Acute appendicitis

Acute appendicitis

Introduction

One of the health problem experienced by people is the acute appendicitis. This condition is characterized by sudden inflammation of the appendix that is often caused by the obstruction of lumen. This further leads to the invasion of the appendix wall by the gut flora- a kind of bacteria.  After screening and testing Andrew, A 30-year man, it was evident that he was suffering from acute appendicitis. The man was complaining of diffused abdomen pain. It is always advisable for any person to seek for medical attention the moment something in the body is not working well.  The well-being of a person begins with the person him/her self.  Understanding how your body functions is essential in ensuring that one seeks for the right medication. Andrew had taken a very important step of seeking medical attention after realizing that he was not feeling the way he has been feeling. Something was going contrary to his expectation and decided to seek medical advice on this problem.  This paper covers on the clinical diagnoses, physical symptoms, treatment and prognosis of the patient suffering from acute appendicitis.

Anatomy of acute appendicitis

 Anatomy is concerned about how the body structure is built. The anatomy of appendix is hereby explained.  An appendix is a small tubular that extend on the right side of the colon, closer to the section that the small intestine intersect to the colon. Its length is estimated to be from one inch to nine and it appears like a stubby number 2 pencil. It arises from the blind pouch of the cecum where the three outer longitudinal muscles band of the colon called tenia merge (Jeffrey 2012, para. 4). It is found easily by pulling up the colon to find the tenia and is run backwards.  It has its own blood supply in leaves of fat that comes from the mesentery of the cecum.  There is also a small appendiceal artery, which looks like an arcade running along the lower edge of the organ. In  across section  analysis of appendix it depicts or shows its  tabula nature,  it has  an outer serosal 1 cell  thick peritoneal  that covers  the  appendix. It has a muscle layer that is stain light in. What follows this is a layer of connective tissues known as the submucosa, which are the strongest layer of bowel known to have been the source of the cello strings, old tennis racquet strings and catgut. Under the sub mucosa there is a thin muscle layer and a final lining layer called mucosa. Mucosa is thin and resembles that of colon as it is studded with features known as crypts of lieberkuhn (Jeffrey 2012, para. 3). These crypts of lieberkuhn exist through intestine and are used to perform various functions including intestinal contents stool and food among many others. Intestinal stem cells are dark purple cells found at the base of these crypts. Appendix has high or large number of lymphoid aggregates in the submucosa that produce secretory antibodies essential in assisting to handle toxins in the guts. Some stool may pass into appendix but is pushed back to the colon by the appendiceal peristalsis (Jeffrey 2012, para. 6).  Appendix also makes mucous and antibodies which are also pushed into the cecum through the process of peristalsis.

Pathology

There are various causes of appendicitis. Some of the cause is believed to be faeces that are trapped in the appendix that ends up causing blockage. This causes bacteria’s to manifest the areas and start multiplying causing it to swell.  Source of blockages also comes from the inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease (National health services 2013, para. 3). Stomach infects that travels to the stomach is also one of the believed cause of this condition.

 One of the signs and symptoms is experiencing localized and diffusing abdominal pain (MedLine Plus 2003, para. 2). The pain is aggregated through movement and coughing and therefore the patient has to reduce movement and coughing to reduce the instances of pain. Other symptoms that manifest among individuals suffering from this disease include, vomiting, nausea, anorexia localized tenderness, guarding and rebound tenderness in the right of illac fossa. Other symptoms are instances of illusion among children, watery diarrhea and vomiting, a vague anorexia an abdominal pain and an elderly that maybe shocked and not in pain (Medicinenet 2013, para. 4). Pregnant women may experience higher tenderness and pain but sill right illac fossa symptoms are highly manifested.  The appendix may break open (ruptures) reducng the pain for a short period making an individual to feel better (Rosner, Werber, Hohle, and Stark 2013, 2).  The moment the lining of the abdomen swells and is infected in a condition called peritonitis, the individual experiences severe pain and becomes sicker.

Appendicitis is one of the common causes of acute abdomen in UK as around 10% of the population usually develops this disease.  It is also common complexity among people aged between the age of 10 and 20 but also occurs   at all ages and is common in men and because of this, it is usually removed at 10-20% of appendicitis (MedLine Plus 2003, para. 4). Common risk factors associated with acute appendicitis include abscess, abnormal connections between skin surface and abdominal organs called fistula. Other risk factors include blockage of the intestine that causes to rupture and infections, infections in the abdomen a condition referred to as peritonitis and infections of the surgical wound among others. It is therefore, important for the patient and the doctor to ensure that these risk factors are minimized to enhance the healthy condition of an individual. Other complications include adhesions that may result to intestinal obstruction.  Maternal mortality is likely to increase with perforation in late pregnant woman.  Fetal death is also below 1.5% but increases to between 20- 35% in the incidences of perforation (BBor-Fuh Te-Fa Jih-Chang Meng-Sheng, Meng-Wei and Yui-Rwei 2007, 666).

Role of imaging modalities in the diagnosis and how it can be seen in image

During examination and testing appendicitis, signs are evident if pain increases when the doctor press gently on the person lower right belly.  If the person is having peritonitis, touching the belly leads to spasm of the muscles. Furthermore, rectal exam may be carried out. In case this is carried out, there is tenderness on the right side of the rectum of an individual that may be suffering from this disease. Doctors may use alternative options during their diagnosis of whether a patient is suffering from acute appendicitis or not. These are abdominal CT scan and abdominal ultrasounds (Uwaezuoke, Udoye and Etebu 2013, 70). These are imaging modalities that help doctors to detect any of the complications on the appendix of the patient.  Abdominal x-rays aims at investigating the organisms such as spleen, intestines and stomach organs. This test is normal carried out in radiology department at a health facility.  Before being subjected to this testing it is important to inform the practitioner as to whether one is pregnant, is on medication, has IUD insertion, and if  one has  barium contrast media-x-ray in the previous 4 days Even though abdominal examination is the test required when diagnosing acute appendicitis, other methods can be used such as X-ray scan and ultrasounds.  Other investigations may include urinalysis, pregnancy tests full blood count investigation on whether there is raised inflammatory markers and consideration of diagnostic laparoscopy.  This is more reliable and recommended among younger women. These tests should be done to help ascertain any risks or conditions related to acute appendicitis (Papadopoulos, Michalopoulos, Tzeveleki and Basdanis 2007, 92).

Ultrasounds helps in detection of appendicitis in children and this is manifest by the free fluid that is collected at the right iliac fossa.  An appendix is also visible and has no blood flow in color Dopler.  Computed Tomography CT scan are popularly used nowadays in diagnosis of appendicitis. They have sensitivity and specificity rate of 95% (Pickhardt, Lawrence, Pooler and Bruce 2011, 789). These signs are manifest through CT by absence of oral dyre (oral contrast) in the appendix, and visual enlargement of appendiceal more than 6mm in its cross sectional diameter. Enhancement of appendiceal wall with IV contrast furthermore, the inflammation that are caused by the appendicitis in the areas surrounding the peritoneal fat can also been seen hence indicating signs of appendicitis.

Treatment and prognosis

Treatment is very critical and important after the patient is diagnosed with the complications. In case the  person  does not have  complications related to  this diseases,  the  doctor  removes the appendix if there is still doubts that the person may be having the condition. This is important to ensuring that the individual is satisfied with his state (Gronroos 2011, 43). This is called appendectomy. This thinking is also developed because some of the methods that may have been used in the diagnosis may not be perfect and as a result, this aims at alleviating such worries (Kimura, Yamauchi, Inoue, Kimura, Yamakage, Aimono and Sumita 2012, 575).  In some instances, the operation may show that the appendix is normal and in real sense, it may not be normal. Therefore, in such circumstances, the doctor explores or removes the parts of the abdomen to examine and ascertain for any other causes of the pain.  In case these avenues are exhausted, the doctor may now embark on CT7 scans that will help to show abscess from any ruptured appendix. In such scenario, the doctor provides infection treatment. The appendix will only be removed after the infection and the swelling have healed.

Two types of treating appendicitis are available and they include; laporatomy and laporascopic surgery. Laparatomy is the traditional method of surgery that has been used to treat this condition.  It involves removal of appendix through one larger incision in the lower part of the abdomen.  This surgery is usually 2 to 3 inches long. It also allows the   surgeon to examine various structures in the abdominal cavity in a process also known as exploratory laparotomy (Kimura, Yamauchi, Inoue, Kimura, Yamakage, Aimono and Sumita 2012, 576).  During the operation the parent is made to relax and unconscious. The modern method of surgery of treating this condition is laparoscopic and the surgeon makes three to four incisions on the abdomen.  Each of these incisions is approximately 0.25 to 0.5 inches.  In this kind of appendectomy, a special surgical tool laparoscope is inserted in the incision and connected to an external monitor that aids in examining the infected area.  This operation requires the patient to be placed in anesthesia as it lasts for about 2 hours.

In terms of prognosis, carrying out appendectomy is safe way of treatment as it reduces mortality rate for non-perforated appendicitis of 0.8 percent to 1.5 percent. Mortality rate is also more than 20 percent among people or patients aged more than 70 years. This is because of the delays in its diagnosis and treatment. Furthermore, removing the appendix before it ruptures helps an individual to get well quickly after undergoing a surgery.  However, if the appendix ruptures before a surgery is done, the probability for recovering at a slower pace and developing other complications such as access are higher (Dongo, Kesieme, Iyamu, Okokhere, Akhuemokhan, and Akpede 2013, 2).   It is also likely that spontaneous resolution of early appendicitis occurring and to manage this medical treatment using antibiotics may be one of the alternatives to carrying out a surgery. To reduce surgical infections, it is also recommended that the doctor or the surgeon use preoperative antibiotics even though their roles still remains unclear.

Conclusion and summary

In conclusion, acute appendicitis is a condition that is increasing among people. Even as it increases, there seems to be less knowledge and awareness about it. Therefore, it is essential for any person that feels abdominal pains and other symptoms discussed in this paper such as nausea, vomiting, shaking, constipation, and chills among many others to seek the interventions of the doctors as quickly as possible. Diagnosis is essential to ascertaining whether it is acute appendicitis or not.  In case of ascertainment, immediate medication or treatment is required to manage it before it goes beyond control. Therefore, it requires the effort of the individual to learn to improve his or heath status by reporting impacts to the medical practitioners.

In summary, acute appendicitis is a problem that continues to spread. If UK statistics which indicates that 10% of the population have this conditions, it requires the concerted efforts of all people to help reduce its prevalence.  Acute appendicitis is a manageable condition.

Bibliography

BBor-Fuh Sheu, Te-Fa Chiu, Jih-Chang Chen, Meng-Sheng Tung, Meng-Wei Chang and Yui-     Rwei Young. 2007.  “Risk factors associated with perforated appendicitis in elderly        patients presenting with signs and symptoms of acute appendicitis.” Journal of Surgery       77(8): 662-666. DOI: 10.1111/j.1445-2197.2007.04182.x

Dongo, Andrew, Kesieme, Emeka, Iyamu, Christopher, Okokhere, Peter, Akhuemokhan, Odigie and Akpede George. 2013. “Lassa fever presenting as acute abdomen: a case series.”    Virology Journal 10(1): 1-7.  DOI: 10.1186/1743-422X-10-123.

Gronroos, Juha. 2011. “Clinical suspicion of acute appendicitis – is the time ripe for more             conservative treatment?” Minimally Invasive Therapy & Allied Technologies 20(1): 42- 45. DOI: 10.3109/13645706.2010.496958.

Jeffrey, Sedlack. 2012. The anatomy and physiology of the appendix.         http://www.appendicitis.pro/the-john-hunter-memorial/the-anatomy-and-        physiology.html

Kimura, Yoshinobu, Yamauchi, Masanori, Inoue, Hikaru, Kimura, Saori, Yamakage, Michiaki,   Aimono, Mako and Sumita Shinzou. 2012. “Risk factors for gastric distension in patients    with acute appendicitis: a retrospective cohort study.” Journal of Anesthesia 26(4): 574-         578. DOI: 10.1007/s00540-012-1353-2.

Medicinenet. 2013. Acute appendicitis.

Pickhardt, Perry, Lawrence, Edward, Pooler, Dustin and Bruce Richard. 2011. “Diagnostic           Performance of Multidetector Computed Tomography for Suspected Acute         Appendicitis.” Annals of Internal Medicine 154(12): 789-W291

Papadopoulos, Vasileios, Michalopoulos, Antonios, Tzeveleki, Ioanna and Basdanis George.       2007.  “Acute appendicitis perforating into the bladder mimicking cystitis.” Surgical       Practice 11(2):90-95.

Rosner, Bettina, Werber, Dirk, Hohle, Michael and Stark,Klaus. 2013. “Clinical aspects and self- reported symptoms of sequelae of Yersinia enterocolitica infections in a population-based   study, Germany 2009-2010.” BMC Infectious Diseases 13(1):1-8. DOI: 10.1186/1471-     2334-13-236.

Uwaezuoke, Stanley, Udoye, Ezenwa and Etebu Ebitimitula. 2013.  “Endometriosis of the            appendix presenting as acute appendicitis: a case report and literature review.” Ethiopian     Journal of Health Sciences 23(1): 69-72.

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