BY: Obalola Mus’ab
Many wonder what the appendix and appendicitis really are. However, the appendix is a worm-like organ whose function is shrouded in mystery. It is also called vermiform (wormlike) appendix and considered by most as a vestigial organ (a part that was once functional). It sits around the junction of the small intestine and large intestine usually attached to the caecum. It is a thin and blind ended tube about 9cm long and located around the right lower part of the abdomen.
The function of the appendix is quite unclear. Some say the appendix acts as a store house for good bacteria, others say the appendix is just a useless remnant from our evolutionary past.
Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. It is a common and urgent surgical illness manifesting into abnormal shapes, generous overlap with other clinical syndromes and significant morbidity which increases with diagnostic delay. Infact, despite diagnostic and therapeutic advancement in medicine, appendicitis remain a clinical emergency and is one of the more common causes of acute abdominal pain.
Acute appendicitis is a very common disease in the world. But its incidence varies in different communities, being high in Europe and America but relatively low in Africa and Asia. However, while the frequency is decreasing in Western countries, it is steadily increasing in developing countries. The incidence of appendicitis gradually rises from birth, peaks in the late teen years, and gradually declines in the geriatric years.
Studies suggest that acute appendicitis is the first serious disease to emerge with dietary sophistication and the adoption of fibre-depleted diets. Its incidence rises when unrefined home-ground cereals and cellulose-rich diet are replaced wholly or partially by refined white flour and sugar. Cellulose-depleted diet leads to a low residue, a long transit time, formation of tenacious and firm faeces and development of high intraluminal pressure. Firm, tenacious and slow-moving faeces may accumulate in the lumen of the appendix, becomes thickened to form faecoliths and obstruct the appendix.
Obstruction of the lumen is probably the most important causative factors in acute appendicitis. The obstruction is by a faecolith in about 70% of patients but it may be by fibrous adhesions or stricture in the lumen, serosal adhesion and kinking of the appendix, or lymphoid hyperplasia. Occasionally the obstruction is by parasites – ova of schistosoma, oxyuria – foreign bodies or a tumour such as carcinoid tumour. However, no single organism, bacterial, viral or protozoal, is mainly associated with acute appendicitis.
SIGNS AND SYMPTOMS
Early signs and symptoms of appendicitis often are mild, consisting merely of a loss of appetitie and/or nausea and a sense of not feeling well.
Typically, the attack starts with central abdominal pain which may be a dull ache in an ordinary inflammation or colicky when there is an associated obstruction. After a variable time, the pain moves usually to the right lower part of the abdomen. In some cases of variation in the position of the appendix, the pain could be in the right middle, right lower and lower middle part of the abdomen. In others however, it may start in the right lower part of the abdomen and not in the central abdomen.
A second symptom of appendicitis is loss of appetite which may progress to nausea and even vomiting. Nausea and vomiting also may occur later due to intestinal obstruction from the expanding inflammatory mass or abscess rather than from local inflammation. Vomiting often occurs once at the beginning of the attack but in many, especially where gangrene or perforation has resulted, it may be frequent.
Constipation is usual but diarrhoea may occur in 20% of patients especially in the young and when the appendix is pelvic in position and so irritates the rectum. An inflamed pelvic appendix lying over the bladder irritates it and causes frequency and pain on urination. The temperature may be normal initially but as the disease progresses, fever sets in and fever is more common in children.
Another sign could be a consequential pain on the right lower part of the abdomen when deep palmar pressure is applied on the left lower part of the abdomen when lying down and relaxed, this is known as the Rovsing’s sign.
Appendectomy (removal of the appendix) remains the only curative treatment of appendicitis. The surgeon could use the traditional approach ( one large cut) or laparoscopy (several small cuts and using a camera to see inside). However, while the diagnosis is in question, antibiotics treat any potential infection that might be causing the symptoms and in general antibiotics alone cannot effectively treat appendicitis.
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