About Appendicitis - Everything You Need To Know

What is Appendicitis?

Appendicitis is a condition in which the appendix becomes inflamed, swollen or infected and filled with pus, causing pain in your lower right abdomen. The appendix is a finger-shaped pouch-like structure attached at the beginning of the large intestine. It is a small tube of tissue that projects from your colon on the lower right side of the abdomen. Although the exact role of the appendix in the body is not clear, studies suggest that it helps in maintaining abdominal immunity by fighting with infections. It is one of the most commonly performed surgical emergencies of the abdomen and as much as 10% of the population develops appendicitis at some point.

How does Appendicitis form?

Appendicitis is caused by the blockage of the appendix. The blockage might be caused as a result of the mucus that builds up within the appendix or may be due to the stool that comes into the appendix from the cecum. The blockage may as well be caused by various infections such as virus, bacteria, or parasites in the digestive tract or due to the swelling of the lymphatic tissue that lines the wall of the appendix.

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Types of Appendicitis

1. Acute Appendicitis

2. Chronic appendicitis

Causes of Appendicitis

• Infection in the digestive tract

• Abdominal or traumatic injury

• Constipation or buildup of hardened stool

• Tumor in the appendix

• Inflammatory bowel disease

• Increased/enlarged lymphoid follicles

• Increased number of intestinal worms, also known as ascaris

Symptoms of Appendicitis

• Pain initiating from the belly button and moving towards the lower right side of the abdomen

• Indigestion

• Loss of appetite

• Constipation

• Nausea and vomiting

• Fever

• Swollen abdomen

• Inability to pass gas

• Diarrhea

Diagnosis of Appendicitis

Tests:

• Blood Test: You may be required to go for a blood test in order to find out your white blood cell count which would help the doctor to find indications of a possible infection or inflammation.
• Urine Test:  In order to make sure that a kidney stone or urinary tract infection is not causing you any pain or discomfort, the doctor may want you to go through a urinalysis.
• Abdominal X-Ray: An abdominal imagery test such as an x-ray might be carried out in order to determine if you are suffering from appendicitis or any other possible complications that might be the cause of severe pain or discomfort.
• Ultrasound: Ultrasound is another type of an imagery test that uses sound waves to create pictures of the inside of your abdomen and pelvic region. It helps the doctor to look for the signs of inflammation, abscess formation and other problems in your appendix.
• Computed Tomography (CT) Scan: This type of imagery test uses a combination of X-ray images taken from different angles around your body to create cross-sectional images of the organs inside your abdomen. CT scans are considered to be 90% accurate in diagnosing acute appendicitis.
• Magnetic Resonance Imaging (MRI) Scan: MRI scans can be as effective as CT scans in detecting a condition of appendicitis. This is a type of non-invasive test that uses magnets and radio waves to create cross-sectional images of the abdomen which allows the doctor to check for abnormalities in the tissues and organs inside the body. This is the most commonly preferred method used in determining the appendix of a pregnant patient.

Self-Diagnosis:

Usually, in the early stages of appendicitis, the symptoms are quite vague. Some of the signs might include:

• Pain near the belly button that moves to the lower right side of the abdomen.
• Loss of appetite.
• Nausea and vomiting.
• Mild fever.
• Problems during bowel movements.

In general, you might feel like you are having a stomach ache that is just a little worse than normal but appendicitis can progress quite fast. Within less than a day, your problems might get worse. You may feel even sicker as you will most likely suffer from high fever, followed by vomiting, and the pain may travel from around the belly button to the right side of your abdomen and then to the lower right side of the abdomen, making it unbearable.

Diagnosis By Doctor:

If you are suffering from any of the signs and symptoms of an inflamed appendix or appendicitis and visit a doctor, the doctor will carry out a diagnosis by the following ways:

• The doctor will review your symptoms and go through your medical history to rule out the possibility of other health problems.
• You might be asked to pinpoint the area where you feel the pain. Based on that, the doctor might physically check for tenderness, possible percussions and rebound pain.
• The doctor will then try listening to your abdomen by placing a stethoscope, and carry out certain assessments like a digital rectal and pelvic examination.
• Depending upon your conditions, the doctor might recommend you to go through a blood test and urinalysis, that will eliminate the possibility of other complications.
• Based on the analysis made by the doctor and the readings of the above-mentioned medical evaluations, you might be required to go through imagery tests such as x-ray, CT-scan, MRI scan and ultrasound.

Appendicitis Severity

Grade 1 – Early Appendicitis

It is in this stage that you are likely to feel the pain near your navel and it might feel like a cramp and you probably would not be able to pinpoint the affected area. This is usually the first sign of a possible inflammation in your appendix and you might also go through other symptoms like loss of appetite, followed by nausea and vomiting.

Grade 2 – Suppurative Appendicitis

This is the stage where the bacteria and inflammatory fluids accumulated in the lumen of the appendix enter the muscular wall of the appendix and subsequently cause intense pain when the inflamed membrane rubs against the parietal peritoneum lining the abdominal cavity. You will experience the shift of pain from the belly button area to the lower right abdominal area in this stage.

Grade 3 – Gangrenous Appendicitis

At this stage, the blockage of the appendix leads to inflammation, and increased pressure, preventing blood flow into the organ. Such a condition is considered a medical emergency and if the blockage does not receive proper treatment on time, it can result in the breaking or tearing of the appendix which can have severe complications.

Grade 4 – Perforated/Ruptured Appendicitis

Sometimes the infection of an appendix can result in the formation of a hole that allows the infection to spread to the other parts of the abdomen. During such cases, the stool that is stored inside the appendix leaks out into the abdomen which then results in an inflammatory reaction by our body, creating abscesses. Due to the inflammation, the bowel gets easily crumbled, making it difficult for surgical removal. These intra-abdominal abscesses can cause prolonged fever, pain, and can result in a slow recovery.

Grade 5 – Phlegmonous Appendicitis or Abscess

An inflamed or perforated appendix can sometimes be separated by the adjacent greater omentum (a double-layer of fatty tissue that covers and supports the organs and intestines in the lower abdomen) or by a complete blockage of the small intestine, resulting in phlegmonous appendicitis or abscess, leading to a swollen, reddened, thickened and compacted appendix.

Risks & Complications of Appendicitis

During Surgery:

Although rare, there might be a number of complications involved during an appendectomy that include the following:

• Reaction of anaesthesia: Before performing an appendix removal surgery, a person might be put under the influence of anaesthesia in order to eliminate the pain which would likely expose them to complications like difficulty in breathing during the surgery, depending upon how their body reacts to it.
• Bleeding: If a person is suffering from severe appendicitis, it is possible that the appendix might lead to massive rectal bleeding which can be caused by severe gastrointestinal haemorrhage from an appendiceal stump. However, such cases are considered to be extremely rare.
• Inflammation caused by bursting of appendix: During an appendectomy, the appendix may burst, causing inflammation followed by redness or infection around the abdominal area.
• Bowel Obstruction: Following an abdominal surgery, there might be subsequent bowel obstruction due to the formation of adhesions around the appendix.
• Infection of the wound: As cuts or incisions are made in the skin while performing a surgery, it might lead to an infection around the area of the wound, causing symptoms like redness, swelling or bleeding, followed by pain and fever.
• Injury to the nearby organs: Although least likely, a surgical procedure might cause damage to the nearby organs and tissues which can also lead to the development of a scar tissue and can possibly cause bowel obstruction.

If Left Untreated

If a condition of appendicitis is left untreated, infected bacteria that is stored inside the appendix causing an inflammation cuts off blood supply, leading to the development of a hole or tear in the dead wall. As pressure builds up due to the blockage, it results in the bursting of the appendix. This can cause the bacteria and pus to flow into the central part of your body that holds the liver, stomach and intestines, also known as the abdominal cavity. This is considered a medical emergency as it can lead to severe and life-threatening complications.

How to Prevent Appendicitis?

By far, there is no proven way to prevent the occurrence of appendicitis. However, you might be able to lower the risk by maintaining a proper and healthy diet that includes adequate amount of fruits, vegetables, oats, brown rice, whole wheat and other whole grains that are rich in fibre.

When to consult a doctor for Appendicitis?

If you are suffering from inflamed appendicitis, you will most likely experience a number of signs and symptoms that include sudden intensifying abdominal pain, loss of appetite, fever, followed by unpleasant bowel habits, nausea and vomiting. As soon as you notice any of these symptoms, you should seek medical help and consult the doctor without any further delay, as within a day, your symptoms might get a lot worse and involve life-threatening complications.

Questions to ask your doctor for Appendicitis Treatment

• How severe is my appendicitis?
• Can appendicitis go away on its own?
• Is it possible to treat my appendix without surgery?
• What are the dietary restrictions that I should follow?
• What are the long-term consequences of an appendectomy?
• How do I know if it is gas or appendicitis causing the pain?
• What are the chances of my appendicitis returning back after surgery?
• How can I treat my appendicitis at home until the appendectomy is performed?

Appendicitis Treatment Options & Cost

Non-Surgical

In certain cases of acute appendicitis where the relapse rate is less than 14%, the appendicitis can be treated with antibiotics and might never require surgery. If you have a condition of an uncomplicated appendicitis where the appendix has not yet ruptured and is yet to develop into the perforated stage, you can opt for an oral antibiotic treatment. The doctor might carry out certain medical assessments in order to determine the severity of your condition before considering your eligibility to go for a non-surgical method of treatment.

Surgical

Surgery is considered as the standard method of treating appendicitis, which is also known as appendectomy. Generally, after your diagnosis, the doctor will go through all the reports of your medical evaluations and recommend a surgery if there are signs of an infection and a possible rupture of the appendix in order to eliminate the risk of any further complications. If you are suffering from symptoms like long-lasting abdominal pain and fever, you will most likely be required to go for a surgery, where the surgeon will completely remove the appendix to treat the condition.

Types of Appendicitis Surgery

• Open appendectomy: This is one of the surgical procedures carried out in order to remove an appendix where the surgeon makes a single, large cut/incision of about 5-10 centimeters in the lower-right abdominal area. After making the cut, the abdominal muscles will be separated, making an opening through the lower-right area of the abdomen and the appendix will be completely removed before closing the wound with stitches. In case there is a complication like bursting or rupture of the appendix the doctor will wash out there pus or infected bacteria from the abdominal cavity using saline or salt water. A small tube might be inserted through the incision to drain out fluids before closing the lining of your abdomen and the abdominal muscles with stitches.
• Laparoscopic appendectomy: This is considered a much-advanced procedure compared to the conventional method of an appendix removal surgery. During this process, the surgeon makes two or three tiny incisions in your abdomen rather than a single large cut and inserts a laparoscope – a thin tube with a camera and light attached to it, which allows them to view the inside of your abdomen. Once the laparoscope is inserted, the surgeon inflated the abdomen with CO2 gas. This helps the doctor to have a distinctive view of the appendix and the other organs inside the abdomen. As soon as the appendix is located, the surgeon ties it off with stitches and removes it. After that, the incisions will be dressed clean and be closed using sutures or bandages. This method of appendectomy is becoming increasingly popular as it involves fewer complications and has a shorter postoperative recovery time.

Appendicitis Surgery Preparation

• Almost like every other surgical procedure, you will have to refrain from consuming anything for at least 8 hours before the surgery. An empty stomach would make it easier for the doctor to have a clear view inside your abdominal cavity, ensuring a safe and effective treatment.
• It is important to consult your doctor if you are going through any medications and the doctor can accordingly assist you in how the medicines should be taken before and after the surgery.
• You will have to avoid taking certain drugs like aspirin, blood-thinners, vitamin E and arthritis medicines prior to a week before the surgery.
• If you have a history of bleeding disorders or are allergic to anaesthesia, it would be a wise decision to let your doctor know about it before going for the surgery.
• Upon reaching the hospital, you might be required to go through certain medical evaluations like blood tests, chest x-rays and other tests in order to eliminate any potential complications during the surgery.
• If you plan on taking a shower, you should make sure that you take it before going for the surgery as doctors recommend keeping the surgical area dry after the operation which helps to avoid infections and other complications in the wounded area after the surgery.

What to expect during Appendicitis Surgery?

• You will be put under the influence of general anesthesia which would help in easing the pain and discomfort during the surgery.
• Small incisions will be made around your abdominal area, through which the doctor will remove your appendix.
• The surgeon will inflate the areas of your abdomen using harmless CO2 gas by inserting a cannula, in order to have a distinctive view of the appendix.
• Through one of the incisions, a medical device called laparoscope (a thin lighted tube attached with a camera) will be inserted, which would allow the doctor to see your internal structures and guide the instruments.
• Once your appendix has been spotted, the surgeon will use surgical instruments to separate it from the intestine and close the ends with staples.
• After your appendix is removed, the laparoscope and other surgical instruments will be removed.
• The incisions will then be closed with sutures, followed by skin glue or skin closure tapes.

The surgeon might switch to an open procedure of appendectomy in case your appendix cannot be removed laparoscopically, which might happen due to the following reasons:

• Extensive infection or abscess.
• Perforated appendix.
• Obesity.
• Dense scar tissue from previous surgery.
• Bleeding problems during the operation.
• Difficulty in viewing the organs using a laparoscope.

After Appendicitis Surgery

• After your appendix is removed and the surgery is complete, you will be placed under observation until the reaction of the anaesthesia wears off.
• Your vital signs such as breathing and heart rate will be closely monitored to eliminate the risk of any further complications.
• Once the anaesthesia wears off, and your blood pressure, breathing, and pulse rate are stable, you will be moved to a cabin or hospital room.
• Depending upon your overall physical condition and the procedure of the treatment, you will be prepared for a discharge from the hospital.
• You will be advised to keep the surgical area dry and clean for the next few days to avoid possible infections in the wounded area.
• During the first few days after undergoing an appendectomy, you may feel moderate pain in the areas surrounding your abdomen and the doctor will accordingly prescribe antibiotics to deal with the pain and prevent any further infections.

Cost of an Appendix Removal Surgery in India

The cost of an appendix removal surgery in India with Pristyn Care can range anywhere from ₹45,000 to ₹55,000. However, this cost is not to be considered as an absolute as it may vary from person to person depending on multiple factors like:

• Type and location of the hospital chosen to undergo the treatment
• Consultation fees of the doctor
• Amount to be paid for diagnostic tests and other lab tests
• Severity of the condition of appendicitis that requires treatment

Before & After Appendix Removal Surgery

If the appendix is safely removed before rupturing or developing into a complicated stage, the results of a laparoscopic appendectomy wouldn’t take much time to show up. The post-operative complication will be minimal and the results of the treatment will be immediate. The treatment will certainly ease the painful and discomforting symptoms.

Appendicitis Surgery Cost with Insurance

Since the symptoms of a condition of appendicitis can involve severe pain and discomfort, it is medically necessary to treat the condition. Hence, most health insurance providers cover the cost of an appendix removal surgery. To gather information more about the documentation, and claim process you can get in touch with our team and get thorough assistance.

Appendix Surgery Recovery Time

The usual recovery time after a laparoscopic appendectomy takes about 1 to 3 weeks at the most and people are generally able to return to work and resume with daily activities within the given time frame whereas, in case of an open appendectomy, the recovery process takes about 3 to 4 weeks before a patient can get back to following a normal daily routine. However, the rate of recovery varies from person to person, depending on the severity of the condition and the response of the patient’s body to the treatment.