Appendicitis is the inflammation or swelling of the appendix, a finger-like appendage sized about 3.5 inches long and attached to the beginning of the large intestine, found at the lower right side of the abdominal area. The appendix has no known purpose or function in the body, and is simply a tube-like tissue structure that is closed at one end and opens into the large intestine at the other end.
However, in some instances certain pathologies may affect the appendix and it ends up being inflamed and infected, to the point of having the potential to cause serious harm and even death to the individual. How can a seemingly purposeless appendage cause system-wide damage and such severe consequences? Learn what happens in appendicitis and find out.
The trigger that sets off an inflammation in the appendix is perceived to be either a general infection in the stomach that somehow reaches to affect the appendix, a trauma, or an obstruction localized in the narrow pocket that the appendix has.
In many cases, primary obstruction is seen as the cause of appendicitis. This obstruction may be a small piece of hardened rock-like stool known as a fecalith, a foreign body, or intestinal worms and parasites. As the obstruction occupies the space inside the narrow structure of the appendix, swelling and mucus production occurs, increasing the chances of even more debris accumulating and irritating the appendix.
The progression of this obstruction and swelling increases the pressure in the appendix walls, occluding the small blood vessels that supply the appendix and obstructing lymphatic flow. As the appendix receives insufficient blood supply, its tissues eventually die and become necrotic, causing pus and bacteria to leak out of its walls. If this continues, the inflamed appendix bursts and spreads infectious material in the entire abdomen, resulting to a condition known as peritonitis. Eventually, the bloodstream can be contaminated and the condition becomes septicemia or blood poisoning, a systemic condition that can lead to death.
The typical symptoms of appendicitis start off as a dull pain around the area of the umbilicus or navel. This is because the nerves of the appendix enter the spinal cord at the level of the navel, so the pain starts around that area instead of where the appendix is actually located. Later on, as the disease process progresses and the appendix becomes so inflamed that it becomes swollen and enlarged, it begins to irritate the abdominal wall adjacent to it and the pain becomes localized to the right lower side of the abdomen.
The characteristic pain of appendicitis can be severe upon gentle palpation of the right lower abdomen, but can also be assessed by eliciting the Rovsing’s sign— deeply palpating the left side of the abdomen to check for a pain reaction on the right side of the abdomen. The pain occurs because deeply palpating the left side of the abdomen pushes bowel contents toward the appendix, increasing the pressure around the affected area. Further signs of appendicitis are loss of appetite, vomiting, fever, and abdominal distention with gas. Missing the signs is considered medical negligence.
Upon diagnosis of appendicitis through patient description of symptoms, physical examination and laboratory tests, typical management involves the removal of the appendix, ideally before it ruptures. The surgical procedure is known as appendectomy, and may involve either a traditional surgery or a minimally invasive laparoscopic surgery.
