One of the most common problems I see that require surgery is Appendicitis. Appendicitis is basically a blockage and subsequent infection of the Appendix. The appendix is a small tubular structure that is connected to the right side of the colon. It’s about 0.5 inches wide by 5-8 inches long and the lumen, or inside of the tube, is connected to the colon.
Appendicitis develops when the base of this tube gets blocked by stool or food or bacteria. Bacteria live in our GI tract (which including the colon and appendix). And the job of the bacteria is to proliferate. So, if the base of the appendix gets blocked, and there are bacteria in there, the bacteria multiply and sooner or later begin to stretch the appendix. That’s when we start to feel pain.
The interesting thing about this is that the stretch of the appendix does not cause us to feel pain right where the appendix lives (which by the way is in the right lower portion of our abdomen). But rather we start to feel pain around the umbilicus (belly button) area first. It is usually a gnawing or crampy pain that may come and go. Once the bacteria starts to grow through the wall of the appendix, the appendix is now considered to be infected. Once that appendix is infected we start to feel the pain right where the appendix lives, which is again, the right lower abdomen (doctors call it the RLQ or the Right Lower Quadrant).
Of course, a REALLY important thing to know is how long this process takes. It generally takes less than 24 hours from when the base of the appendix becomes blocked, to when we feel the pain in the right lower quadrant. Some other symptoms that we may or may not develop are fevers, chills, nausea, vomiting and even diarrhea at times. The doctor books say patients develop “anorexia” as well….which is essentially saying that patients don’t feel hungry if they have appendicitis. In my clinical practice, I’ve found this to often be correct, but not always 100%.
Once I talk to a patient about the diagnosis of appendicitis I usually get the question “is it perforated”. If the bacteria proliferates enough, it actually can break open the appendix and spill stool into the abdomen. Yea, you guessed it…not such a great situation. But, this is generally when the infection is let go longer than 48-72 hours. It happens more in kids and elderly adults. The kids have a more difficult time communicating their symptoms thus, they are typically diagnosed after a longer time of infection. Elderly adults have less pain in general, and their diagnosis is also found after a longer time of infection. When the appendix does burst there is a higher risk of becoming very sick, but this does not happen in every situation, and if treated most people have very good outcomes (as in they live, and have few complications).
So, the question I get a lot is “do I have Appendicitis”. Now that you know how we get appendicitis, you probably can guess the questions I might ask a patient. Do you have abdominal pain? Is it in the “RLQ”? When did it start? Do you have nausea? Vomiting? Fevers & chills? If the patient answers that the pain is in the right lower quadrant, plus any of the other symptoms, then I generally recommend the patient sees a physician for a physical exam. Based on the physical exam from a doctor, that will determine if more investigations (labs & possibly CT scan) are needed.
So, if you or a family member develops fairly sudden onset (less than 24 hrs) of right lower quadrant abdominal pain that does not improve, it’s best to see your nearest physician as soon as possible.
The best thing about appendicitis? It’s a fairly straight-forward, short surgery with a quick recovery time and most patients are home 12-24 hours after the surgery.