இளைய தலைமுறையினருக்கு தான் அதிக அளவில் அப்பெண்டிக்ஸ் என்று கூறப்படும் குடல்வால் அழற்சி ஏற்படுகிறது. நான்கு அல்லது ஐந்து வயதுக்கு உட்பட்ட குழந்தைகளுக்கு குடல்வால் அழற்சி ஏற்பட்டால் என்னாவது? அவ்வளவு சிறிய குழந்தைகள் என்ன மாதிரியான வலி ஏற்பட்டு இருக்கிறது என்று துல்லியமாக கூறமாட்டார்கள். அப்படி கூற அவர்களுக்கு வயதும் இல்லை. அதனால் குழந்தைக்கு ஏற்பட்டிருக்கும் வலி குடல்வால் அழற்சியால் தானா என்பதை கண்டறியும் மிகப்பெரிய பொறுப்பு குழந்தைகள் நல மருத்துவர்களிடமும், பொது மருத்துவர்களிடமும் தான் உள்ளது. அவர்கள் சரிவர அறிகுறிகளை ஆராய்ந்து தகுந்தபடி அறுவை சிகிச்சை நிபுணரிடம் பரிந்துரைக்க வேண்டும்.
குடல்வாலில் ஏன் அழற்சி ஏற்படுகிறது?
Peritonitis is the inflammation or infection in the peritoneum. This is a thin layer that covers all the abdominal organs and is an inner lining of the abdomen wall. An inflammation to the peritoneum can be caused mainly when the fluid in the gastro intestinal tract comes in contact with the peritoneum. This can happen due to a ruptured appendix, ulcer perforation, gallbladder infection, intestinal perforations, trauma to the abdomen (accidents where the abdomen suffers from rupture and injuries) . Let us know more.
What actually is Peritonitis?
Simply put, it is the inflammation or infection that affects the peritoneum. Most infections in our body are due to bacteria, virus, fungus and other pathogens that enter the body system. Peritoneal infection is also similar. Because pathogens have entered the peritoneum region, this infection occurs. The infection inflames the abdominal organs. The peritoneum actually functions to contain the infection locally and protects the other organs while the body actually responds and fights the infection to ward off the pathogens.
How Peritonitis can occur?
If the peritoneal tissue is compromised and breached then they get exposed to an array of pathogens. The compromise can occur because of rupturing of appendix, any underlying medical condition, or abdominal injury.
Peritonitis due to a ruptured appendix
An inflamed appendix gives enough warning by the typical pain it manifests. The pain actually will be unbearable if the appendix has reached a point of rupturing. The pain can be felt in the lower right abdomen below the navel region. When all these symptoms are ignored, then the appendix ruptures. A ruptured appendix spills its entire content into the peritoneum. The content of the appendix is generally faeces which we all know is replete with bacteria and other pathogens. The contents may also contain undigested food particle, the corrosive digetsive juices including bile and acid. When this content spills to the peritoneum, infection manifests.
Significant Symptoms of Peritonitis
The patient will look really sick. Abdomen wall which is supposed to be soft to touch becomes a rigid like a cardboard. The abdomen which is supposed to move will remain rigid, severe pain, trachypnea (shallow breathing and so increased breathing). The patient will be still because of the pain that manifests in the abdomen.
When the doctor examines the abdomen they will have severe pain, high grade fever, trachycardia. When the surgeon examines with a stethoscope, there will be absence of any movement inside the abdomen (silent abdomen).
Some of the other common symptoms of peritonitis include nausea, vomiting, dehydration, not enough urine output, etc.
Radiologically (In X-rays) there will be air under the diaphragm. This is because the intestinal air ecaped into the abdomen cavity.
Treatment of Peritonitis due to ruptured appendix
Peritonitis is generally treated as critical. They need to be treated as an emergency procedure. It is infact common to observe many patients voluntarily saying that a ruptured appendix has to be operated in six hours. The abdomen region has to be washed and removed of all the content of the ruptured appendix first. This is done surgically only. In the same surgery, the appendix removal is also done simultaneously. After the surgical procedure is over, the patient is generally given dosage of antibiotics to help the body fight the infection.
Failure to treat Peritonitis
Any delay or failure to treat peritonitis can lead to sepsis. The infection can spread to the blood and thereby the infection begins to reach other organs of the body. As the infection spreads unabated, multiple organ failure (heart, kidney, and brain) is the result. This can be life threatening and can lead to death.
Dr. Maran M’s opinion of ruptured appendix and peritonitis
Dr Maran is of the opinion that most appendicitis condition can be diagnosed by modern methods and only very rarely the patients can ignore all the symptoms. He however cautions that peritonitis occurring due to ruptured appendix still happen due to ignorance and neglect. So Dr Maran advises to take pain in the stomach seriously and consult a good gastro surgeon who can easily diagnose if appendicitis is present.
Shit happens to all and that is the natural process. As a matter of fact, shit should happen daily to all. If shit is not happening to you daily, then watch closely what your body is saying. We know these statement well enough as they are connected to whether you are constipated or not. But did you know you could also guess the health of your body by looking at your stool? Yes that is right. The form and color of your stool can indicate your health. Let us dive into this shit.
Some may wonder if an internal organ like appendix can burst. We tend to assume that if there is acute stomach pain, the physician would do physical examination to doubt appendicitis. A diagnosis would lead to finding appendicitis in you. You would get an appendix removal surgery done and remove the appendix. This is what most of you would think. But according to Dr Maran M, a gastro surgeon who regularly performs many appendix surgery in Chennai, it is not an easy sequence of events many times. Let us look at the challenges.
The occurrence of Appendicitis in Children is common nowadays. But what happens if appendicitis may have occurred in children as young as four or five years old? Children that young may not exactly tell what the pain is all about and it becomes the duty of the paediatrician or physician to observe the symptoms carefully and report.
குடல்வால் வெடிக்குமா என்று சிலர் கேட்கலாம். வயிற்று வலி வந்தால், மருத்துவர் சோதித்துப் பார்த்து குடல்வால் நோய் உள்ளது என்பார். உடனடியாக அகற்றிவிட பரிந்துரைப்பார். நீங்களும் உடனே அறுவை சிகிச்சை முடிந்து ஒரு வழியாக வீடு வந்து சேர்ந்துவிடுவீர்கள். இப்படி தான் நடக்கும் என்று நாம் எல்லோரும் நினைக்கிறோம் அல்லவா? ஆனால் பல சமயங்களில் இவ்வளவு சுலபமாக நடப்பதில்லை. ஏன்? விரிவாக பார்ர்ப்போம்.
The mainstay of treatment to appendicitis is appendectomy, the surgical removal of appendix. Off late the latest laparoscopic techniques used in the surgical removal offers quick and easy fix for appendicitis. The approach to antibiotic though has merits, is not practiced widely.
The very mention of comparing Tonsillitis and Appendicitis might make you wonder what can be the connection between the two. This is because Tonsillitis happens in the inner throat region and Appendicitis happens in the inner lower abdomen. Then what makes both comparable? Here is an interesting comparison between the two.
An inflammation or infection of the appendix needs the entire appendix to be removed by surgery. This surgical condition is termed as Appendicitis. The surgical removal of the appendix is termed as Appendectomy. In common parlance, the surgery is called appendix operation or simply appendix removal surgery. Appendectomy is done mainly by keyhole approach these days. It is referred to as Laparoscopic Appendectomy or commonly referred to as laparoscopic appendix removal surgery. It may be mentioned that in earlier days appendectomy was done by open surgery methods.
Why Would Appendix Develop Inflammation?
The reason for the inflammation of Appendix is generally unknown. It is widely believed that an obstruction to the lumen of the Appendix may be the reason. The obstruction to the lumen may be partial or complete. The obstruction is generally caused by the faecal matter which accumulates inside the appendix to cause inflammation. This inflammation exerts pressure on the wall of the appendix or tissues of the appendix. As a matter of fact, this causes extreme pain.
Other reasons for inflammation of Appendix or Appendicitis
Generally, bacteria, virus and other pathogens affect the gastrointestinal region. This infection is quite normal. Very rarely this gastrointestinal infection can affect the appendix. This type of infection of the appendix is termed as secondary appendicitis. It implies that primary infection lies somewhere else in the gastrointestinal tract. As a result of this infection from somewhere, the appendix gets infected as a result. This condition is because of low immunity.
Although secondary appendicitis is very rare, if found at an early stage they are curable with antibiotics. If secondary appendicitis has proceeded, it can be cured by appendix removal surgery.
Appendicitis is all about accumulation of faecal matters inside the appendix and the resulting inflammation. That is what Faecal impaction can cause in long run. Faecal impaction is the concrete-like solidification of faecal matters in the wall of the colon. This stone-like fecal solid stays in the bowel. As a result, this can cause non-movement of faeces.
Constipation is the major cause of faecal impaction and it happens mostly because of wrong food habits. Some of the reasons for constipation are
- Food low in fiber
- Not dehydrating yourself properly
- Insufficient nutrient intake
- Problems in the digestive system
- Certain medications
- Prolonged hospital admissions and being bed-ridden
The constipation caused has the potential to lead to faecal impaction. People with faecal impaction are at higher risk in developing appendicitis.
Video of Dr. Maran who performs appendix removal surgery on Appendicitis
Here is a video of Dr. Maran, the leading gastro surgeon in Chennai who has performed many appendix removal surgery in Chennai. In this short video, Dr. Maran explains what is an appendix organ and what to do in case of appendicitis.
Who are vulnerable to appendicitis?
Data suggests that people between the age of 10 and 40 are the most vulnerable to develop appendicitis. This does not mean that appendicitis does not happen to people who are above 40. As a matter of fact, it does happen.
Generally speaking not only constipation but there are other reasons like genetics, etc. They play a role in developing appendicitis leading to the subsequent appendix removal surgery.
What are the Initial Symptoms of Appendicitis
- Dull aching pain starts near the naval area
- Mild Fever
The Later Symptoms of Appendicitis
- Pain more localized in the lower right abdomen
- Pain becomes more intense and catchy
- High Fever
- White cell count increases because the body is fighting infection
General Diagnosis of Appendicitis
Generally, when there is a stomach pain, we tend to go to a general physician and not to an appendicitis surgeon. A well experienced general physician generally would do a thorough physical examination. If the physician suspects appendicitis, the physician would definitely refer you to an experienced gastro surgeon.
But in some cases, the general physician would administer an antibiotic and suppress the pain. This in fact is a challenge. If the initial symptoms are present, it is better to visit a GI surgeon. The GI surgeon should rule out appendicitis.
We wrote a blog post on the easy availability of antibiotics these days. In that blog we have discussed how antibiotics rather impact treatment of appendicitis. You can read the blog here.
The GI surgeon on the other hand does a thorough physical examination. Experienced gastro surgeons can tell the presence of appendicitis by physical examination. They routinely perform appendix removal surgery and that is the reason. However to confirm the appendicitis surgeon would recommend Ultrasound or CT Scan.
Here is a CT Scan picture showing three scenarios. A normal appendix, an appendix with acute appendicitis and an appendix with rupture.
Here is another picture that shows the ultrasound image of a ruptured appendix. An ultrasound or CT scan confirms a rupture in the appendix. The appendix surgeon performs an appendix removal surgery immediately if the report confirms.
General Diagnostic Challenges of Appendicitis
Loss of appetite, pain in the right lower abdomen and vomiting, are typical symptoms of appendicitis. As a matter of fact, these symptoms manifests only in 50% of people with appendicitis. Generally, the diagnostic accuracy of appendicitis is more in men than in women.
General Diagnostic Challenges of Appendicitis in women
The pain caused by appendicitis in the right lower abdomen can mimic other abdominal medical conditions. So this confusion adds to the challenges. Women suffer from abdominal pain associated with menstruation, ovarian cyst, right side kidney stones, etc. Such pain mimics the appendicitis symptom too. Hence all these factors are challenges to a proper clinical diagnosis of appendicitis. So if there is a general suspicion, an ultrasound report can help to rule out appendicitis.
General Diagnostic Challenges of Appendicitis in children
Young Children may not exactly tell what and where the pain is. It is therefore the duty of the paediatrician or physician to observe the symptoms carefully and report.
We wrote a detailed post on the challenges faced in finding appendicitis in children. You can read the blog here.
General Diagnosis of Appendicitis
This early stage of the appendix is treated with simple antibiotics. However, the risk remains. The qualified gastro surgeon decides the surgical need. The appendicitis surgeon recommends appendix removal surgery only after assessing the patient. Even if initially treated medically with antibiotics, after many years it may warrant a surgical removal. Laparoscopic procedures are effective in early removal of the inflamed or infected appendix. Easy laparoscopic approach makes recovery from surgery very simple.
If Appendicitis is not treated?
The inflammation worsens if appendicitis is not treated . It may then lead to the rupturing of the wall of the appendix. This rupture is commonly referred to as bursting of the appendix. This condition is medically termed as “Peritonitis”. The increase in the inflammation asa result causes the appendix wall to rupture. Consequently, the faeces and other infected matters leak into the abdomen and aggravates the infection leading to Abdomen Sepsis. An untreated infection enters the blood stream and causes Septicaemia.
If Appendix bursts or ruptures the symptoms will be
- Abdomen becomes tight like a stone (board like rigidity)
- Severe Fever
- Severe vomiting and pain
- Patient becomes toxic because of Septicaemia
If Appendicitis proceeds to this condition, it is a surgical emergency. Therefore, the patient is moved immediately to the hospital for appendix removal surgery. The appendix surgeon cleans the inner abdomen first in the surgery.
Abscess – The other complication of a ruptured appendix
One of the other complications of a burst appendix is the formation of something called abscess. Consequently, abscess forms around the area where the burst has happened. It is a collection of pus around the area. This collection of pus is because the body’s immune system has been fighting the infection all along.
The treatment for an abscess is usually administering antibiotics. The appendicitis surgeon drains the pus in the abscess area during appendectomy surgery. The appendicitis surgeon drains before administering the antibiotics. This draining is mandatory as part of the cleaning of the abdomen during the appendectomy surgery or appendix removal surgery.
Surgical procedures after appendix wall ruptures
The patient’s abdomen area now has faeces and other infected matters leaked inside. The appendix surgeon cleans this thoroughly. It is imperative that the abdomen is free of all these foreign and toxic materials. The appendicitis surgeon cleans and ensures the same. If the patient has an abscess then pus collects in the appendix region. The appendicitis surgeon completely drains this out along with the faecal matters.
The appendicitis surgeon proceeds to remove the appendix after the abdomen cleaning the abdomen. The patient is under observation and the surgeon prescribes medications. As a matter of fact, the medications include antibiotics. This is to overcome the infections caused by the ruptured appendix.
Is Appendicitis Preventable?
No. Appendicitis is not preventable. Because appendicitis affects anyone. There are no strong proof linking this surgical condition to any other factors. Generally, people with constipation and younger have a higher chance of getting appendicitis.
So it is any day better to consume foods high in fiber content to have normal bowel movements. Greens like Murunga Keerai, vegetables like carrot, fruits like banana, millets like Varagu, are specially rich source of fiber. The above are just examples of some food available in India which are rich in fiber. So include these foods liberally in your diet. Furthermore, be conscious about foods that cause constipation. Junk foods, food heavily laden with preservatives, added artificial flavors, etc, cause stress to our digestive system. It is better to avoid consuming such foods.
Appendicitis happens due to many reasons. A good food habit has nothing to with getting or not getting appendicitis.
Conclusion by Dr. Maran – Appendicitis in a nutshell
Dr. Maran is a gastro surgeon who regularly does appendix removal surgery in Chennai. He explains to us that appendicitis can happen to anyone. Therefore, Dr Maran advises us to not ignore any pain in the stomach. According to Dr. Maran who performs Appendix Surgery in Chennai, appendicitis is easily cured in the early stages. In conclusion, he tells us that removing the appendix by surgical means is the only solution.