1.

Definition

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from

your colon on the lower right side of your abdomen. The appendix doesn't seem to have a
specific purpose.

Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins
around the navel and then moves. As inflammation worsens, appendicitis pain typically
increases and eventually becomes severe.

Although anyone can develop appendicitis, most often it occurs in people between the ages of
10 and 30. Standard treatment is surgical removal of the appendix.

Appendicitis most often affects people between the ages of 10 and 19 years, and is usually
caused by an abdominal infection that has spread to the appendix, or by an obstruction that
has blocked up the appendix.

If your child's abdominal pain worsens with movement, deep breaths, coughing, or sneezing,
the chance that he or she has appendicitis becomes all the more likely. It's important,
however, to look for other signs of appendicitis.

2. Causes
A blockage in the lining of the appendix that results in infection is the likely cause of
appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed,
swollen and filled with pus. If not treated promptly, the appendix can rupture
3. Clinical Manifestation

In most adults, there is a very specific set of appendicitis symptoms that accompany
abdominal pain. These often include:

Loss of appetite

Nausea

Vomiting

Low-grade fever

Inability to pass gas

Abdominal swelling

Constipation or diarrhea
Research suggests, however, that appendicitis usually affects children differently than adults.

Along with abdominal pain, most kids with appendicitis often experience fever and a
symptom known as rebound tenderness, a sharp pain that develops after pressure is placed
on the lower right abdominal area and quickly released.

Children may also have an elevated white blood cell count, which is a sign of a bodily
infection this is something your doctor can check.

Importantly, though some kids with appendicitis do experience other hallmark symptoms of
appendicitis, including nausea, vomiting, and lack of appetite, these signs are not predictive
of appendicitis in children, according to a 2007 study published in the Journal of the
American Medical Association.

Additionally, appendicitis may elicit different sets of symptoms with very young children.
Some studies suggest that kids between the ages of 2 and 5 most often experience
stomachaches and vomiting if they have appendicitis; fever and loss of appetite also
frequently occur.

For infants less than 2 years old, appendicitis usually causes vomiting, stomachaches, and
fever, though diarrhea is not uncommon, either.

When to see a doctor

Make an appointment with a doctor if you or your child has worrisome signs or symptoms.
Severe abdominal pain requires immediate medical attention..

4. Complications

Appendicitis can cause serious complications, such as:

A ruptured appendix. A rupture spreads infection throughout your abdomen

(peritonitis). Possibly life-threatening, this condition requires immediate surgery to
remove the appendix and clean your abdominal cavity.
A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a
pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a
tube through your abdominal wall into the abscess. The tube is left in place for two
weeks, and you're given antibiotics to clear the infection.

Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the
abscess is drained, and the appendix is removed immediately.
 5. Tests and diagnosis

To help diagnose appendicitis, your doctor will likely take a history of your signs and
symptoms and examine your abdomen.

Tests and procedures used to diagnose appendicitis include:

Physical exam to assess your pain. Your doctor may apply gentle pressure on the
painful area. When the pressure is suddenly released, appendicitis pain will often feel
worse, signaling that the adjacent peritoneum is inflamed.

Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your
abdominal muscles in response to pressure over the inflamed appendix (guarding).

Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital
rectal exam). Women of childbearing age may be given a pelvic exam to check for
possible gynecological problems that could be causing the pain.

Blood test. This allows your doctor to check for a high white blood cell count, which may
indicate an infection.
Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary
tract infection or a kidney stone isn't causing your pain.
Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal
ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find
other causes for your pain.

6. Treatments and drugs

An appendictomy , which involves the surgical removal of the appendix, is the

standard treatment for appendicitis in children as well as adults.

If appendicitis is not caught in its early stages, the appendix can rupture and cause an
infection of the peritoneum, the membrane lining the abdominal cavity. This infection,
called peritonitis, can quickly spread, potentially causing death.

Because appendicitis is more difficult to diagnose in children than adults, some 30

percent of kids with the condition will suffer from a perforated (ruptured) appendix
before being treated.

For many years, doctors thought the best course of action for a perforated appendix is
to take care of the infection of the peritoneum with antibiotics before conducting an
 appendectomy. In this case, the appendix isn't removed until 6 to 8 weeks after the initial
diagnosis.

However, research published in the journal Archives of Surgery in 2011 suggested

that kids recover quicker and are less likely to suffer from post-surgery complications,
such as surgical site infections, if their ruptured appendices are removed within 24 hours
of diagnosis.

Appendicitis treatment usually involves surgery to remove the inflamed appendix.

Before surgery you may be given a dose of antibiotics to prevent infection.

Surgery to remove the appendix (appendectomy)

Appendectomy can be performed as open surgery using one abdominal incision about 2
to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a
few small abdominal incisions (laparoscopic surgery). During a laparoscopic
appendectomy, the surgeon inserts special surgical tools and a video camera into your
abdomen to remove your appendix.

In general, laparoscopic surgery allows you to recover faster and heal with less pain and
scarring. It may be better for people who are elderly or obese. But laparoscopic surgery
isn't appropriate for everyone. If your appendix has ruptured and infection has spread
beyond the appendix or you have an abscess, you may need an open appendectomy,
which allows your surgeon to clean the abdominal cavity.

Expect to spend one or two days in the hospital after your appendectomy.

Draining an abscess before appendix surgery

If your appendix has burst and an abscess has formed around it, the abscess may be
drained by placing a tube through your skin into the abscess. Appendectomy can be
performed several weeks later after controlling the infection.

7. Lifestyle and home remedies

Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To
help your body heal:

Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit
your activity for three to five days. If you had an open appendectomy, limit your activity
for 10 to 14 days. Always ask your doctor about limitations on your activity and when
you can resume normal activities following surgery.
Support your abdomen when you cough. Place a pillow over your abdomen and apply
pressure before you cough, laugh or move to help reduce pain.
 Call your doctor if your pain medications aren't helping.Being in pain puts extra
stress on your body and slows the healing process. If you're still in pain despite your pain
medications, call your doctor.
Get up and move when you're ready. Start slowly and increase your activity as you feel
up to it. Start with short walks.
Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it
easy and rest when you need to.
Discuss returning to work or school with your doctor. You can return to work when
you feel up to it. Children may be able to return to school less than a week after surgery.
They should wait two to four weeks to resume strenuous activity, such as gym classes or
sports.

8. Alternative medicine

Your doctor will prescribe medications to help you control your pain after your
appendectomy. Some complementary and alternative treatments, when used with your
medications, can help control pain. Ask your doctor about safe options, such as:

Distracting activities, such as listening to music and talking with friends, that take your
mind off your pain. Distraction can be especially effective with children.
Guided imagery, such as closing your eyes and thinking about a favorite place.
REFERENCES :

http://www.mayoclinic.org/diseases-conditions/appendicitis/basics/alternative-
medicine/con-20023582. Sunday, 1st of March 2015. At 16.59 WIB