It's 10 pm. Severe pain in your belly. You are in ER. Previous day you had a nice party with your friends. Then pain started around your umbilicus (navel). You thought first: aha, probably you ate something bad, it will go away. But it doesn't. You have vomited once and lost appetite. Pain did not improve but worsened. After a day of suffering you decided to visit
hospital. Long taxi trip. Pain is shooting every time car bumps into a pot. Nurses ask you bunch of questions and place in an available room. There is a confused 90 something years old women in neighbor room. She mumbles something incomprehensibly. The woman has come from a nursing home. She suffers Alzheimer disease and yells every night for past 7 years. She has history of multiple medical problems. They brought her in ER after she developed fever. Nurses draw your blood. You pain is getting gradually worse. Change your position, pull your legs. Pain doesn't go away. When ... doctor comes? At last ER physician sees you. He writes H+P and ER orders. A stretcher is rolled in. They take you to a radiology department and put into a big machine looking like a gate. Everybody leaves you and machine drives you into big metal doughnut. They bring you back into ER.Surgical intern comes. He did not rest since 5 AM. He asks bunch of same questions again and pokes your belly. A tired resident comes. He pokes your belly again. You still wait, become bored, complain on delay, call your relatives. It's already 2 AM. At last resident discuss your symptoms with attending over phone. He tells you that you have appendicitis and CT scan confirmed it. History and physicals are written. Admission orders are written. Pre-op orders are written. Antibiotics are prescribed. IV fluid is running 80 ml an hour. You sign consent for operation. Transporting guys take you upstairs - depending on severity of your symptoms - straight to or to floor. Attending will operate you first thing in morning.
Classically appendicitis starts as a pain that began in periumbilical region (around navel - you belly pot). Then pain moves to right lower quadrant of abdomen. Nausea and vomiting often present after onset of pain. Classically, patient has low grade fever (this means around 37-38 C or 101-102 F), positive psoas sign (you stretch your leg and this movement increases your pain), positive Rovsing sign (Doctor pokes in your left lower quadrant of abdomen, and you fill pain in you right lower quadrant), Leukocytosis. Leukocytes are white blood cells - WBC. Usually there are around 4000-9000 white cells per micro liter of you blood. When you have inflammation in you body count goes up.
Your pain during appendicitis classically localizes in Mc Burney's point. That is one third between your umbilicus and anterior superior iliac spine (this is bony point that is sticking most prominently from your pelvis - you can palpate it yourself on side of your belly). For confirmation a doctor also may try to elicit obturator sign - he will ask you to bend you knee and bring your heel to your groin - this manoeuver increases pain during appendicitis. Similar test is raising of leg while you lie on stretcher. That movement also increases your pain.
Appendicitis is inflammation of appendix supposedly due to narrowing of this lumen. That narrowing may be caused by hyperplasia of appendix (means too big growth, overgrowth of tissue) . That variant happens in children mostly. Another variant - is fecalith (small stony fecal material) that impacts into appendix lumen. That is seen in young adults mostly.
Appendix itself is a small part of gut . It is pencil-size sticking out gut. Gut is a continuos tube. Mouth is entry. Anus is exit. Appendix sticks out from wall and ends blindly. It has only one entrance. Appendix is attached to Caecum (part of gut - literally means blind colon in Latin). Appendix of ruminating animals (animals that chew grass, like cow) is very long and big. Appendix in humans is reduced to pencil-size. However it doesn't disappear. There is a theory that appendix plays role in immune response. The walls of appendix are actually filled with lymphatic tissue containing lymphocytes (those are subtype of White Blood Cells). Lymphatics is responsible for immunity.
The removal of appendix doesn't really change immunity significantly. Nonetheless, it is not something redundant. Unless it is inflamed there is no good reason to remove it .
Now, acute appendicitis is acute inflammation of appendix. Suffix "-itis" means inflammation in Latin. Appendicitis is also most common cause of acute abdomen. Acute abdomen in surgery is a condition in abdomen that requires urgent actions, usually surgical.
To diagnose appendicitis you need to have right lower quadrant pain.
The pain should be present together with either appropriate history (all those classical signs and lack of appetite) or Leukocytosis (increase in white blood cells in blood).
Patients often ask questions: Can I avoid surgery? Can you treat me with antibiotics alone? You told me that it is possible to treat appendicitis with antibiotics alone. Please, I do not want surgery, my mother (father, brother, fiancee) said that I can avoid surgery.
The answer is: you can try to avoid it probably, but odds of death are much higher if you treat appendicitis without surgery. Untreated appendicitis may lead to perforation in less than a day. Sun rises. Sun sets. Appendix bursts. So, prompt surgical intervention is main solution. On occasion, surgeon may even find a normal-appearing appendix and no other problem explaining symptoms. He may remove appendix anyway because it is better to remove a normal-appearing appendix than to miss mild case of appendicitis.
To cool down infection before surgery doctors use antibiotics. Antibiotics may convert acute appendicitis into more chronic type. However removal of appendix is choice.
With modern technology it becomes much easier to distinguish appendicitis and other causes of pain in right lower quadrant. Yet there is no 100% proof diagnostics. Sometime doctors treat with antibiotics alone, when they are not sure. Though, modern CT-scan shows appendicitis almost close to 100%.
What would happen if you miss appendicitis and appendix bursts? You will get one of most dreaded surgical complication - peritonitis. Again, "-itis" equals inflammation. Peritoneum means peritoneal cavity.
