Paging Dr. Frischer - Appendicitis

Did you know that modern medical science hasn’t determined exactly what the appendix does? What we do know for certain is that it is a 3-½ inch tube of tissue that extends off of the large intestine, and that we can easily live without it! Appendicitis, an inflammation of the appendix, is one of the most common reasons for a visit to the emergency room. One in 15 of us will experience it. It can strike at any age, but it is most common between the ages of 5 and 40. Your chances of having it are greater if you are male, fall into a lower income group, and live in a rural area. If left untreated, the appendix will eventually burst or perforate, spilling infectious material into the abdominal cavity. This can lead to peritonitis; a serious inflammation of the abdominal cavity’s lining that can be fatal unless treated quickly with antibiotics.

Appendicitis is a result of a blockage. The blockage is most commonly caused by calcified fecal deposits (appendicoliths or fecaliths), but can also result from masses trapped in the intestine (bezoars), trauma, intestinal worms, swollen lymph nodes, a foreign body, infections, or cancer.

Pain from the inflammation is the first classic symptom. It begins around the navel, becomes sharp, and travels into the right lower abdomen. When that area is touched during a physical exam, there will be deep tenderness at McBurney’s point, which is known as McBurney’s sign. Walking, coughing, or any jarring movement makes the pain worse. The second typical symptom is nausea with possible vomiting. Next come fevers as high as 102 degrees, with loss of appetite, abdominal swelling, and constipation or diarrhea.

Note, however, that perhaps a third of appendicitis cases don’t follow this classic pattern, and the diagnosis becomes more difficult. Appendicitis symptoms can resemble gallbladder problems, bladder or urinary tract infections, colitis, gastritis, ovarian diseases, or intestinal infections. If the diagnosis is not straightforward, the patient will be closely observed and will have a CT scan and lab tests.

There is only one treatment for appendicitis: surgery to remove the appendix. Appendectomies are most typically laparoscopic. Removing the appendix is actually a simpler procedure then trying to remove the blockage! Even if the diagnosis is not completely certain, the dangers of a ruptured appendix are so great that surgeons will err on the side of caution, and quickly remove it. Recovery after an appendectomy is typically easy, depending on how severe the condition was prior to surgery.

Can appendicitis be prevented? The generally accepted medical wisdom is that it cannot. However, since fecal deposits are a common cause of blockage of the appendix, appendicitis appears to be seen less frequently in people who eat high fiber diets that include plenty of fresh fruit, vegetables and whole grains.

If you suspect appendicitis, do not eat or drink. Do not use pain medications, antacids, laxatives, or heating pads. These may cause an inflamed appendix to rupture! Seek medical attention immediately, because a ruptured appendix is extremely serious, and speed is critical.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: May 14, 2015 - Volume 14 - Issue 05