Sunday, January 14, 2007

Appendicitis

I consider myself somewhat of an expert on appendicitis. Not only have I had it myself, but my husband (boyfriend at the time) had it, and I diagnosed it immediately when I heard his symptoms. In my own case, I knew I had appendicitis several days before the doctors figured it out, to my detriment.

It all goes back to my childhood when even then I was fascinated by medical subjects. I was a huge fan of Cherry Ames, Student Nurse, and all of the sequels. I also got caught up in another nurse series about a nurse called Sue Barton. In one of the Sue Barton books, Nurse Sue herself becomes sick with appendicitis. Although the books were for kids, they did describe the symptoms quite accurately. And when I got those same symptoms when I was about 23 years old, I knew I had appendicitis.

In my case, the symptoms had happened more than once. One day I had noticed a kind of gnawing pain in the pit of my stomach that didn't go away for several days. I popped Tums periodically and assumed it was indigestion. It did go away and I forgot about it - until a month or so later it came back, and got worse. The pain persisted until it finally moved downward. I got myself driven to the local hospital emergency room and they checked me out, decided I had gastritis, and sent me home with a shot of Demerol! I asked, "Aren't you even going to do a white blood count?" (as even then, my hypochondriacal knowledge included the fact that appendicitis causes the white cell count in the patient's blood to become very high due to the infection in the appendix). The resident in charge of the ER said "No, you don't have appendicitis, don't worry, go home." Later on the pain persisted so I called them again and they said to put a hot water bottle on my stomach! (Do not do this if you have symptoms of appendicitis. It makes it worse).

To make a long story shorter, 5 days later I ended up in the hospital with a burst appendix and was in for 10 days recovering from a nasty operation and getting IV antibiotics until I was well enough to go home.

So, in order to prevent this from happening to you, I will let you know more information about appendicitis than you ever thought you would need or want to know:

Appendicitis:
What is it?

The appendix is a small organ that is what is called "vestigial," meaning it is no longer a useful part of your body and basically exists to cause you problems, similar to your wisdom teeth. It is attached to your large intestine, usually on the right lower side of the abdomen. However, there are some people whose intestines are twisted or otherwise misaligned and the appendix can be elsewhere. This just makes life more difficult for these people. If you think I had trouble getting a diagnosis as it was, you can imagine what would have happened if my appendix had been on the other side.

Sometimes the appendix can become blocked, either by feces, infection or even swollen lymph nodes. In some cases, an injury can cause this. Some people have a genetic predisposition to develop appendicitis. Once the appendix is blocked, pressure builds up and it becomes inflamed. At this point the person is considered to be suffering from appendicitis and unless the offending organ is removed quickly, it can become a serious or life-threatening condition. The appendix can become gangrenous and burst, scattering nasty microbes all over the unlucky person's insides. This is called peritonitis and it is a Very Bad Thing.

What are the symptoms?

The symptoms of acute appendicitis may include:

  • Pain, starting near the belly button, moving gradually downward and to the right
  • Loss of appetitite, nausea, or vomiting
  • Constipation or diarrhea
  • Low fever
  • Abdominal swelling

Some people may feel as if they have to make a bowel movement; however, if they have these symptoms they should NOT take a laxative.

One key symptom that often occurs is what is called "rebound tenderness." To find out if you have rebound tenderness, lie on a flat surface such as a bed, press into the abdomen around the area of the pain, and let go suddenly. If it hurts a lot more when you let go than when you first pressed in, you have rebound tenderness. Go to the hospital.

Another symptom that I have not seen listed anywhere, but certainly happened in both my case and my husband's, is profound nervousness. You develop a feeling of panic and feel you can't calm down. It may be a result of the infection causing adrenalin to be released in the system. Of course, if you are a hypochondriac as I am, you may get this feeling any time you think you are about to die of some strange disease. So this is not as definitive as the rebound tenderness! However, since it happened to my husband as well, and he does not tend to panic easily, I felt it was worth mentioning.

How is it diagnosed?

Back in the day, they didn't have all the fancy diagnostics they have nowadays, which is why I was not diagnosed easily. Now, if you arrive at the emergency room with your list of symptoms, they will do all the usual things like check your heart, your blood pressure, and other vital signs. They should do a blood test to see if you have a high white blood cell count from infection or any other signs of disease. Unlike in 1978, they also have ultrasounds and CT scans that can more accurately identify the source of the pain and diagnose the problem much more easily.

How is it treated?

Once appendicitis is clearly the cause of the pain, the patient is operated on and the appendix removed. This can be done through a small incision or else with laparascopic surgery, where there is a thin tube with a camera used to guide the surgeon as he uses several small incisions to access the area. This method results in a shorter recovery time and less scarring.

Will you get it?

You might, but it isn't that common. Lifetime risk of getting acute appendicitis is 8.6% for males, 6.7% for females (Rothrock et al, 2000).

If you suspect you have appendicitis, call your doctor immediately and go to the hospital. It is best to have your own physician overseeing your care, particularly if you have a good relationship with your doctor. But whether it is your own doctor or the doctor in the emergency room, you know when there is something wrong with you. Don't let them send you home without doing the proper tests to make sure they have diagnosed you correctly. Believe me, I know this from experience!

Source of this information was the National Digestive Diseases Information Clearinghouse website.

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