A
reporter with this newspaper featured a report on Saturday, August 8,
2015, entitled “A community where nine out of every 10 villagers have
appendicitis.” He wondered what could be the reason for a situation
whereby almost nine out of 10 persons in a particular community had
undergone surgery as a result of the illness.
The youths informed the reporter that
appendicitis and hernia were common among members of their community.
They disclosed that several persons have died as a result of the
conditions.
The reporter deduced that this could be
attributed to the villagers’ travails on hardship, hard work, farming
and absence of potable water in the community.
The import of this piece is to shed light
on the medical condition called appendicitis, being one of the
commonest abdominal emergencies seen anywhere in the world.
To start with, appendicitis is more
common in females than in males. It used to be thought of as a
cosmopolitan disease; but in the last two decades or so, evidence has
suggested that this is not necessarily true. Indeed, there is no
hospital, large or small, that does not have to deal with this condition
in all parts of Nigeria, whether in the urban areas or in the
hinterland.
The appendix is a small, thin pouch about
five to 10cm long. It’s connected to the large intestine, where faeces
(stools) are formed. No one knows exactly why we have an appendix; and
removing it is not harmful.
Appendicitis is a painful swelling of the
appendix, which causes pain in the abdomen. There are four types of
appendicitis: acute appendicitis, sub-acute appendicitis, recurrent
appendicitis, and chronic appendicitis
Acute
appendicitis is the commonest surgical condition of the abdomen. Acute
appendicitis may occur at all ages, while sub-acute appendicitis may
resolve with medications.
Signs and symptoms
Appendicitis typically starts with a pain
in the middle of the abdomen (tummy). The pain may come and go. Within
hours, the pain travels to the lower right-hand side, where the appendix
usually lies, and becomes constant and severe.
Other symptoms are anorexia, nausea, and
low grade fever. Pressing on this area, coughing or walking may all make
the pain worse. The patient may lose appetite, feel sick and
occasionally experience diarrhoea.
The single most important physical
finding by the doctor is right lower abdominal pain on palpation of the
abdomen. Other findings include low-grade fever, peritoneal signs, and
guardedness.
Causes
It’s not exactly clear what the causes of
appendicitis are, although most cases are thought to occur when
something, usually a small piece of seed, stone, faeces (stool) or a
swollen lymph node within the wall of the bowel blocks the entrance of
the appendix. This obstruction leads to the development of inflammation
and swelling.
Diagnosis
The overall diagnostic accuracy achieved
by history, physical examination, and laboratory tests has been
approximately 80 per cent.
The ease and accuracy of diagnosis varies
by the patient’s sex and age, and is more difficult in women, children,
elderly persons and women of childbearing age because acute
gynaecologic conditions (e.g., pelvic inflammatory disease) may cause
symptoms similar to appendicitis.
If the diagnosis of appendicitis is clear
from the patient’s history and physical examination, no further testing
is needed, and prompt surgical referral is warranted.
When the diagnosis is not clear,
management options for suspected appendicitis include observation in a
hospital, diagnostic imaging to clarify the diagnosis, laparoscopy, and
appendectomy.
In atypical cases, ultrasonography and
computed tomography (CT) may help lower the rate of false-negative
appendicitis diagnoses, and reduce morbidity from perforation.
Complications
It may rupture with the escape of faecal
material and various bacteria into the abdomen, thus causing more severe
disease called peritonitis.
An abscess cavity forms around the
appendix, with the development of severe illness, high-grade fever and
considerable discomfort.
A mass is formed by a combination of
certain structures within the abdomen, the intestines and the appendix
itself, called an appendix mass.
Treatment
In most cases of appendicitis, the
appendix will need to be surgically removed as soon as possible. Removal
of the appendix, known as an appendectomy or appendicectomy, has an
excellent success rate.
Most people make a full recovery from an
appendectomy in a couple of weeks, although strenuous activities may
need to be avoided for up to six weeks after open surgery.
Prevention
As the causes are not fully understood,
there’s no guaranteed way of preventing appendicitis. The risk of the
disease may be reduced by the increasing consumption of high fibre diets
and vegetables, since such foods make bowel movements regular and
shorten the digestion transit time.
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