Appendicitis: Early Symptoms and Most common questions. How do you check if you have appendicitis?


The appendix is part ot the large intestine and has the shape and size of an earthworm. It is usually in the lower abdomen on the right side, but its position may vary. It serves no function, but that doesn't mean it should be removed. The indefensible vogue for that sort of surgery has passed. Inflammation of the appendix is caused by a bacterial infection usually associated with blockage of its opening. The complications of acute appendicitis include rupture and peritonitis with intra abdominal abscesses. The operation for the unruptured appendix carries a very small risk in otherwise healthy individuals. A ruptured appendix, on the other hand, even in this day of antibiotics, carries a bad outlook in about five in one hundred individuals. In order to prevent acute appendicitis some surgeons may choose to remove the normal appendix when they are operating in the abdomen for another disease.

Is it true that the disease is less common than it was twenty five years ago? 

That's true. It is partially due to the improved treatment of respiratory infections, which are probably the related cause in some cases. In addition, the increased use of antibiotics probably cures or arrests some mild cases which are unrecognized.

My daughter is sixteen. Why do you ask about her menstrual period? What has that to do with this? 

When some women ovulate, a small amount of blood is spilled into the abdomen. This produces an irritation of the body lining that can resemble appendicitis. Therefore, we can suspect that possibility if the symptoms occur in the middle of the menstrual cycle. This condition is called mittelschmerz (middle pain); it does not require surgery. This may occur on several occasions in a woman's menstrual lifetime. She may recall it and recognize the similarity of each instance. The pain may also be on the left side, when the blood leaks from the left ovary.

I thought that acute appendicitis only occurs irl younger people.

It can occur at any age from infancy to senility, but the disease is more common in younger people. The diagnosis is harder to make at the extremes of age because the disease is less common and behaves differently.

What has age to do with it? 

In early childhood, for example, appendicitis may simulate infectious diarrhea, or kidney infections, or abdominal reaction to a respiratory infection. In old age it may mimic gallbladder disease, pneumonia, or cancer of the intestine.

I've had attacks like this before. Why is an operation required this time? 

It is undoubtedly true that an individual can recover by himself from a mild attack of appendicitis. This is what may have occurred, or it may not have been appendicitis. However, now the examination reveals definite peritonitis, so it is no longer safe to wait. The inflamed appendix is the cause of the peritonitis. When the abscessed appendix is removed, the peritonitis ordinarily resolves.

Why do you X-ray the chest and the kidneys? 

This is a precaution. Sometimes infections in the chest can be associated with abdominal pains that can simulate appendicitis; a kidney stone may do the same thing. The X ray is a way of being sure beforehand. Of course, it is possible to have both penumonia and acute appendicitis.

What is a blood count; of what use is it in the case of appendicitis? 

The white blood cells are involved in infections and therefore in appendicitis. They often, but not always,increase in number during an infection. Under a microscope it is easy to count the number of cells present in a drop of blood from the fingertip and thus to suspect the presence of an infection. This test is not infallible. It is only one of several ways of arriving at a diagnosis. How then is the diagnosis of appendicitis made? By the type and location of the pain and by examination of the abdomen for areas of tenderness and muscle spasm over the inflamed area, combined with tests that eliminate other possibilities.

Why is an internal or rectal examination required? 

Sometimes the inflamed appendix is in the pelvic area, in which case the tenderness may be discerned only in the pelvis and the abdominal examination can be completely unrevealing. Rectal examination helps in this problem. An old teaching in medicine and surgery says that if the physician doesn't put his finger into the pelvis, he'll end up putting his foot in the diagnosis. In this type of case the early diagnosis can be completely missed if an incomplete examination is done. The proper examination for the possibility of appendicitis requires that a rectal examination be included.

Why do you want me in the hospital for observation? Isn't it dangerous to wait? Can't the appendix rupture meanwhile? 

Hospitalization is a wise precaution when the diagnosis is not certain. Repeated examinations and serial blood studies usually allow a diagnosis after a one or two day stay. If it is appendicitis, then, of course, you can be promptly operated on.

What do you mean by an appendix abscess and that the appendix will be removed later? 

This appendix has been infected for some time, and there is now an abscess around it not in it but around it. In this situation it is best to evacuate the pus by an operation now. In six weeks the appendix, which was the cause, should be removed; otherwise the situation may occur again and it may not remain in one spot this time.

What happens if you operate and find that it's something else? 

The surgeon will do what is required to cure whatever is found to be the cause of the symptoms.

Do you then take out the appendix too? 

This is usually advisable so that one won't run into this problem again.

I'm going to the jungle for a year, away from any hospital. Should I have my normal appendix removed to avoid getting acute appendicitis while on this expedition? 

This has been done; it is one justifiable approach. On the other hand, if you get sick, it might be something else that would require skilled attention, necessitating your getting to a medical facility in any case. Having had an appendectomy might give you a false sense of security. Unless you have had trouble with your appendix before, I wouldn't advise it. The World War II Navy experience showed that appendicitis can sometimes be cured with antibiotics; this would be a wise initial method of management until you are able to obtain proper medical attention.

How long will I be in the hospital? 

The uncomplicated appendectomy requires a hospital stay of five to six days and a convalescence of ten to fourteen days.


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