Appendicitis

Appendicitis

DIGESTIVE DISORDERS- Appendicitis

The term appendicitis means inflammation of vermiform appendix. Appendicitis is a non-contagious emergency condition where the sufferer rolls on the floor with excruciating pain in the abdomen. It is one of the commonest things that is often thrown out by performing surgery (others are – tonsils and adenoids)

The name appendix means “additional”. Does this mean it is just an additional part of our body? What is the function of the appendix? Does it absorbs anything or secretes anything? Does it work for any purpose or does it monitor digestion? Or is it a waste having this part? Science has not proved its efficacy in answering all these questions.

But, recently, researchers have accepted that the appendix, tonsils and adenoids (all are of lymphoid tissues) must have some function related to immunity or resistance power.

Vermiform appendix is a long, worm-like or tail-like blind tube that springs out from the intestines in the right lower abdomen. Ileum is the end part of small intestine and caecum is the starting part of large intestine. The appendix emerges from the junction of these. It is about 8-10 cm long and about 1 cm thick. Its lumen opens inside the intestine. Like ileum, the appendix also has all intestinal layers and more lymphoid follicles.

The appendix is supposed to produce antibodies related to immunity. The lymphoid follicles are seen more in number between the ages 8-18. So, it is somewhat bigger and longer in children, whereas in the case of adults, it usually gets atrophied, is shrunk and shapeless. It is due to this shrinkage that adults have a greater risk of getting obstructive appendicitis.

Incidence and risk personalities

• Youth – mainly teenage and 20 to 30 age group
• Males have more incidences than females
• People who suffer from constipation and who are deprived of fibre diet have more chances of getting appendicitis
• Sometimes familial disposition is noted

Causes

- Appendicitis may be caused by infection and obstruction. It is often developed from infection rather than plain obstruction.

• Infection – from bacterias or trophozoites. (E.coli, streptococcus, staphylococcus, amoebiasis, etc).
• Obstruction – usually infection precedes the obstructive process since infection causes swelling of lymphoid follicles in the appendix. This swelling causes narrowing of lumen (tube) of appendix. The obstruction can also cause blockage of blood flow, gangrene and pus collection. The other cause for obstruction is usually due to hardened faecal mass i.e. faecolith. Worms are rare in causing obstructive appendicitis. The obstruction causes pain due to distension of appendix with increase of intra luminal fluid due to blockage of drain.
• In some incidences, trauma or injury can also be found to be a causative factor.

Symptoms may vary widely according to positions of the appendix and diet.

• Initially there will be a generalised pain in the abdomen, especially around umbilicus, which gradually gets localised to the right lower abdomen (characteristic feature of appendicitis)
• Slow onset of pain usually shoots up to a severe sharp pain within 12 hours
• Usually, low-grade fever accompanies with rigor, nausea and vomiting
• Tenderness and firm swelling can be felt on palpation over right lower abdomen
• Abdomen wall or muscles become rigid to prevent pain on moving, i.e. muscle guard
• Pain is mostly aggravated with touch, pressure, moving, cough, sneeze, deep breath, straining for stool, etc.
• Loss of appetite with diarrhoea or constipation. Also fear of food will be there due to pain, vomiting and diarrhoea.

Bloated abdomen with rumbling sound and urge to pass stool or urine

Sudden disappearance of the pain with no improvement in general condition should be seriously interrogated, since it indicates the worsening of the condition due to gangrene formation or rupture of appendix with silent rigid abdomen.

In chronic cases, slight pain on exertion or heavy diet may occur with frequent indigestion or constipation or diarrhoea. Great exhaustion will be there due to defective absorption of intestines.

To arrive at final diagnosis – Physical examination and investigation are helpful. Diagnosis of appendicitis is very important, since there are lots of complaints which can mimic the pain of appendicitis. The common conditions often confused with the appendicitis pain are pelvic inflammatory disease, myoma uterus, ovulation pain, i.e. on 14th day from the start-up of menses, ovarian cysts, tubal pregnancy, kidney stones, peptic ulcer, etc. So the doctor should rule out other complaints before treating or operating upon the patient for appendicitis or otherwise the innocent appendix will get assaulted unnecessarily.

Classical points which pinpoint’s appendicitis pain are

• Pain in Mcburney’s point i.e. junction of lateral and middle thirds of the line joining the right anterior superior iliac spine (hip prominence) to umbilicus
• Rebound tenderness – Pain shoots up when doctor takes up his palpating hand from right lower abdomen – releasing pain.
• Pressure in left lower abdomen can cause pain in right lower abdomen

Pain will be more when patient moves his right leg by flexion or internal rotation

Investigations – Usually, for appendicitis, ultra sonography is performed as the first and final line of investigation for diagnosis. In more doubtful cases, CT, MRI can help to clear the case. Routine blood tests can show changes in chronic appendicitis with the indication of increase of lymphocytes. No other changes can be identified or made out with the blood test or others.

General treatment – Usually a course of antibiotics will keep away all the symptoms of the appendicitis. If left untreated or gets maltreated, there is a chance of the bursting of the appendix mass to infect the whole abdomen. Initially, most doctors treat the condition with antibiotics and resort to elective surgical removal within a month. In allopathy, doctors usually advice removal of the appendix to get rid of the problem since it may act as an infective focus and cause complaints. So they usually resort for surgery even after the person feels better after the antibiotic course.

Also, latest laparoscopy methods with the advantage of fewer scars and lesser recovery time makes many patients opt for surgery. In chronic cases, adhesions may be there, attaching the appendix with adjacent structures which may need incision options of surgery. Pulse and BPshould be carefully watched while treating for fear of peritonitis or shock.

Care during attack

• Bed rest
• Avoid oral foods and go for intravenous (IV) drips
• Once you get better, liquid diet can be taken, if tolerated

To prevent future attacks

• Take fibre-rich diet like vegetables, fruits, etc.
• Take meals at regular intervals
• Drink plenty of water to move the digested particles easily
• Don’t do any exercises for abdomen muscles, also don’t lift any weight for 3 months
• Avoid alcohol, beer, tobacco, smoking, coffee, tea, etc., since these things can precipitate the pain
• Avoid antacids, pain killers and laxative drugs, since they can mask the symptoms of the disease and also sometimes these drugs can precipitate the attack
• Avoid psychological tension or anxiety

Homeopathic approach – Homeopathy can help in treating the chronic condition of appendicitis, but in case of acute emergency, if time doesn’t permit taking Homeopathic medicines, then, there is no other go except the way of surgical removal. Everyone would know that life is more important than the system or the doctor. Each and every system has its own limitations and advantages. When the condition is very acute and requires emergency surgical intervention, then don’t wait and waste time any more without getting the appendix operated upon. Acute appendicitis is really a difficult condition to treat, since it involves danger to life. Due to that fear, many doctors and patients accept surgical procedures in doubtful conditions also. Everyone should be very careful in treating appendicitis, since it can recur acutely at anytime.

Many patients can feel the same pain in the same area, even after the removal of appendix. Here these patients can now rule out appendicitis pain and trace other factors without blaming the innocent appendix.

And if you can escape from the acute first episode without operation, Homeopathy can help you avoid unnecessary operation with symptomatic treatment. Usually, the first episode will subside within a week, but the patient may have residual, persistent symptoms even after relief. Each and every symptom of the patient will be treated in Homeopathy with careful analysis for complete cure. Homeopathic treatment can provide lifetime solutions by curing it completely if treatment is taken properly.

Homeopathic medicines commonly used in the case of appendicitis are Ars Alb, Belladonna, Bryonia, Colocynth, Dioscorea, Echinacea, Ferrum phos, Hepa sulp, Ignatia, Iris Tenax, Kali bich, Lachesis, Lillium Tig, Lycopodium, Mag phos, Nat sulp, Nux vom, Plumbum, Pulsatilla, Pyrogen, Rhus tox, Sulphur, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

 

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)