Inflammation of the appendix (acute appendicitis) What is the appendix (appendix)? The appendix vermicularis (appendix) is the part of the digestive system that is located at the junction between the small intestine (ileum) and large intestine (caecum), which is located in the lower right area of our stomach. The appendix has many lymphoid follicles that produce immunoglobulin A (Ig A) which functions as the immune system. In addition, the appendix also functions as a reservoir for the recolonization of good bacteria in our colon.
Why can there be inflammation of the appendix (appendicitis)? Inflammation of the appendix (appendicitis) is one of the most common cases of surgical emergency in daily practice, commonly seen in children and young adults. Most cases occurred in the second decade, where more cases were male than female (8.6% vs 6.7%).
The etiology of appendicitis is the obstruction (blockage) of the appendix lumen. This obstruction can be caused by fecalith (hardened stool), calculi (stones / seeds), enlarged lymph nodes, or parasites (worms). When there is a blockage, there is an increase in pressure within the wall of the appendix which is getting higher where the mucosal wall of the appendix produces mucus fluid so that it will cause swelling of the appendix which gets bigger over time, then there will be disruption of blood vessel circulation in the appendix wall which aggravates the swelling that has been occurs, and can eventually cause rupture of the appendix (perforated appendicitis).
What are the signs and symptoms of appendicitis? The diagnosis of appendicitis is confirmed by history, physical examination, and supporting examinations (blood laboratory, ultrasound, appendicogram, or abdominal CT scan). Although all age groups are at risk for acute appendicitis, sufferers are mostly in the 10 to 30 year age group with the following symptoms:
The pain gets worse moving or coughing
Constipation or diarrhea
Nausea and vomiting
The location of the onset of pain can vary depending on the location of the appendix. In the case of pregnant women with appendicitis, pain can be felt in the middle / upper abdomen due to the higher location of the appendix due to being pushed by the enlarged uterus. Patients who are in pain usually show a lying posture by flexing the hips and bending the knees towards the abdomen, to reduce the pain. In the McBurney area (bottom right) you will find tenderness. The psoas sign and obturator sign can be found to be positive. In addition, it is also known as the "Alvarado Score" as a diagnostic criterion for appendicitis.
How is appendicitis treated? Acute appendicitis is one of the most common surgical emergency conditions. The treatment for this condition is surgery to remove the inflamed appendix. This procedure is called an appendectomy.
An appendectomy can be performed by open surgery or by a laparoscopic procedure. Open surgery requires a large incision in the abdominal wall, while laparoscopy requires only a few small incisions. Laparoscopic procedures require a shorter hospital stay, smaller surgical wounds, and relatively short recovery to normal activities compared to open surgical procedures.
Patients can usually begin to get up and walk or move within 12 hours of surgery, whether open or laparoscopic.
Acute appendicitis is a disease that cannot be prevented. But this health problem tends to be less common in people who eat lots of fiber from vegetables and fruits.
- The Appendix. Dalam: Brunicardi FC, Andersen DK, Billiar TR, et al editor. Schwartz’s Principles of Surgery, 10th ed. Mc Graw Hill. 2015: 1241- 1257.
- Appendix. Dalam: Pennington EC, Burke PA, et all. Current Surgery 14th ed. Mc Graw Hill. 2015: 651-655.