How to recognize the Signs of Acute Appendicitis?

In the USA, appendicitis occurs in 7% of the population, with an incidence of 1.1 cases per 1000 people per year. Some familial predisposition exists considering number of affected people. Incidence of appendicitis is lower in cultures with a higher intake of dietary fiber nutrition. Dietary fiber decreases the viscosity of feces, decrease bowel transit time, and discourage formation of feces. That predisposes individuals to obstructions of the appendicle lumen. Although most of population knows this, it is not clear yet exactly everything about appendicitis. Considering dangers appendicitis could provoke, it very important question how to recognize the signs of acute appendicitis.

What is appendix?

Appendicitis is inflammation of the appendix, beginning when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix. It could also block with the stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening, called a fecalith. This literally means a rock of stool. At other cases, the lymphatic tissue in the appendix may swell and block the appendix. Bacteria normally found within the appendix then begin to invade the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria called inflammation. If the inflammation and infection spread through the wall of the appendix, the appendix can rupture, so the infection can spread throughout the abdomen. In advanced stages of inflammation when the wall of the appendix begins to break down, occurs gangrenous, perforated, or ruptured appendicitis. Because of the risk that happens if appendicitis is untreated, the treatment of appendicitis is emergence.

There are several the main symptoms of appendicitis but those are different from person to person.

Abdominal pain is at first diffuse and poorly localized and not confined to one spot. The pain is so difficult to pinpoint that when asked to point to the area of the pain, most people cannot exactly indicate the location of the pain. Once the peritoneum becomes inflamed, the pain changes and then can be localized clearly to one small abdominal area. Generally, this area is between the front of the right hipbone and the belly button of the patient. The exact point is famous as McBurney's point. If the appendix ruptures and infection spreads throughout the abdomen, the pain becomes diffuse again as the entire abdomen becomes inflamed.

• Nausea and vomiting occur in appendicitis and may be due to intestinal obstruction.
• Progressive tenderness in the right lower abdomen occurs as coughing or trying to move about.
• Loss of appetite is also common symptoms for acute appendicitis.
• Fever appear, but is usually not very high.

Elevated white blood cell count is symptoms found in diagnostic researches as well. Abdominal pain near navel in earliest stages, right-side abdominal pain in later stages, abdominal pain on activity, abdominal pain on breathing, abdominal pain on coughing, and abdominal pain on sneezing are also signs of acute appendicitis. Abdominal sensitivity where touching the area is painful, constipation, diarrhea, loss of appetite, inability to pass gas are symptoms. Low fever, abdominal swelling, bad breath, and constipation are also symptoms for acute appendicitis. Taking pain medications may mask the symptoms of appendicitis because the appendix often ruptures after 24 hours if not treated. Then it is spreading infection to surrounding abdominal organs. In some cases, the symptoms of appendicitis are not a clear-cut and appendicitis is difficult to diagnose. Pain may not start in the mid abdomen or belly button region and tenderness may not be prominent.

Diagnosing of acute appendicitis

White blood cell count usually becomes elevated with infection. In early appendicitis, before infection sets in, it can be normal, but most often there is at least a mild elevation. Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts, but any infection or inflammation can cause this count to be abnormally high. Therefore, an elevated white blood cell count alone cannot be sure sign of appendicitis.

Urinalysis is a microscopic examination of the urine that detects red blood cells, white blood cells and bacteria in the urine. Urinalysis usually is abnormal when there is inflammation or stones in the kidneys or bladder. These conditions can be confused with appendicitis sometimes. Therefore, an abnormal urinalysis suggests that there is a kidney or bladder problem, but normal urinalysis is more characteristic of appendicitis.

Abdominal X-Ray may detect the fecalith, which is the hardened and calcified, pea-sized piece of stool that blocks the appendiceal opening. This is especially common in children.

Ultrasound is painless procedure that uses sound waves to identify organs within the body. Ultrasound can identify an enlarged appendix or abscess. During appendicitis, doctors are able to see appendix in only 50% of patients. Therefore, not seeing the appendix during an ultrasound does not exclude appendicitis as a diagnosis.

Barium enema is an x-ray test where doctors fill in the liquid barium into the colon from the anus to the colon. This test can, at times, show an impression on the colon in the area of the appendix where the inflammation from the adjacent inflammation.

CT scan of the area of the appendix is useful in diagnosing appendicitis and peri-appendiceal abscesses. It is useful as well as in excluding other diseases inside the abdomen and pelvis that can mimic appendicitis.

Laparoscopy is a surgical procedure wherein a small fiberoptic tube with a camera into the abdomen through a small puncture made on the abdominal wall. Laparoscopy allows a direct view of appendix as well as other abdominal organs.

Since there is no one a test able to diagnose appendicitis, the approach to suspected appendicitis may include a period of observation, tests as previously discussed, or surgery. It is also possible to have a drop test.  Patient has to stand on tip of the toes and drop to the heels. This sent a sharp pain to the appendix area and confirmed appendicitis. The push test that the nurse did, or rebound tenderness, where pressure is not on the area that hurts. This should avoid each doctor, because that can cause the appendix to rupture. Instead, push on the opposite side of the abdomen, and then quickly remove fingers. Patient will feel the pain over the area of the appendix, without having actually touched it.

What is acute appendicitis treatment

The treatment of acute appendicitis starts only when the diagnosis is clear. Most commonly, it is surgically removing the inflamed appendix in the operation known as appendectomy. This is common surgery and a common problem in the world. During operation doctor will use a small incision in the right lower abdomen or by use of laparoscopic instruments in selected patients. If the appendicitis is uncomplicated, which means it is not associated with an abscess or perforation, patient is able to go home as soon as 24 to 48 hours after operation. Because health care providers cannot always be sure that the appendix is inflamed until they examine it during surgery, about 10%-removed appendixes are did not inflame and are not appendicitis. If patient had surgery and appendix is normal, it doctor is going to remove it anyway, while other possible causes of abdominal pain will be looked for. It is appropriate for a surgeon to risk removal of a normal appendix.