Digestive Health Appendicitis

Subject: Digestive Health Appendicitis Sun Jan 02, 2011 8:51 pm

Appendicitis
is a condition in which your appendix becomes inflamed and fills with
pus. Your appendix is a finger-shaped pouch that projects out from your
colon on the lower right side of your abdomen. This small structure has
no known essential purpose, but that doesn't mean it can't cause
problems.

Appendicitis causes pain that typically begins around your navel and
then shifts to your lower right abdomen. Appendicitis pain typically
increases over a period of 12 to 18 hours and eventually becomes very
severe.

Appendicitis can affect anyone, but it most often occurs in people
between the ages of 10 and 30. The standard appendicitis treatment is
surgical removal of the appendix.

Symptoms

Signs and symptoms of appendicitis may include:

* Aching pain that begins around your navel and often shifts to your lower right abdomen
* Pain that becomes sharper over several hours
* Tenderness that occurs when you apply pressure to your lower right abdomen
* Sharp pain in your lower right abdomen that occurs when the area
is pressed on and then the pressure is quickly released (rebound
tenderness)
* Pain that worsens if you cough, walk or make other jarring movements
* Nausea
* Vomiting
* Loss of appetite
* Low-grade fever
* Constipation
* Inability to pass gas
* Diarrhea
* Abdominal swelling

The location of your pain may vary, depending on your age and the
position of your appendix. Young children or pregnant women, especially,
may have appendicitis pain in different places.

When to see a doctor
Make an appointment with a doctor if you or your child experiences signs
or symptoms that worry you. Abdominal pain so severe that a person is
unable to sit still or find a comfortable position requires immediate
medical attention.

Causes

The cause of appendicitis isn't always clear. Sometimes appendicitis can occur as a result of:

* An obstruction. Food waste or a hard piece of stool (fecal stone)
can become trapped in an orifice of the cavity that runs the length of
your appendix.
* An infection. Appendicitis may also follow an infection, such as a
gastrointestinal viral infection, or it may result from other types of
inflammation.

In both cases, bacteria may subsequently invade rapidly, causing the
appendix to become inflamed and filled with pus. If not treated
promptly, the appendix can rupture.

Complications

Appendicitis can cause serious complications.

A ruptured appendix
If your appendix ruptures, the contents of your intestines and
infectious organisms can leak into your abdominal cavity. This can cause
an infection of your abdominal cavity (peritonitis).

A pocket of puss that forms in the abdomen
Infection and the seepage of intestinal contents may form an abscess — a
pocket of infection (appendiceal abscess). Appendiceal abscess requires
treatment before the abscess tears, causing a more widespread infection
of the abdominal cavity.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general
practitioner if you experience abdominal pain. If your doctor determines
you have appendicitis, you'll likely be referred to a surgeon who can
remove your appendix.

Questions your doctor may ask you
To help in diagnosing your condition, your doctor is likely to ask you a
number of questions about your signs and symptoms, such as:

* When did you first begin experiencing abdominal pain?
* What part of your abdomen hurts?
* Has the pain moved from one part of your abdomen to another part?
* How severe is your pain?
* What makes your pain more severe?
* What helps relieve your pain?
* Do you have a fever?
* Do you feel nauseous?
* What other signs and symptoms do you have?

Questions you can ask your doctor
Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. Some basic questions
to ask your doctor include:

* Do I have appendicitis?
* Will I need any more tests to determine whether I have appendicitis?
* Do I need surgery for my appendicitis?
* How soon do I need surgery?
* What are the risks of appendix surgery?
* How long will I need to stay in the hospital after surgery?
* How long will it take to recover after surgery?
* How soon after surgery can I go back to work?
* Can you tell by my signs and symptoms whether my appendix has burst?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

Tests and diagnosis

The pain from appendicitis may change over time, so establishing a
diagnosis can sometimes be difficult. In addition, abdominal pain can
arise from a number of health problems other than appendicitis. To help
diagnose appendicitis, your doctor will likely take a history of your
signs and symptoms and perform a thorough examination of your abdomen.

Tests and procedures used to diagnose appendicitis include:

* Physical exam to assess your pain. Your doctor may apply gentle
pressure on the painful area. When the pressure is suddenly released,
appendicitis pain will often feel worse, signaling that the adjacent
peritoneum is inflamed. Other signs your doctor may watch for include
abdominal rigidity and a tendency to stiffen your abdominal muscles in
response to pressure over the inflamed appendix (guarding).
* Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
* Urine test. Your doctor may want you to have a urinalysis to make
sure that a urinary tract infection or a kidney stone isn't causing your
pain. If it is a kidney stone, red blood cells are usually seen during
microscopic examination of the urine.
* Imaging tests. Your doctor may also recommend an abdominal X-ray,
an ultrasound scan or a computerized tomography (CT) scan to help
confirm appendicitis or find other causes for your pain.

Treatments and drugs

Appendicitis treatment usually involves surgery to remove the inflamed
appendix. Other treatments may be necessary depending on your situation.

Surgery to remove the appendix (appendectomy)
Appendectomy can be performed as open surgery using one abdominal
incision that's about 2 to 4 inches (5 to 10 centimeters) long. Or
appendicitis surgery can be done as a laparoscopic operation, which
involves several small abdominal incisions. During a laparoscopic
appendectomy, the surgeon inserts special surgical tools and a video
camera into your abdomen to remove your appendix.

In general, laparoscopic surgery allows you to recover faster and heal
with less scarring. But laparoscopic surgery isn't appropriate for
everyone. If your appendix has ruptured and infection has spread beyond
the appendix or if an abscess is present, you may require an open
appendectomy. An open appendectomy allows your surgeon to clean the
abdominal cavity.

Expect to spend one or two days in the hospital after your appendectomy.

Draining an abscess before appendix surgery
If an abscess is present, it may be drained by placing a tube through
the skin and into the abscess. Appendectomy can be performed several
weeks later after the infection is under control.

Lifestyle and home remedies

Expect a few weeks of recovery after surgery to remove your appendix. If
your appendix burst, it may take longer to recover. During this
recovery time, you can take steps to help your body heal after surgery,
such as:

* Avoid strenuous activity at first. If your appendectomy was done
laparoscopically, limit your activity for the first three to five days
after surgery. If you had an open appendectomy, limit your activity for
the first 10 to 14 days after surgery. Ask your doctor when you can go
back to your normal activity.
* Support your abdomen when you cough. You may feel abdominal pain
when you cough, laugh or make other movements. Place a pillow over your
abdomen and apply pressure before these movements to brace yourself.
* Call your doctor if your pain medications aren't helping. Being in
pain puts extra stress on your body and slows the healing process. If
you're still in pain despite your pain medications, call your doctor.
* Get up and moving when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks.
* Sleep when you feel tired. As your body heals, you may find you
feel sleepier than usual. Take it easy and rest when you need to.
* Discuss returning to work or school with your doctor. You can
return to work when you feel up to it. Children may be able to return to
school less than a week after surgery, though strenuous activity, such
as gym class or sports, should be limited for two to four weeks after
surgery.

Alternative medicine

Your doctor will prescribe medications to help you control your pain
after your appendectomy. Some complementary and alternative treatments,
when used along with your medications, can help control your pain. Ask
your doctor about safe options, such as:

* Distracting activities, such as listening to music and talking with friends, that take your mind off your pain
* Guided imagery, such as closing your eyes and thinking about a favorite place

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