The Appendix

Hi, this is Dr. Buck Parker, General Surgeon, and in this article I want to talk to you about the diagnosis of Acute Appendicitis. Acute Appendicitis is when the appendix (a small finger like projection with a blind pouch that lives in the right side of the abdomen) becomes infected. The reason the appendix becomes infected is because it usually 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 very rapid rate. Since the appendix is blocked off, and it’s a blind ending pouch, there is no where for the bacteria to go, so the appendix gets bigger and bigger until eventually…without surgery, it will burst and stool will spill into the abdomen. The appendix gets blocked off for many different reasons, but I now want to focus on how doctors diagnose appendicitis, and then how we treat it.

First the diagnosis is usually a constellation of symptoms such as abdominal pain, fevers, chills, maybe nausea and vomiting. These symptoms although common, may or may not be present. Most people have belly pain that starts around the navel, and moves slowly over several hours to the right lower abdomen. When you have appendicitis, it will not get better on its own, so if the pain goes away, then most likely the diagnosis is not appendicitis.

Some tests are very helpful in diagnosing appendicitis. First, is a blood test to check for the white blood cell count.  If the white blood cells (or the infection fighting cells) are elevated, that is a good indication  that there is inflammation or an infection going on somewhere. Secondly is an 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 an appendicitis. Sometimes the ultrasound can confirm that the appendix looks abnormal and together with the other signs and symptoms, the diagnosis can be made. And finally, a CAT scan or a CT scan of the abdomen may be used to look at the appendix. The CAT scanner is like an X-ray machine that can look at bones, muscles, blood vessels and solid organs like the liver and even the appendix. Depending on your symptoms, all or some of these tests will be used.

Let’s talk about the treatment. The treatment for appendicitis is an operation to remove the appendix. Plain and simple. For most people, antibiotics just won’t work, and an operation to remove the appendix‚ called an “Appendectomy” is needed. (ectomy is Latin for “removal”) There are two types of Appendectomies. First is the “old-fashioned way”, where the surgeon makes an incision 4-5 inches long over 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 than a Laparoscopic Appendectomy. A laparoscopic appendectomy uses 3 small incisions…one 1/2 an inch, and two 1/4 of an inch long, together with a small camera and small instruments to remove the appendix. With the Laparoscopic Appendectomy, patients generally experience less pain in the immediate post-operative period than in the “old fashioned way”.

There are of course a few risks associated with an appendectomy that you should know so you are completely informed about your operation before you have it. Anytime we do any procedure there are risks associated with that procedure. Even a procedure as small as taking a few drops of blood can have risks. 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 bleeding and infection. Bleeding can be mild and self limiting‚ meaning it stops on it’s own‚ or it can be moderate….as you may require a blood transfusion..or severe as you may require an additional operation to stop the bleeding. Second is infection. Infections can also be mild, moderate or severe with treatment ranging from antibiotics, to opening the incision, to another operation. Since we are moving the bowels around when we take out the appendix, the bowels can become injured. If it is recognized right away, they can be fixed most of the time without additional incisions during the same operation. If it is not recognized until after the operation, an additional operation to fix the bowels will be required. The bladder is also at a small risk of being injured, and the treatment is usually continuation of a bladder catheter for 3-5 days. Other than those risks, there are always risks of anesthesia, which depending on your health, may be anywhere from minor to severe. The anesthesiologist will speak to you about your specific anesthesia risks 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 hours after arrival to the hospital. As long as you are eating OK, your pain is controlled with pain pills and you are walking OK, you can be discharged home. Some people experience nausea associated with the anesthesia during the operation, and if you are still nauseated and are unable to swallow pain pills and eat regular food, then you’ll need to stay a bit longer in the hospital until that clears up.

After you are discharged home, you may remove the bandages over the incisions 48 hours after your operation. You should remove the plastic tape and gauze, but leave the Steri-Strips (little tape strips) over the incision for at least 7 days. After the 7 days, if they have not fallen off already, you may remove them. When the Steri-Strips are still on, you can wash in the shower over them with soap and water. Just be sure to dry them well after the shower, and don’t soak in a tub or bath for about 10 days. You should be gentle with the incisions the first couple of weeks, as they are watertight, but not very strong yet. At about 6 weeks, the incisions are about 60% strength of the original tissue.

Well that about sums up or topic for this video. I hope this helped to clarify some things about the diagnosis, treatment and after care of appendicitis for you. If you have any questions, please feel free to email, call or even walk on into our office (you know…the old-fashioned way) anytime.

-Dr. Buck