Appendicitis - causes, symptoms, diagnosis, treatment & pathology

Summary

The appendix, a worm-shaped tube connected to the large intestine, has an uncertain function but is known for causing appendicitis when inflamed. Obstruction by fecaliths, undigested seeds, or lymphoid hyperplasia leads to increased pressure and pain. If untreated, the appendix may rupture, leading to peritonitis and abscesses. Appendicitis is diagnosed through symptoms like fever and right lower quadrant pain, with treatment involving appendectomy and antibiotics.

Takeaways

• 🌟 The appendix is a small, worm-shaped tube attached to the cecum of the large intestine.
• 🤔 The exact function of the appendix remains unknown, but it may play a role in gut flora and the immune system.
• 🐛 Some theories suggest the appendix is a 'safe-house' for beneficial gut bacteria.
• 🚨 Appendicitis is a common surgical emergency, affecting about 10% of the population.
• 🚫 Inflammation of the appendix often occurs due to obstruction, such as a fecalith or undigested seeds.
• 🦠 Lymphoid hyperplasia, particularly in children and adolescents, can also cause obstruction and appendicitis.
• 💧 When the appendix is obstructed, it continues to secrete mucus and fluids, leading to increased pressure and pain.
• 🛑 Bacterial overgrowth occurs when the appendix is blocked, triggering an immune response and potential abscess formation.
• 🌡️ Symptoms of appendicitis include fever, nausea, vomiting, and pain at McBurney's point.
• ⚠️ If left untreated, increasing pressure can lead to ischemia and rupture of the appendix, causing peritonitis.
• 🔪 The standard treatment for appendicitis is appendectomy, surgical removal of the appendix, along with antibiotics.
• 🧼 Complications of a ruptured appendix include the formation of periappendiceal and subphrenic abscesses.

Q & A

What is the appendix and where is it located in the human body?

The appendix is a small, one-ended tube that is attached to the cecum of the large intestine. It is sometimes referred to as the vermiform appendix, with 'vermiform' meaning 'worm-shaped,' which describes its appearance.

What is the current understanding of the function of the appendix?

The exact function of the appendix is unknown, but some theories suggest it may serve as a 'safe-house' for gut flora, or play a role in the lymphatic and immune systems. Other viewpoints consider it a vestigial organ with no current function.

What is appendicitis and how common is it?

Appendicitis is a condition where the appendix becomes inflamed, causing abdominal pain. It is the most common surgical emergency of the abdomen, affecting about 10% of the population.

What are the common causes of appendicitis?

Appendicitis is often caused by an obstruction in the appendix, such as a fecalith (a hardened lump of fecal matter), undigested seeds, pinworm infections, or lymphoid hyperplasia, particularly in children and adolescents.

How does the appendix's function of secreting mucus contribute to appendicitis?

The appendix continuously secretes mucus and fluids even when obstructed. This buildup of fluid increases pressure within the appendix, causing it to expand and leading to abdominal pain.

What happens when the appendix is obstructed and continues to secrete mucus?

When the appendix is obstructed, the continued secretion of mucus and fluids leads to a buildup that increases pressure within the appendix. This can cause the appendix to swell and push on nearby nerve fibers, resulting in pain.

How does the immune system respond to an inflamed appendix?

The immune system responds by recruiting white blood cells, leading to an increase in serum white blood cell count. Pus may also accumulate in the appendix, and patients may develop a fever as part of the body's response to infection.

What are the classic symptoms of appendicitis?

Classic symptoms of appendicitis include right lower quadrant abdominal pain, particularly at McBurney's point, fever, nausea, and vomiting.

What can happen if appendicitis is left untreated and the appendix ruptures?

If appendicitis is untreated, the pressure in the appendix can increase to the point of rupture, allowing bacteria to escape into the peritoneum, potentially causing peritonitis and the formation of an abscess, such as a periappendiceal abscess or subphrenic abscesses.

What is the standard treatment for appendicitis?

The standard treatment for appendicitis is an appendectomy, which is the surgical removal of the appendix, along with the administration of antibiotics. If abscesses are present, they are also surgically drained.

Are there any known negative side effects of removing the appendix?

Removing the appendix is not known to have any negative side effects. In some cases, it may be removed prophylactically during other abdominal surgeries to prevent future appendicitis.