Appendicitis

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Appendicitis is inflammation of the intestinal appendix, and affects the mucosa, lymphoid tissue and muscle layer.

Its main symptom is severe pain on the right side of the abdomen. The appendix is located at the beginning of the large intestine, in the lower right part of the abdomen. It has the shape of a pink worm when it is not inflamed. Inside there are many lymphoid follicles of the immune system, similar to those in the tonsils of the pharynx. It is generally accepted that perforation occurs between 24 and 48 hours after the onset of symptoms. However, in 13% of cases it can be perforated before 24 hours.

The most frequent complications of appendicitis are the following:

Abdominal abscess.
Diffuse peritonitis.
Pileflebitis: the most severe and rare, septic emboli are formed that go to the liver and can form abscesses.

Currently these complications are rare, except in the case of people who have weakened defenses (elderly), or in people with appendicitis very advanced by a late diagnosis.

The problem of appendicitis is not the inflammation of the appendix itself, but if we let the box evolve, the appendix can become necrotic and literally rot in the abdomen. This would cause a situation of urgency, peritonitis, with great risk to the patient’s life. For all this it is a medical emergency.

The symptoms of appendicitis are:

Pain begins in the epigastrium (in the upper abdomen) or in the periumbilical region (in the center of the abdomen in the belly button area). It is a dull and continuous pain (colicky pain).
Nausea and vomiting.
The pain radiates to the right flank of the abdomen and ends up being located in the right iliac fossa (lower right area of the abdomen) continuously.

Appendicitis occurs as a result of obstruction of its lumen, that is, the internal canal of the appendix. This obstruction happens for different reasons:

Hyperplasia of lymphoid follicles: it is the most frequent cause of appendicitis. The appendicular lymphoid follicles work just like the pharyngeal tonsils, so that if they are infected by a microbe they become inflamed, grow and obstruct the light.
Appendicolito or fecalito: it is the second most frequent cause. Through the large intestine all the fecal mass passes to the anus. Occasionally a small stool may occlude the appendicular lumen.
Foreign bodies: in the same way as a fecalite, a foreign body that we have ingested could obstruct the appendicular light, as long as it was the right size.
Microorganism and parasites: either because they obstruct light directly or because they inflame the lymphoid follicles. The microorganism that is most related to appendicitis is Yersinia.
Tumors: it is very rare for the face to appear causing an appendicitis; they can be from the appendix itself or from the colon.

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You can differentiate several stages or stages in appendicitis:

Stage 1. Simple or catarrhal appendicitis: when the lumen of the appendix becomes obstructed, the mucus it secretes, as it secretes any part of the intestine, can not flow freely and begins to accumulate inside it. This causes the bacteria that are part of the intestinal flora to multiply in excess and start the inflammatory process. At this stage the appendix has a normal outward appearance and only inflammation can be identified under a microscope.
Stage 2. Phlegmonous or fibrinous appendicitis: little by little the appendix becomes distended as its internal pressure increases. There comes a time when the pressure is so high that the blood can not properly irrigate the appendix. The appearance of the appendix is inflammatory: red and enlarged.
Stage 3. Gangrenous appendicitis: the walls of the appendix become weakened, both by the lack of blood supply, and by the increase in internal pressure. There are parts that begin to become necrotic and turn black and can secrete pus.
Stage 4. Perforated appendicitis: finally the walls are broken and all pus and feces are released into the abdominal cavity, resulting in peritonitis.

The symptoms can be of any type and in any degree, only a good abdominal exploration can channel the diagnosis of appendicitis with greater certainty.

The treatment of appendicitis is surgical and urgent; the appendix is removed and inflammation is eliminated (appendectomy). Only in patients with subacute appendicitis, which has a longer duration without general involvement, surgery is usually performed later.

If there is generalized peritonitis, the abdominal cavity is washed.

In all cases intravenous antibiotic prophylaxis is performed.

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