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  • Dr. Whitney-Cashio

Decoding Your Doctor: Appendicitis

Updated: Jun 23


When listening to your doctor, do you often find yourself feeling like this on the inside?


Don't worry, you're not alone. Even the most well-trained doctor will sometimes come across a sub-sub-sub specialist (say pediatric-cardio-electrophyisologists) who'll talk to them in what sounds like a very authoritative important-sounding word salad. Just saying.


I often get asked by my patients to explain a medical diagnosis that, you know, doesn't seem to make sense. As the ancients used to say, and as modern neuroscience confirms, the only way that the human mind can ultimately remember something is to have a mental picture that helps to anchor the concept to something that you already know.


With that in mind, let's quickly tackle one of the more common concerns for those coming to the office or the Emergency Room with a complaint of "abdominal pain."


Appendicitis


This is one of the true abdominal emergencies. The appendix is a small, worm-shaped (hence “Vermiform”) appendage located at the base of your large intestines, on the right side. It has a small, narrow opening into itself but no exit, not connected to anything.


What causes appendicitis?


Appendicitis occurs when, for unknown reasons, the appendix become infected with bacteria. When that happens, bacteria begin to produce a severe immune system reaction, and white blood cells rush to the area. Dead white blood cells) then form what we all know as pus, and this causes the appendix to swell.


When the appendix becomes inflamed and swells, it brushes up against the nerves in the abdomen and causes pain. As you can see from the picture above, the appendix is long, tubular, and not attached to any other structure. Therefore, when inflamed it can brush up against any local structure and thus cause a myriad of different forms of abdominal pain.



How is it diagnosed?


In the United States, when appendicitis is suspected, your doctor will order several types of studies:


- Blood work

> The doctor is looking for signs of infection or other causes of pain


- Urine tests

> in order to check for pregnancy, infection or bleeding in the urine

> In other words, is something else causing the pain?


- A computed tomography (CT) scan

> This is looking for evidence that the appendix is infected OR

> To see if there is something else that's causing the symptoms.

How is it Treated?


Surgery, either open (the old-fashioned way with a 3-4 inch incision) or laparoscopically (3-4 tiny incisions which use cameras and specialized tools) to remove the appendix.



Laparoscopic surgery

How soon must it be taken out?

It depends. If it is what your doctor determines is “early” appendicitis and depending upon the time of day that you are diagnosed, it can usually be taken out sometime within the next 24 hours.


On the other hand if your doctor and the surgeon determine that you have a more advanced case of appendicitis, then they may take you to the operating room immediately.

What if my appendix has ruptured?


A ruptured appendix is a very big deal because that means that bacteria, instead of being confined to the digestive system, are now spilling into the abdominal cavity, also known as the “peritoneum” (pear-it-tow-knee-um). If not immediately treated, this spillage can develop into a life-threatening condition known as “peritonitis.”


In the case of appendix rupture, the current standard of care is to:

- Admission to the hospital

- Start broad spectrum IV antibiotics and pain control

- Gain control of the infection

- Surgery to remove the appendix and wash out any remaining areas of infection.


How long will I be in the hospital?

It usually depends on several factors:


* Has the appendix ruptured?

o No

> Expect a much quicker hospital stay, especially for a laparoscopic procedure.

o Yes

> Expect the stay to be somewhat longer.


* How many medical conditions do you have?

o Healthy?

> Likely less than 24 hours

o Have more complicated medical conditions?

> It depends on how you respond to the surgery.

> Some do well, but others with medical conditions such as diabetes, heart or lung problems, or depressed immune systems may very well linger longer in the hospital.

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