Ever wondered if running around after a meal causes appendicitis? There are lots of rumours about acute appendicitis. The confusing symptoms that shout appendicitis might not be true.
Read below for a rundown on appendicitis!
What Is Acute Appendicitis?
Acute appendicitis is a condition categorized by inflammation of the appendix which is treated surgically.
Fun Fact!
Did you know that the great magician Harry Houdini, famous for escaping impossible situations, passed away from complications of appendicitis?
While it has been claimed that he passed away due to a punch in the stomach, it was discovered that his demise was a result of an abdominal infection which is a complication of acute appendicitis.
However, those were the days when antibiotics were yet to be discovered. Since then, the medical and surgical fields have progressed far. In this day and age, deaths from appendicitis have become a rare occurrence.
The Appendix and Appendicitis
’Appendix’ in this context is not referring to the end page of a document. It has another meaning in the medical context. Let us start off by understanding these terms a little bit better.
The appendix is a little finger-like pouch hanging from the tip of our caecum which is the first portion of our large intestine. Appendicitis, however, is the inflammation of the appendix.
While the difference between them is a highly debated topic, it is famously known as a vestigial organ. An organ which serves no clear function to humans after centuries of evolution. However, the appendix contains immune tissues which contribute to our gut immune system.
New theories suggest that it may serve as a reservoir for beneficial gut bacteria. So….
How Common is Appendicitis?
Globally, appendicitis is one of the commonest causes of sudden abdominal pain with a lifetime risk of 8.6% in Males and 6.7% in Females. It is also most common in adolescents and young adults. In a year, there is an average of 100 new cases per 1000 people.
In Malaysia, a district hospital in Johor found that approximately 1/6 of emergency cases in their surgical department were related to appendicitis.
Will I get appendicitis if I exercise after eating?
NO!
Most of us would have heard of this old wives’ tale told to us when we were children. While there is no truth in it, we may actually experience some abdominal discomfort while exercising after a meal for different reasons.
One popular theory is that during physical activities, blood is redirected to our muscles away from our gut. Then, it leads to disruption in the digestive processes which may cause abdominal cramps and aches.
Does eating fruits with seeds cause appendicitis?
While technically possible, it very rarely leads to appendicitis.
A study of 1969 diagnosed cases of appendicitis showed 1 single case that was caused by fruit seeds. This accounted for 0.05% of appendicitis cases. Results were similar in similar studies in the past.
What actually causes appendicitis?
The main cause of appendicitis is proposed to be an obstruction at the opening of the appendix pouch.
Obstruction of the opening leads to a build-up of mucus within the appendix pouch. The increased pressure against the walls leads to compromised blood flow to the appendix. There is also overgrowth of bacteria within the appendix.
These factors lead to the irritation and inflammation of the appendix. Common causes of the obstruction are as below:
Lymphoid Hyperplasia
In the young, lymphoid hyperplasia is thought to be the main cause. During infections, the immune tissues in the appendix wall may swell up in a state of hyperactivity. This leads to the narrowing of the appendix opening and eventual obstruction.
Appendicolith / Fecalith
Fecaliths are stony masses made up of hardened faecal matter. When these occur in the appendix, they are called appendicoliths which may obstruct the opening of the appendix.
Tumours
Appendicitis caused by tumours primarily affects older individuals. Tumours within the appendix cause direct obstruction while tumours outside of the appendix may compress on the appendix causing an indirect obstruction.
Parasitic Infections
In some parts of the world, parasitic infections are common. These worms invade and feed in our intestines. When invading the appendix, the worms may cause an obstruction of the appendix opening.
It is also important to note that in many cases, the cause of obstruction may not be identified.
Do I have appendicitis?
The common symptoms of acute appendicitis are:
- Severe pain in the right lower area of the abdomen
- Nausea and vomiting
- Fever
- Loss of appetite
- Anorexia
These symptoms generally develop over the course of a few hours and worsen throughout the day.
Classically, the abdominal pain starts at the centre of the abdomen around the area of the navel/umbilicus. Over time, the pain shifts to the lower right area of the abdomen. This is a pattern of pain called migratory pain.
Is appendicitis dangerous?
It may be scary that acute appendicitis is categorized as an emergency case. However, if medical attention is sought promptly, treatment is relatively safe.
A study in 2016 showed that the global death rate related to acute appendicitis was 0.28%. In Malaysia, the death rate due to acute appendicitis in 2020 was 0.07 per 100,000 people.
In certain cases, appendicitis cases may be complicated by perforations in which the overwhelming pressure and wall damage cause the appendix to essentially pop open. Such cases will lead to further interventions, longer hospital stays and the need for further antibiotics.
Research has shown that the risk of perforations can be reduced with the prompt seeking of medical evaluation. A majority of perforations occur after the first 24 hours of symptoms. Thus, delaying medical attention may increase one’s risk of developing a perforation.
What can I expect during the visit to the doctor?
The doctor would ask you a series of questions to have a better idea of your condition. You should also expect the doctor to examine your abdomen.
Subsequently, the doctor may suggest blood tests and imaging modalities (CT scan) to rule out certain diseases. If the final diagnosis is acute appendicitis, the patient will need to admit to the hospital.
How is appendicitis treated?
The mainstay treatment for acute appendicitis is a surgical intervention with the goal to remove the appendix. This is called an appendicectomy or appendectomy. Patients will also receive pain medications and antibiotics prior to the surgery.
There are two main surgical approaches to performing an appendicectomy.
Open Appendicectomy
The open approach has been the conventional approach to appendicectomies since the 1890s. It involves a pinkie-length incision at the lower right area of one’s abdomen where the appendix is located and removed.
Compared to the newer laparoscopic approach, it has the advantages of a shorter operating time and lower rates of post-operative intra-abdominal abscesses (an uncommon operative complication in which there is an infected collection of pus in the abdomen).
Laparoscopic Appendicectomy
Also known as keyhole surgery, the laparoscopic approach is a minimally invasive technique where 3 small incisions are made around the abdomen where the laparoscopes are inserted to locate and remove the appendix.
These laparoscopes are narrow rods that are equipped with tools to perform such surgeries. While the camera at the end of the laparoscopes, it displays the area of interest on a monitor for the surgeon to visualize.
The laparoscopic approach has gained popularity over the open approach over the past few decades. Its advantages are shorter hospital stay, reduced post-operative pain, lower rates of wound infections and better scar cosmetics but patients should expect a slightly longer operating time.
Do I really require surgery?
While the mainstay treatment for acute appendicitis cases is an appendicectomy, there has been recent interest in the usage of antibiotics alone in the treatment of acute appendicitis.
Research has shown that in selected cases of uncomplicated appendicitis, antibiotics alone may be sufficient in the treatment of acute appendicitis.
However, it is important to note that there are caveats and multiple factors that must be taken into consideration consider before selecting this modality. There is also a significant risk of reoccurrence. A large proportion of patients will require an appendicectomy in the future.
What happens if I get appendicitis while I’m pregnant?
Diagnosis of appendicitis may sometimes require imaging modalities to rule out other differential diagnoses. In pregnancy cases, a safe imaging technique such as ultrasound and MRI would be used to avoid harm to the baby.
Generally, the treatment of appendicitis in pregnancy is similar to an appendicectomy. While surgery may be intimidating, the surgical risks are comparable to non-pregnant patients.
What may actually cause a risk of harm to the baby is if it is complicated by an appendix perforation. This in fact further stresses the importance of seeking early medical attention which may reduce the risk of such complications.
Can I prevent appendicitis?
To date, there is no proven way to prevent appendicitis.
Takeaway
Acute appendicitis is a common treatable disease in our population. Seeking early medical attention is crucial in reducing the risk of complications such as appendix perforation.
If you are feeling ill and experiencing any concerning symptoms, do not hesitate to consult a doctor.
References: