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Could that Feeling be Appendicitis?



What is appendicitis? 

The appendix is a small organ attached to your large intestine on the right side of your body, typically down near your hip. It may have once played a role, however due to dietary changes over the course of time from the prehistoric era to now, the appendix now has no significant role in digestion. It can however sometimes get a piece of digested material (or ‘faecolith’) lodged in its neck or opening and causes local infection. This infection can lead to swelling and further inflammation, causing the appendix to touch other structures such as the inside of your abdominal wall and cause pain. If it gets too swollen it can burst, causing release of pus and other material into the abdominal quality. This can be particularly worrisome as it could lead to sepsis (blood infection).

How do I tell if my pain is appendicitis?

The symptoms of appendicitis rarely come on all at once, instead there are a number of symptoms that may precede each other and some that may be more severe than others. These include:

  • Nausea, and vomiting

  • Diarrhoea

  • Fever

  • Abdominal pain: this may start of all over the abdomen or centred around your belly button but then move to the bottom right hand side of your abdomen, near where you can feel your hip bone on the right

  • Dehydration – commonly as a result of prolonged vomiting

  • Pain on walking, or movement – appendicitis patients will typically want to stay in bed and not have to move

What should I do?

If you believe you have symptoms consistent with appendicitis, you should present to the Emergency Department (ED) of your nearest hospital. It is advisable to get a family member or friend help with transport, and not to drive if you feel dizzy or incapable of driving safely. Remember in a medical emergency, call ‘000’ for ambulance services.

What happens next:

  • The staff at the hospital will most likely give you some pain relief as well as measure your vital signs to determine how serious your condition is.

  • A cannula may be inserted intravenously and you will receive fluids entering your bloodstream directly to improve hydration.

  • A surgeon will usually assess you to confirm the diagnosis of appendicitis, for which the most definitive treatment is an appendicectomy (removal of the appendix). Over 90% of appendicectomies are performed through keyhole surgeries, which leave minimal scarring and reduce risk of infection. Most of these surgeries occur within 24 hours of presenting to the hospital.

  • Antibiotics may be started in the ED or just before surgery, and be continued while you recover from your operation.

  • Pain relief may be continued after the operation as needed.

  • Some patients can be discharged as early as 24 hours after their operation while some may stay for as long as a week.

  • Once discharged, it is always advisable to rest and obtain a medical certificate for work or school. You may find it beneficial to see your GP within the next couple of weeks after discharge to go over what you experienced. It is important to keep mobilising while at home, however – it’s good for your recovery and even good for your stools!

  • An outpatient appointment will be arranged for you by the hospital.

Complications

If untreated, the complications of appendicitis can be severe. Sepsis can result from infection of the bloodstream with bacteria in your appendix. This may cause shock, or infections in other vital organs.

Especially after perforated (burst) appendicitis, an abscess within your abdominal cavity may form – a collection of pus in one area that causes ongoing inflammation. This is sometimes felt as a mass you can feel under your skin. It may cause an ongoing fever and significant pain. If pain or fever persists after your operation it is important to see your GP or re-present to the hospital.

As with any operation, there are risks associated with appendicectomies – such as:

  • Infection at the surgical site

  • Infection within the abdomen

  • Bleeding

  • Reaction to the anaesthetic

  • Accidental perforation of the bowel

  • Scarring

  • Scars within the abdomen

  • Severe constipation after surgery

Next steps

After you have had an appendicectomy, you can no longer get appendicitis. If you have a similar pain, or recurrent symptoms – see your GP or go to hospital depending on the severity.

In the post-operative period, make sure you keep walking and eating so that you return to full health – but don’t overdo it! You can normally return to work or school within a few days.

 

References

  • Martin, R., Weiser, M. and Chen, W. (2018). Acute appendicitis in adults: Clinical manifestations and differential diagnosis. [online] Uptodate.com. Available at: https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-and-differential-diagnosis [Accessed 9 Apr. 2018].

  • Royal Children's Hospital (2013). Clinical Practice Guidelines : Abdominal pain. [online] Rch.org.au. Available at: https://www.rch.org.au/clinicalguide/guideline_index/Abdominal_pain/ [Accessed 9 Apr. 2018].

  • Tjandra, J., Clunie, G. and Kaye, E. (2006). Textbook of Surgery, 3rd Edition. 3rd ed. John Wiley & Sons.

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