Introduction

Appendicitis is a disease, which affects the appendix and it is characterised by inflammation.¹ As a result of this inflammation, the appendix will get swollen and this can be caused by either an accumulation of poo or an upper respiratory tract infection affecting the lymph nodes.1 It is important to take action against appendicitis once the symptoms start to occur to prevent sepsis and death. Knowing the symptoms and treatment can be lifesaving, as it has affected many individuals and can affect any age. In England, appendicitis affects approximately 50000 individuals annually.¹ Having an understanding about appendicitis is essential, particularly their symptoms in order to obtain effective treatment. 

Understanding appendicitis

Anatomy and function of the appendix

The appendix is a small organ part of the large intestine and is attached to the cecum, a pouch that connects the small intestine to the large intestine. The appendix has a tubular and blind-ended hollow structure.² In adults, the appendix is approximately 8-10 cm long.³ The appendix is a vestigial organ, which means that it has not got any specific function within the body. Although, it may have some function in the immune system.⁴ 

Causes of appendicitis

The main cause of appendicitis is a blockage of the appendiceal lumen (mucus produced by the appendix) which causes appendicolith, where the appendix turns into a stone-like structure.⁵ Following this blockage, bacteria starts to accumulate and cause inflammation, perforation (formation of a hole through the wall of the appendix) and abscess formation (pus caused by a bacterial infection).⁵ 

Signs and symptoms

The main symptom of appendicitis is abdominal pain, mainly felt in the centre of the abdomen.¹ With time, the pain will move to the lower right-hand side of the abdomen, where the appendix is located.¹ 

The other main symptoms of appendicitis include:¹

• Sickness 
• Nausea 
• Constipation or diarrhoea 
• Loss of appetite)
• High temperature 

Diagnosis of appendicitis

Medical history and physical examination

The first diagnostic method of appendicitis includes a physical examination, where a doctor will examine the abdomen by pressing on the area where the appendix is located.¹ However, before the physical examination, a medical history of the individual is typically taken, where any symptoms of appendicitis the patient is experiencing is noted down. 

Diagnostic tests

Laboratory testing

For an accurate diagnosis of appendicitis, further tests may be needed, including laboratory testing. 

Laboratory testing can involve: 

• Blood tests to check for a high white blood cell count, which is typically observed in appendicitis patients and to determine whether neutrophil-predominant leukocytes are present^5,6
• C-reactive protein level tests as an elevated level of C-reactive protein (a protein produced by the liver in response to inflammation) is an indicator of complicated appendicitis⁵ 
• Urine test to check if the patient has a urinary tract infection (UTI) or bladder infection, which are common amongst appendicitis patients¹ 
• Pregnancy tests to determine if the symptoms caused as a result of ectopic pregnancy or other pregnancy-related conditions⁶ 

Imaging studies 

Imaging tests for diagnosis of appendicitis is an important method that includes:

• Computer tomography (CT) scan - CT scans have a high chance of accuracy for appendicitis The scan can recognise characteristics such as an enlarged appendix, thick appendiceal wall, periappendiceal fat stranding (abnormal appearance of fat tissue that surrounds the appendix) and increasement of the appendiceal wall⁵
• Magnetic resonance imaging (MRI) - MRIs have a high sensitivity and are specifically used to observe appendicitis. They can also can be used in pregnant women. However, MRIs are expensive and require expertise to find out the result⁵ 
• Ultrasounds to view appendicitis inside the abdomen

Diagnostic laparoscopy

A laparoscopy can be used to diagnose appendicitis and other diseases such as cancer. A laparoscopy is a small surgery, known as a keyhole surgery, where the surgeon will make a small incision into the abdomen where a thin, flexible tube with a camera (a laparoscope) is inserted to see inside and observe any signs of appendicitis. The patients will be on general anaesthetic during the procedure to ensure no pain will be felt.⁷

Treatment options

Non-surgical management

Some non-surgical management options for appendicitis include: 

• Antibiotics 
• Observation and monitoring by your healthcare provider 

Surgical options

Appendectomy

An appendectomy is a surgery to remove the appendix. It can either be a keyhole surgery or open surgery. Keyhole surgery or laparoscopy is the most common technique and where it can be used to both diagnose appendicitis and remove the appendix. On the other hand, an open surgery involves making a large incision and, is mostly used due to a burst appendix or a lump formation.¹

Complications of appendicitis

Similarly to other health issues, appendicitis has complications that can arise from not seeking treatment. The main complications include peritonitis and abscess formation. 

During peritonitis, the appendix bursts and the peritoneum (a part of the abdomen) gets infected by bacteria found in the appendix.¹ When peritonitis happens, further complications can arise, including:¹

• Severe abdominal pain 
• High temperature 
• Feeling sick or being sick 
• Rapid heartbeat 
• Shortness of breath 
• Swollen abdomen 

If peritonitis is not treated, it can lead to life-threatening complications and even death. 

Abscess formation can occur after the appendix bursts or following surgery to remove the appendix.¹ An abscess is the formation of pus as immune response to prevent infection.¹ The abscess is either treated with antibiotics or a needle will be inserted into the skin where the pus can drain. The abscess will then be washed out and a course of antibiotics will be given after this procedure.¹ 

Recovery and post-operative care

Following an appendectomy, appropriate care and recovery should be considered. However, it is a minor surgery and the patient will be discharged on the same day if no other issues have been found.⁸ The main consideration is to look after the wound, including keeping it dry to prevent any infection. If a dressing is used, then it has to be replaced regularly.⁸ 

The other consideration is bowel movement, as after the surgery the patients may encounter some constipation issues, where it may be recommended to take laxative medication. Foods rich in fibre may also be eaten for constipation relief alongside drinking plenty of fluids.⁸

Prevention of appendicitis

There are no proven ways to prevent appendicitis. However, it is important to maintain a healthy lifestyle and be aware of the symptoms for early recognition and achieving prompt medical attention. 

Summary

Appendicitis is a disease, affecting the appendix which can be dangerous if not treated on time. It can lead to sepsis and even death if the appendix bursts. This will then cause bacteria to spread in the abdomen and cause organ failure as a result of infection. `Symptoms of appendicitis can be confused with other abdomen-related diseases, so it is important to go to the doctor once signs of appendicitis arise. Diagnosis of appendicitis involves methods such as a physical examination, laboratory testing of blood, C-reactive proteins, urine and pregnancy, imaging studies and diagnostic laparoscopy. Treatment options may include non-surgical management, or surgical interventions, such as an appendectomy to prevent further fatal complications. Surgery for appendicitis is a simple procedure with straightforward aftercare. Overall, appendicitis can be cured following early diagnosis and intervention.