What is appendicitis and how is it treated?

What is appendicitis?

Appendicitis is a disease that occurs as a result of inflammation of the organ called the “vermiform appendix” or more commonly known as the “blind intestine”. The word vermiformis means “like a worm”. Appendage Vermiformis or “Blind Intestine”; It is located in the lower right quadrant of the abdomen, where our small intestine connects to our large intestine, i.e. our colon. It is half an inch thick and 6 to 9 inches long.

What is the function of appendicitis?

For years it was believed that appendicitis was useless; It has been known as a remnant of man’s evolutionary journey from the Stone Age to the present day. Today, however, there is evidence that the immune system, which is the body’s protective mechanism, works in the development of cells, especially in the gastrointestinal tract, and in the formation and maintenance of flora. intestinal (the layer of microorganisms in all of our small and large intestines that aid our digestive system and provide various benefits). started to emerge.

Inflammation of the Vermiformis appendix is ​​called “acute appendicitis” or simply “appendicitis”. It is often mistakenly thought that the healthy state of the organ is also called appendicitis. But it’s wrong.

What are the symptoms of appendicitis?

Classic symptom of appendicitis; This is intense, severe pain that begins throughout the abdomen and then gathers in the lower right quadrant (area) of the abdomen. This pain is often accompanied by a loss of appetite. Nausea may occur but occurs long after the pain begins. If nausea and vomiting start first, it may be a sign of food poisoning or a different illness rather than appendicitis. If the inflammation becomes severe, the patient may develop a fever.

Symptoms of appendicitis are a little more complex in pregnant women. Pain tolerance increases in the pregnant woman’s body and the abdominal wall relaxes to make room for the growing uterus. Therefore, the pain may not be perceived in a classical way. The results of the examination cannot always guide the doctor correctly.

Symptoms of appendicitis during pregnancy, in addition to vague abdominal pain;

Burning, burning pain behind the breastbone

Change or irregularity in bowel habits,

There may be extremely vague and atypical symptoms, such as excessive gas.

Also, as the uterus grows and the large intestine pushes upward, the location of the Appendix Vermiformis changes to the right side of the abdomen and then to the upper right side, and the pain may be felt in these areas or on the back.

In order not to miss the diagnosis of appendicitis in pregnant women;

Take a very detailed history of the patient,

Detailed review,

If the doctor’s suspicion of appendicitis persists, he should examine the abdomen using magnetic resonance imaging (MRI), as this is the only method that does not harm the baby.

In case of perforation of the appendix in pregnant women, the baby can be lost with a probability of 36%. This rate corresponds to nearly one in three cases.

What causes appendicitis inflammation?

The Vermiformis appendix looks like an elongated, worm-like tube. One end is closed. The other end is associated with the large intestine.

open end of appendicitis;

leftover food,

parasites,

Swollen lymph nodes here,

It can become clogged due to petrified intestinal waste.

Obstruction of the open end for any reason causes secretions formed in the Vermiformis Appendix to not drain and accumulate and cause the caecum to swell. Abdominal pain begins when swelling and tension reach a certain degree. With increasing tension and pressure in the cecum, the veins close and the edema worsens. In the meantime, the bacteria in the liquid accumulated inside, taking advantage of being isolated from all the body’s defense mechanisms, begin to multiply. As a result of all this, the organ becomes inflamed. At this point, the patient’s abdominal pain settles in the lower right region. This condition is called acute appendicitis.

If the circulation is disturbed and the pressure inside increases, the caecum, which inflates like a balloon, is perforated and the bacteria-filled fluid leaks into the abdomen. This situation is often called “appendicitis explosion” or perforation.

Does appendicitis occur in all age groups?

Appendicitis occurs in all age groups. But it often happens in the 20s and 30s. The risk of appendicitis in men and women is almost the same. However, it is more common in men than in women.
Can children get appendicitis inflammation?

Unfortunately, acute appendicitis can also be seen in children. 1 in 8 children are brought to hospital emergency rooms with a preliminary diagnosis of acute appendicitis. Almost half of them are diagnosed with acute appendicitis and operated on.

Signs and symptoms of acute appendicitis in children are basically similar to those in adults.

During the first four weeks of infancy, that is, appendicitis in newborns;

abdominal swelling,

He may show signs of drowsiness or restlessness.

School-age children can usually be diagnosed with appendicitis in time. However, since preschool children have low body awareness and difficulty expressing themselves, and their immune system is not yet fully developed, there is usually a perforation of appendicitis at the time of diagnosis.

How is appendicitis diagnosed?

The diagnosis of acute appendicitis can be made with 90% accuracy in men and 80% in women, usually by taking a detailed patient history and physical examination.

In cases where the patient is pregnant, child or elderly, in cases belonging to atypical and risk groups, appendicitis is possible due to the possibility of harming the patient and the risk of encountering various health problems after the operation, due to misdiagnosis and negative discovery operation (recognition that the patient does not have appendicitis during the operation), the diagnosis should be clarified.

Blood tests and additional imaging modalities may be used to clarify or support the diagnosis. Ultrasound is the preferred first method because it is usually quick and does not contain radiation.

In young women and elderly patients, the use of computed tomography is valuable in order not to miss other possible diseases if the ultrasound does not give results.

As mentioned earlier, in pregnant women attempts are made to clarify the diagnosis with magnetic resonance imaging (MRI), as it does not contain radiation and can provide detail. If the suspicion is very high but no results can be obtained with any method, the patient can be taken to the operating theater and the abdomen can be examined with a 5mm camera inserted into the navel under general anesthesia and a definitive diagnosis can be done.

How is appendicitis treated?

Treatment for appendicitis is surgery. Although some cases had been treated with intravenous antibiotics in the past, about a quarter of these cases relapsed within a year and were operated on in worse and more advanced condition. For this reason, the “follow up with antibiotics” method of treating appendicitis is not a preferred approach today.
Appendicitis surgery can be performed using open (conventional) or closed (laparoscopic) surgical methods. Robotic technology is not preferred for appendicitis surgery because it is very expensive and requires larger incisions than laparoscopy.

How is appendicitis surgery performed?

During the operation, the patient’s inflamed caecum, namely appendicitis, is removed under general anesthesia. The area where it connects to the large intestine, namely the root part, is closed with a suture, knot or mechanical surgical cutting tools (stapler). If there is any inflammation that has seeped into the area, it is cleaned.

In appendicitis surgery; Both open and closed surgeries are preferable methods. They both have their pros and cons. Although closed surgical methods are becoming increasingly popular today, the doctor, the patient;

your age,

your sex,

to your weight,

Type of body,

Depending on the degree of inflammation, the patient will apply the most appropriate method.

Another very important point is that acute appendicitis, found in about 1% of patients, can develop due to newly appearing cancer in this area. For this reason, patients and doctors should follow the pathology report of the extracted part and confirm that no cancer or precancerous condition is observed.

How long does appendicitis surgery take?

Appendicitis surgery lasts on average between 20 and 60 minutes.

Whether there is a flare-up of appendicitis,

If the patient has adhesions from previous surgeries,

Various factors, such as whether the vermiform appendix is ​​in its normal anatomical location, determine the duration of appendicitis surgery.

How to eat after an appendicitis operation?

The bowel functions of each patient who receives general anesthesia return between 12 and 48 hours. This period can be extended up to 72 hours, especially in very inflammatory and delayed cases.

After appendicitis surgery, until full recovery of bowel functions;

do not overeat;

Pursue nutrition with simple and basic foods,

Avoiding foods that are extremely fibrous and difficult to digest, such as wraps and dates, during this period will help you overcome the problems that can be seen in the early postoperative period.

What should be considered after appendicitis surgery?

You don’t have to lie down “like a patient” all the time. After the appendicitis surgery, the operated person will not get tired;

Take short walks inside and outside the house,

Drink plenty of fluids

Intermittent deep breaths that fill all of his lungs (if he is breathing intermittently and inadequately due to pain) are simple steps that can help him get back to his old health as soon as possible.

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