Acute inflammation of appendix occurs at the moment of plugging the lumen of the appendix with faecoliths (food and paste contents in the intestine), which then leads to inflammation. The appendix is a small, finger-like outgrowth rudimentary in the beginning of the large intestine, which is located on the lower right side of the abdomen, above the right groin. It does not have any role in the human species in the process of degradation or elimination of digested food remains in the intestine. At the place where the fecal mass clogs the lumen of the appendix, the bacteria that normally exist in the intestine and involved in the breakdown of food start to multiply. Many times in our life it is likely to happen that fecal masses enter the appendix, but they are still evicted from the intestine lumen. When this does not happens, an inflammation of the intestine wall occurs, and bacteria that support and exacerbate inflammation enter, leading to the development of the classical clinical picture of acute appendix inflammation.
Symptoms
Patients who have acute inflammation of appendix complain of pain in the right lower part of the stomach, right next to the navel with a feeling of nausea, vomiting , frequent urination and sometimes diarrhea or constipation. Of course in all patients there may be present only some of these symptoms, and localization of the pain may be in other places in the stomach. Some patients, though rarely, have pain left from the navel to the lower part of the back or above the pubic bone. The pain is usually constant and does not go away by changing the position of the body, vomiting or diarrhea.
Age groups of patients
Most commonly appendicitis occurs in children or early twenties, but there are no rules. It can occur at any age. It is somewhat statistically more common in men. However statistics must not fool physicians because patients with acute appendicitis are considered to be with a disease of acute abdomen (acute diseases of the abdominal cavity), which are not treated by drugs but by surgery. Otherwise, if the disease is not diagnosed on time and surgery is not performed, developed inflammation then leads to burst of the appendix and inflammatory contents spills into the abdominal cavity. This usually leads to inflammation of the peritoneum (peritonitis), which can seriously compromise the health of patients; it can lead to sepsis (generalized spread of local inflammation all over the body), which can lead to death.
Diagnosis
Appendix inflammation used to be diagnosed by clinical examination (anamnesis, palpation of the abdomen, measuring body temperature under the arm and in the bowel, then determining leukocytes in the blood). Today all these diagnostic examinations can be done by an ultrasound of the abdominal cavity, which can exclude all other possible causes of similar problems in the abdominal cavity and can certainly be determined with color doppler which would indicate appendix inflammation. There is a great advantage of using ultrasound with color doppler in distinguishing acute pain in the abdominal cavity, because in the individual example of acute inflammation of appendix leukocytes in the blood that were once almost the sole diagnostic sign of whether surgical intervention should be performed or if there should be a waiting period, now an ultrasound examination this waiting for the surgery and bursting of the appendix may be avoided. In practice I have personally had experience with appendix inflammation in different locations and not just the typical symptoms were characterized by normal body temperature and without elevated leukocyte and neutrophil counts in the blood examination, and yet the color doppler saw thickened wall of the appendix. Inflammation manifested as an increased blood supply to the bowel wall thickened with fixed content in the expanded lumen of the intestine.
Why are the symptoms of acute inflammation of appendix so different in some patients? One answer is that everybody’s inflammation begins with a different consistency (hardness) of fecal mass, then we all have different thresholds of pain and other disorders due to organs in the abdominal cavity (position pain and spread of pain) may be slightly different, and the symptoms depend on the age in which inflammation develops. Doctor ‘s advice is: when you feel the above mentioned pain in the stomach and the above symptoms, you should drink tea, black tea at best, be on a diet of toast, toasted bread, if you can eat boiled rice. If the pain does not subdue after a couple of hours, but the symptoms are maintained or grow worse, you should contact a doctor. In these situations, do not take painkillers, especially if you’ve never had similar pain or symptoms since then the doctor will have a harder time examining you, making it more difficult to determine what’s going on.
Treatment
After diagnosing inflammation of the appendix, therapy is surgical There are situations when appendix inflammation is determined, but there are indications that the inflammation will subside by itself. It can be called subacute or smoldering inflammation that should also be addressed immediately by surgery. However, many surgeons are not so inclined, and patients can hardly wait to avoid surgery so the disease subsides temporarily. Almost every such inflammation healed by antibiotics of spontaneously resurfaces a few months. Most often , however, time that is necessary for surgical intervention that is available to us is less and there are fewer hours of repeated inflammation of the appendix before it bursts colon wall and causes complications. In particular, the possible re-appendicitis should be considered and solved immediately at the first inflammation in surgical way, for people who live far from the hospital, by persons engaged in field work away from health clinics or in people living on the islands.