INTRODUCTION OF Appendicitis
Appendicitis is the result of an infected or inflamed appendixThe appendix, a little tube-shaped organ, is connected to the large intestine. Despite the fact that it is uncertain what the appendix does, appendicitis is a serious condition. An appendectomy is often performed by a surgeon to remove the diseased appendix.
The appendix is a small, blind-ended tube that is connected to the cecum’s (big intestine’s) posteromedial end.
Despite having a significant amount of lymphoid tissue, it is not believed to play any crucial roles in the human body.
The anatomy of the appendix will be discussed in this article, along with its anatomical relationships, neurovascular supply, and lymphatic drainage.
Anatomical Organisation and Relationships
The posteromedial region of the cecum is where the appendix develops. It is supported by the mesoappendix, a fold of the mesentery that suspends the appendix from the terminal ileum.Depending on how it connects to the ileum, caecum, or pelvis, the position of the free end of the appendix can be divided into seven basic regions. The most prevalent position is the retrocecal one.
They might also be identified by how they appeared in reference to a clock face:
• Pre-ileal – 1 or 2 o’clock, previous to the terminal ileum.
• Post-ileal, which is 1 or 2 o’clock posterior to the terminal ileum.
• Sub-ileal – 3 o’clock, parallel to the terminal ileum.
• Pelvic – 5 o’clock descent over the pelvic brim.
• Subcecal, or at six o’clock, is below the cecum.
• Paracecal – at 10 o’clock, near the lateral cecal border.
• Retrocecal, or 11 o’clock (behind the cecum).
The appendix develops in the embryological midgut. Therefore, the vascular supply is provided by the branches of the superior mesenteric arteries.
The superior mesenteric artery branch known as the appendicular artery provides arterial supply, and the appendicular vein, which is an exact match, provides venous drainage. The mesoappendix contains each.
The sympathetic and parasympathetic ganglia of the autonomic nervous system innervate the appendix. This action is performed by the ileocolic branch of the superior mesenteric plexus. It travels down the ileocolic artery until it reaches the appendix.
Notably, early appendicitis causes visceral pain to be felt centrally in the abdomen because the sympathetic afferent fibres of the appendix come from T10 of the spinal cord.
The lymphatic system
Both the ileocolic lymph nodes (which round the ileocolic artery) and the mesoappendix receive lymphatic fluid from the appendix.
An inflamed appendix can cause intermittent pain. Or it can burst, causing an abrupt, agonising pain. A burst appendix might allow bacteria to enter the abdominal cavity. These bacteria cause the potentially lethal infection known as peritonitis.
What happened to your appendix?
The lower right side of the abdomen (belly) is where the appendix is located.
How frequently occurs appendicitis?
Appendicitis will strike 5% of Americans at some point. It is the leading reason for stomach pain that necessitates surgery.
Who could develop appendicitis?
Anyone can have appendicitis at any age, but it usually strikes adults in their teens and early 20s. The most common age for appendicitis in children is during the tween or adolescent years. However, elementary-aged children can get appendicitis.
Any of the following signs or symptoms may indicate appendicitis:
- Pain that gets worse when you cough, move jarringly, or do other things.
- Vomiting and nauseous
- Decrease in appetite.
- Low-grade fever that could become worse when the condition gets worse
- Diarrhea or constipation
- Right side lower right abdomen ache that comes on suddenly
- An unexpected ache that often radiates to your lower right abdomen and begins near your navel.
Depending on your age and the location of your appendix, the area of your discomfort may change. Because your appendix is higher when you’re pregnant, the discomfort could feel like it began in your upper tummy.
The appendix, a finger-shaped pouch that emerges from your colon on the lower right side of your abdomen, gets inflamed when you have appendicitis.
If you have appendicitis, you experience discomfort in your right lower abdomen. But for the majority of people, the discomfort usually starts just below the navel and spreads. Appendicitis pain typically worsens as the inflammation intensifies until it is eventually intolerable.
Although anyone can have appendicitis, people between the ages of 10 and 30 are the most likely to do so. The exact cause of appendicitis is unknown.
Swelling and pain develop in your appendix as a result of infection or irritation.
Possible reasons include:
- Abdominal trauma or damage• A blockage at the point where the intestines and appendix converge.
- A urinary tract infection.
- Bowel inflammation illness.
- Internal growths in the appendix.
The most likely source of appendicitis is an infection brought on by a blockage in the lining of the appendix. The germs swiftly grow, resulting in the appendix enlarging, inflaming, and overflowing with pus. If the appendix is not treated right away, it could rupture.
Serious side effects from appendicitis include:
• An appendix rupture
After a rupture, your abdomen gets infected (peritonitis). Because this disease could be fatal, you need emergency surgery to remove your appendix and clean out your abdomen.
• An abdominal pouch that forms and is filled with pus
You could have an abscess (pocket of infection) if your appendix bursts. Most frequently, a surgeon uses your abdominal wall to implant a catheter into the abscess your infection is treated with medication, and the tube is left in your body for around two weeks.
Once the infection has been treated, you will undergo surgery to have your appendix removed. In certain instances, the appendix is removed right away once the abscess has been drained.
Diagnosis of appendicitis
Your doctor will probably collect a history of your signs and symptoms and check your abdomen to aid in the diagnosis of appendicitis.
In order to diagnose appendicitis, a physical exam to gauge your discomfort is one of the tests and methods employed.
Your physician might gently massage the aching area.
Appendicitis pain frequently gets worse when pressure is quickly released, indicating that the peritoneum in the area is disturbed.
Your doctor could also check for abdominal tightness and a propensity for you to guard—straightening up your abdominal muscles—when you put pressure on an inflamed appendix.
The lower rectum may be examined by your doctor using a gloved, lubricated finger (digital rectal exam). A pelvic examination may be provided to women of childbearing age to look for any potential gynecological issues that could concern.
- blood examination
To look for signs of infection, your doctor can examine your white blood cell count.
- Urine testing
Your doctor may advise you to have a urinalysis to make sure that a kidney stone or a urinary tract infection aren’t the cause of your pain.
- Imaging tests
An abdominal X-ray, abdominal ultrasound, computerised tomography (CT) scan, or magnetic resonance imaging (MRI) may also be recommended by your doctor to help confirm the diagnosis of appendicitis
Treatment of appendicitis
Before having surgery, you might be given an antibiotic medication to treat an infection.
An operation known as an appendectomy is necessary for the majority of appendicitis sufferers. An injured appendix is taken out. If the appendix hasn’t already ruptured, surgery prevents it from doing so and also stops the infection from spreading.
You receive intravenous (IV) antibiotics to treat infection prior to surgery. Appendicitis in some mild cases can be managed solely with antibiotics. Your doctor will keep a close eye on you to determine whether you need surgery. The only treatment for an infection in the belly brought on by a ruptured appendix is surgery.
If you require surgery, most appendectomies are carried out laparoscopically. A scope is used to perform laparoscopic surgeries through small incisions. You can recover more rapidly with less discomfort and minimal invasiveness. You may require extensive abdominal surgery (laparotomy) if your appendix ruptures.
Appendectomy: surgery to remove the appendix
A single abdominal incision (laparotomy) measuring 2 to 4 inches (5 to 10 centimetres) long can be used to perform an appendectomy as open surgery.
Or the procedure can be performed laparoscopically, requiring only a few tiny abdominal incisions. During a laparoscopic appendectomy, the surgeon removes the appendix using specialised surgical tools and a camera put into your abdomen.
In general, laparoscopic surgery allows for a quicker recovery with fewer side effects and scars. It might be better for fat people and older adults.
But not everyone should have laparoscopic surgery. You might require an open appendectomy if your appendix has ruptured, the infection has moved outside of it, or you have an abscess.
Plan to spend one or two days in the hospital following your appendectomy.
Eliminating an infection before having an appendectomy
If there is an abscess that needs to be drained around your ruptured appendix, a tube can be inserted through your skin and into the abscess. An appendectomy can be performed after a few weeks of the infection being under control.
PREVENTION from appendicitis
How can I fend off appendicitis?
Appendicitis cannot be prevented with certainty. Eating a high-fiber diet full of whole grains, fresh fruits, and vegetables may be advantageous, yet experts remain perplexed as to why.
PERSPECTIVE / PROGNOSIS
What is the prospects for those who have appendicitis?
After having the appendix surgically removed, you shouldn’t experience any changes because the organ’s purpose is unknown.
Following laparoscopic surgery, some patients return home the same day or within a 24-hour period. In two to three weeks, most people are back to their regularly scheduled active lives.
Your hospital stay will be lengthier following open surgery; it could potentially last a week.
. If your appendix ruptured, you might require long-term antibiotic treatment to entirely eradicate the infection. Your recovery could take six weeks or longer.
LIFE WITH appendicitis
I need to call the doctor soon.
In the event that you have only received antibiotic therapy, call your doctor as soon as you experience any new appendicitis symptoms. In addition, if you experience any of the following while recovering from appendectomy surgery:
- A surgical site (incision) that is infected, as evidenced by redness, swelling, or yellow pus.
- Severe abdominal ache in your bottom right.