Acute appendicitis

It is the inflammation of the vermiform appendix, a structure located in the lower part of the ascending colon.

The term AA was first coined in 1886 and since then this pathology has become the most common surgical disease in all hospitals in the world, with an approximate average of 1000 cases / year.

It occurs more characteristically between 11 to 20 years of age, although this does not mean that it cannot be suffered at any stage of life; and men suffer it more than women.

Why is it produced?

There are various causes capable of producing AA. The main one is infection of the appendix by bacteria naturally present in the intestine.

On other occasions, the initial cause of AA is the obstruction of the appendix by the food present in the intestine and, secondary to this situation, the aforementioned bacteria infect the area. The bacteria that most often produce AA is Bacteroides fragilis.

The anatomical characteristics of the appendix (a long and narrow cul-de-sac) favor its obstruction by food debris.

As a consequence, there is an increase in pressure inside the appendix that causes it to dilate. These processes progressively hinder the arrival of blood to the appendix, eventually leading to infection by bacteria in the colon and subsequent necrosis of the area.

In severe cases, the infection can spread and lead to peritonitis or sepsis .

Symptoms of appendicitis

The typical acute presentation of appendicitis is characterized by: abdominal pain, nausea or vomiting, and low-grade fever.

Abdominal pain is characteristic. Initially it is located in the central region of the abdomen, to move progressively to the lower right region of the same. It is usually a continuous pain. AA can present, sometimes with pain of atypical location, such as the left region of the abdomen, or as diffuse abdominal pain poorly defined by the patient. Keep in mind that not all abdominal pain that is accompanied by a fever is, far from it, appendicitis. In general, these are usually benign and self-limited diseases (for example, acute gastroenteritis ).

In any case, all abdominal pain must be assessed by the doctor from the first moment, and he will be the one who decides the behavior to follow. In the event that the affected person presents a worrisome general condition, they must go quickly to a hospital emergency.

There is also a general malaise and loss of appetite.

Diagnosis

The diagnosis is mainly based on the clinical situation of the patient and on the data of the physical examination. However, there are also some complementary tests, such as a blood test, that can guide us.

Within the physical examination, what we have to expressly focus on is:

Examination of the abdomen : We can find general or localized pain in the lower right region, depending on the time of evolution of the disease.
There are several classic signs that must be looked for carefully:

• Blumberg’s sign: consists of exerting pressure on the lower right area of ​​the abdomen, to later release quickly, the latter maneuver that is more painful for the patient (Blumberg +).
• Rovsing’s sign: The maneuver is identical to the previous one, but performed in the lower left region of the abdomen.
• Psoas sign: With the patient lying on his back and with his legs extended, he is asked to raise his leg on the same side as the
  pain, while we exert counter resistance with our hand. This maneuver increases pain (psoas +).

Rectal examination : its performance is usually useful, mainly in atypical locations of the appendix. It is painful in the area where the inflamed appendix is ​​located.

Blood analysis : it will show us an increase in white blood cells and other markers of active disease.

X-ray of the abdomen : does not provide much information, unless there are complications (for example, intestinal perforation), since the appendix is ​​not seen with this type of diagnostic test.

Treatment of appendicitis

The treatment is surgical, and must be carried out urgently, in order to avoid complications that can sometimes cost the patient’s life.

The appendectomy is performed, a surgical technique almost always easy and fast, and it has no real contraindications (age, underlying diseases), since it is a vital emergency.

The administration of antibiotics prior to surgery helps reduce possible infectious complications of the same.

There is also practically nothing you can do to prevent appendicitis, except, perhaps, to follow a diet rich in fiber, in order to promote intestinal transit.