Hi. This is Dr. Buck Parker, general surgeon.
In this video, I wanna talk about the diagnosis of acute appendicitis. Acute appendicitis is when the appendix, which is a small, finger-like projection with a blind-ending pouch that lives in the right side of the abdomen kind of off to the side or off the end of the colon. It’s when this becomes infected.
The reason the appendix becomes infected is because, usually, it gets obstructed or blocked off at the base. After the appendix is obstructed, the bacteria that naturally live in the appendix do what they do best and reproduce at a really rapid rate. Since the appendix is blocked off and then it’s a blind-ending pouch, there’s really nowhere for the bacteria to go so the appendix gets larger and larger. Eventually, without surgery, it will burst and you’ll have stool spilling into the abdomen.
Let’s talk about how we diagnose appendicitis and how we treat it. First, the diagnosis is usually a constellation of symptoms such as abdominal pain, fevers, chills, maybe some nausea and vomiting. These symptoms, although are common, may or may not be present in somebody with appendicitis. Most people do have belly pain that starts around the naval area and moves to the right lower abdomen over several hours. When you have appendicitis, it just does not get better on its own. If the pain goes away, then most likely, the diagnosis is not appendicitis.
What about tests besides just the history and physical examination? Well, we have a few fancy tests that are very helpful in diagnosing appendicitis. First is a blood test that looks for the white blood cell count. If the white blood cells, or the infection-fighting cells, are elevated or increased, that’s a pretty good indication that there is an inflammation or infection going on somewhere in the body. Secondly, we have the ultrasound. The ultrasound is particularly helpful in women since a problem with the ovary on the right side can cause similar symptoms to an appendicitis. Sometimes the ultrasound will show a normal appendix and an abnormal ovary such as a benign cyst, for example, that will confirm the problem is not appendicitis. That’s pretty useful. Sometimes the ultrasound can confirm that the ovary looks normal and maybe not seeing the appendix together with all the other signs and symptoms, we can say it’s most likely appendicitis. Finally, we have the CAT scan, or the CT scan of the abdomen. This may be used to look at the appendix directly actually. The CAT scanner is kind of like an x-ray machine that looks at bones, muscles, blood vessels, and solid organs such as the liver and hollow organs such as the appendix and the small bowels. Depending on your symptoms, some or all of these tests will be used.
Let’s talk about the treatment. The treatment for appendicitis is an operation to remove the appendix. It’s plain and simple. For most people, antibiotics just will not work, and an operation to remove the appendix called an appendectomy will be needed. -Ectomy is actually Latin for removal. There are two types of appendectomies. First is the “old-fashioned” way where the surgeon makes an incision four to five inches long or with the spot where you have the pain in the right lower abdomen. This is a safe way to have an appendectomy but often, it causes more pain in the post-operative period than what we call the laparoscopic appendectomy. A laparoscopic appendectomy uses three small incisions, one about a half an inch, and two of ’em about a quarter of an inch long. First of all, together with a small camera and also small surgical instruments, we can remove the appendix. With a laparoscopic appendectomy, patients generally experience less pain in the immediate post-operative period than the old-fashioned way.
There are, of course, a few risks associated with an appendectomy you should know about. You’re completely informed about your operation before you have it. Any time you do a procedure in medicine, there are risks associated with that procedure. Even in procedures small as taking a few drops of blood can add risk, but there are some specific risks to the appendectomy I’d like to discuss. Just as any surgery, the two most common risks of an appendectomy are: number one is bleeding, number two is infection. Bleeding can be mild and self-limiting, meaning it just stops on its own. Or it may be moderate, as you may require a blood transfusion. Or even severe as it may require another operation to stop the bleeding. Second is infection. Infection can also be mild, moderate, or severe with treatment ranging from just antibiotics, opening incision, to another operation as well. Since we’re kind of moving the bowels around when we take out the appendix, the bowels can become injured as well. [If] it’s recognized right away, they can most likely be fixed without additional incisions at that operation. If it’s not recognized until after the operation, an additional operation to fix the bowels will be required. Last is the bladder. [The] bladder is also at a small risk of being injured, and the treatment is usually just continuation of the bladder and catheter for three to five days. Other than those risks, there are always risks of anesthesia, which depending on your health, may be anywhere from minor to very severe. The anesthesiologist will generally speak to you about your specific risks of the anesthesia before the operation.
After your operation, most patients are admitted to the hospital for overnight observation. The majority of patients return home in about 24 to 48 hours after arrival to the hospital. As long as you’re eating okay, your pain is controlled with pain pills, and you’re walking okay, you can be discharged for home. Some people do experience nausea associated with the anesthesia. And if you’re still nauseated, unable to swallow pain pills and eat regular food, then you’ll need to stay a little bit longer in the hospital until that clears up.
After your discharge home, you’ll have small bandages consisting of first tape then gauze then this sticky plastic. You can remove the bandages over the incisions after about 72 hours after your operation. You should remove the plastic tape and the gauze, but you leave the steri strips, or the little tape strips directly over the incision. You leave those for about seven days. During that time, you can wash gently over the steri strips in the shower with soap and water but just be sure to dry them well afterwards. You shouldn’t soak in a bath or pool for about 14 days after the surgery as this may make the incisions prone to infection. After about seven days, either the steri strips will fall off, or you can go ahead and remove them yourself. You should be gentle with the incisions the first few weeks after surgery, as they’re water-tight, but they’re not very strong yet. At about six weeks, the incisions are around 60% strength of the original tissue. I ask my patients, usually, to restrain from lifting more than about 15 pounds for 46 weeks this will give the incisions a good chance to heal well. During that time, you could increase your activity as tolerated. Basically, if something is causing you discomfort, you should back off that activity for a week or so before you give it another try.
That about sums up our topic for this video. I hope this helped to clarify some things about diagnosis, treatment, and post-operative care of appendicitis for you. If you have any questions, feel free to email, call, or even just go ahead and walk on into our office the old-fashioned way. I’ll see you in the next video.
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