Overview of Appendicitis
Appendix is an 8-10cm long wormlike extension of cecum which apparently has n function in body. Inflammation of the inner lining of appendix is known as appendicitis which is a common cause of acute abdominal pain. It is a clinical emergency and require prompt surgery to remove appendix (appendectomy). If left untreated, appendix can rupture and spill infectious material in abdominal cavity which causes peritonitis (severe inflammation of peritoneum). Peritonitis can be fatal and needs urgent treatment with strong antibiotics.
Causes and Risk Factors of Appendicitis
Certain infections, lymphoid hyperplasia or obstruction of appendix lumen can cause appendicitis. Obstruction can be caused by calcified fecal stones (fecaliths or appendicoliths), gallstones, tumors, or viral and parasitic infections. Appendicoliths form when fecal material is trapped in appendix lumen and calcium salts become layered on it. Due to obstruction, pus accumulates in lumen and causes inflammation and increased pressure. Increased pressure hinders blood and lymph flow in surrounding vessels, thus blood and oxygen supply to appendix tissue is restricted (ischemia) and tissue starts to die (necrosis). Release of bacteria due to necrosis causes pus formation within and around appendix and finally rupture of appendix and peritonitis, which ends in sepsis and death. Lymphoid hyperplasia is responsible for 50% of appendicitis cases and is associated with various immune and infectious diseases. In few cases, bacteria (Histoplasma, Actinomycetes and Mycobacteria), viruses (Cytomegalovirus, Adenovirus), parasites (pinworms and Schistosomes) and foreign material (activated charcoal or intrauterine device) can also act as causative agents of appendicitis.
Signs and Symptoms of Appendicitis
Appendicitis usually starts with pain in middle abdomen (near navel) and within hours travels to lower right of abdomen where appendix is located. Pain is usually constant and severe and is worsen by walking, coughing, or pressing the area. Other symptoms include loss of appetite, nausea and/or vomiting soon after beginning of pain, abdominal swelling (palpitation), cramps, fever, painful urination, and diarrhea.