix.

· Obstruction - a hard piece of stool may have got trapped in the appendix.
           
The bacteria in the trapped stool may then have infected the appendix.

Diagnosis
· Diagnosis is based on patient history (symptoms) and physical examination backed by an elevation of neutrophilic white blood cells.

· Two categories, typical and atypical. Typical appendicitis usually includes abdominal pain beginning in the region of the umbilicus for several hours, associated with anorexia, nausea or vomiting. The pain then "settles" into the right lower quadrant (or the left lower quadrant in patients, where tenderness develops.

· PALF: pain, anorexia, leukocytosis, and fever
· Atypical histories often require imaging with ultrasound and/or CT scanning
· A blood test - to determine whether there is an infection.
· Urine test - this will identify a kidney or bladder infection.
· An MRI, CT or ultrasound scan - to view a 3-D image of the appendix and see whether it is inflamed (swollen). Color Doppler ultrasound, not CT, should be the first imaging examination for adult patients with suspected acute appendicitis.
· X-ray KUB 

 Treatment
— Laparoscopy (keyhole surgery) Laparotomy is the traditional type of surgery used for treating appendicitis. This procedure consists in the removal of the infected appendix through a single larger incision in the lower right area of the abdomen. The incision in a laparotomy is usually 2-3 inches long. This type of surgery is used also for visualizing and examining structures inside the abdominal cavity and it is called exploratory laparotomy.

Management

Acute appendicitis is typically managed by surgery however in uncomplicated cases antibiotics are both effective and safe. While antibiotics are effective for treating uncomplicated appendicitis 20% of people had a recurrence within a year and required eventual appendectomy.

Pain

Pain medications (such as morphine) do not appear to affect the accuracy of the clinical diagnosis of appendicitis and therefore should be given early in the persons care.Historically there were concerns among some general surgeons that analgesics would affect the clinical exam in children and thus some recommended that they not be given until the surgeon in question was able to examine the person for themselves.

Complication

Peritonitis

If the appendix ruptures and releases the infection into the abdomen the patient may develop peritonitis. The peritoneum will become inflamed. The peritoneum is the membrane that lines the abdominal cavity and covers most of the abdominal organs. Peritonitis causes the bowels to shut down - bowel movements will stop and the bowel will become blocked. The patient will develop a fever and could go into shock. Peritonitis requires urgent treatment

Abscess

If the infection seeps out of the appendix and mixes with intestinal contents, it may form an abscess. If the abscess is not treated it can cause peritonitis. Sometimes abscesses are treated with antibiotics. Often they are surgically drained with the aid of a tube which is placed into the abdomen

Appendicitis Prevention Methods
Nutrition

A healthy diet which emphasizes raw, fresh vegetables and fruits, whole grains and at least eight glasses of liquid a day will provide the fiber needed to prevent constipation and minimize the risk of the appendix becoming infected. Raw food also provides enzymes, which help boost the immune system. Two tablespoons of flax seeds daily will keep stools soft and prevent constipation. Take garlic regularly to boost the immune system. Eat lactic acid fermented foods such as natural, unsweetened yogurt, kefir and sauerkraut regularly to keep the bacterial culture in the colon healthy.

Nutritional Supplements

If surgery has been performed, Vitamin E supports wound healing and Vitamin C prevents infection and supports the immune system. Bioflavonoids work naturally with Vitamin C. These vitamins are excellent during any infection, and Vitamin C can be taken in high dosages if necessary. The B vitamins can be added to the regimen to provide the body with the extra strength needed for the stress of the surgery and illness.



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