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Dr QM Leong
Dr QM Leong

Stages Of Appendicitis: What You Need To Know

Stages Of Appendicitis: What You Need To Know

Appendicitis is when the appendix, a small pouch attached to the large intestine, becomes inflamed and infected.

The condition is characterised by acute abdominal pain, which can be severe and localised in the right lower quadrant of the abdomen.

There are usually various stages of appendicitis, depending on how severe the inflammation is and the presence of complications.

Appendicitis is usually classified into four stages: normal, uncomplicated appendicitis, acute appendicitis, and perforated appendicitis:

Normal Appendix

Located in the lower right side of the abdomen, the appendix is a small, tubular structure resembling a finger attached to the first part of the large intestine. It is filled with lymph, a clear fluid that contains white blood cells that help fight infections and is supplied with its own blood and nerve supply.

Traditionally, the appendix is considered a vestigial organ with no critical role in the body. However, recent studies suggest that the appendix supports the immune system

The appendix is believed to be a safe house for beneficial gut bacteria during gastrointestinal infections, allowing them to repopulate the gut after the illness has passed.

Uncomplicated Appendicitis

This is the earliest stage of appendicitis and occurs when the inflammation affects only the appendix. The symptoms at this stage are often mild, and individuals may experience a dull, achy pain around their navel that gradually moves towards the right lower quadrant of their abdomen.

Other symptoms may include nausea, vomiting, and loss of appetite. With early diagnosis and prompt treatment, appendicitis in this stage can often be managed successfully with antibiotics alone.

Acute Appendicitis

As the inflammation progresses, the condition enters the acute appendix stage, in which the inflammation spreads beyond the appendix to adjacent tissues.

This is also known as the complicated appendicitis stage, at which point the pain becomes more severe and affects the right lower quadrant of the abdomen.

Other symptoms may include fever, chills, and an elevated white blood cell count. An abscess may sometimes form, leading to complications such as sepsis or bowel obstruction. Treatment at this stage typically involves surgery to remove the appendix.

Perforated Appendicitis

The final stage of appendicitis occurs when the inflamed appendix ruptures, allowing its contents to spill into the abdominal cavity. This can cause severe pain and life-threatening complications such as peritonitis, sepsis, or abscess formation.

Treatment at this stage usually involves surgical removal of the appendix and antibiotic therapy to manage any associated infections. Recovery may take longer than in earlier stages, and patients may need to stay in the hospital longer.

What Are The Early Signs And Symptoms Of Appendicitis?

What Are The Early Signs And Symptoms Of Appendicitis?

If left untreated, appendicitis can lead to severe complications, making early detection and prompt treatment essential. Watch out for these symptoms of appendicitis:

Abdominal Pain

The most common symptom of appendicitis is abdominal pain. This pain typically starts around the navel and then moves to the right lower quadrant of the abdomen. Movements such as coughing or sneezing may worsen the pain.

Lack Of Appetite

A reduced appetite is another early sign of appendicitis. Patients may feel full or bloated, even after consuming only small amounts of food. 

Vomiting And Nausea

Nausea and vomiting may occur in the early stages of appendicitis. Patients may experience mild to severe nausea, which can lead to vomiting. Vomiting may also be due to an inflamed and irritated bowel.

Fever And Chills

Patients with appendicitis may develop a low-grade fever, which can be accompanied by chills. Fever and chills are signs that the body is fighting off an infection.

Swollen Lymph Nodes

Sometimes, the individual may develop swollen lymph nodes in the groin area. This can occur due to the spread of infection from the inflamed appendix.

Rebound Tenderness

Pressing on the abdomen and quickly releasing it may cause pain in individuals with appendicitis. This is known as rebound tenderness, a common sign of inflammation in the abdomen.

Diarrhoea Or Constipation

Changes in bowel movements, such as diarrhoea or constipation, can indicate appendicitis. This occurs due to the inflammation in the bowel that is caused by the inflamed appendix.

Urinary Symptoms

Individuals with appendicitis may sometimes experience urinary symptoms such as painful urination, frequent urination, or urgency. This occurs due to bladder inflammation that happens during advanced appendicitis.

Rectal Pain

Inflammation of the appendix can cause pain in the rectum, which can be a significant source of discomfort for some individuals.

Severe Constipation/Difficulty Passing Gas And Stool

Severe constipation and difficulty passing gas and stool are not typical symptoms of appendicitis. 

However, in rare cases, a severely inflamed appendix may compress the bowel and cause these symptoms.

General Feeling Of Unwellness

Feeling generally unwell or fatigued is common in individuals with appendicitis. This can be due to the body’s response to the infection.

What Are The Causes Of Appendicitis?

The exact cause of appendicitis is not always clear, but it is believed to occur when the appendix becomes blocked by a stool or a foreign object. This blockage can lead to the buildup of mucus and bacteria in the appendix, which can cause inflammation and infection. Other factors that may contribute to the development of appendicitis include:

  • Enlarged Lymph Tissue: In some cases, the appendix can become inflamed due to enlarged lymph tissue in the wall of the appendix. This can be caused by infections or inflammatory bowel disease.
  • Trauma: Trauma to the abdomen may also lead to inflammation of the appendix in rare cases.
  • Age and Gender: Appendicitis is most common in individuals between the ages of 10 and 30 and is slightly more common in males than females.
  • Genetics: Studies indicate that individuals with a family history of appendicitis are likely to develop the condition. Additionally, certain genetic variations have been identified that may increase an individual’s risk of developing appendicitis.

How Is Appendicitis Diagnosed?

Diagnosing appendicitis can be challenging, as its symptoms overlap with other conditions. However, early detection and prompt treatment are essential to prevent serious appendicitis complications.

Here’s what you need to know about how appendicitis is diagnosed:

Medical History

The doctor will begin by taking a thorough medical history, which may include questions about the patient’s symptoms, medical conditions, and family history of appendicitis. This can help the doctor determine whether the patient is at increased risk of developing the condition.

Physical Examination

The doctor will then perform a physical exam to assess the abdomen for tenderness, swelling, or a palpable mass in the right lower quadrant. This can help the doctor determine whether suspected appendicitis is the most likely cause of the patient’s symptoms.

Imaging Tests

Imaging tests, such as ultrasound or CT scan, may be used to visualise the appendix and surrounding structures. These tests can confirm the diagnosis of appendicitis and rule out other conditions.

In cases of chronic appendicitis, which may present with more subtle symptoms, imaging tests can be instrumental in making an accurate diagnosis.

Blood Tests

Blood tests are also commonly used in diagnosing appendicitis. Elevated white blood cell count and C-reactive protein levels are expected in cases of suspected appendicitis, indicating that the body is mounting an immune response to an infection or inflammation in the body.

Blood tests can also help rule out other potential causes of abdominal pain and other symptoms.

How Is Appendicitis Treated?

How Is Appendicitis Treated?

The treatment of appendicitis typically involves surgical removal of the appendix, known as an appendectomy.

Prompt surgical intervention is essential to prevent serious appendicitis complications, such as a ruptured appendix, peritonitis, abscess formation, and sepsis.

The appendix can be surgically removed through an open incision or minimally invasive laparoscopic surgery.

Laparoscopic surgery is associated with a faster recovery time and less postoperative pain than open surgery, making it the preferred approach in many cases.

Surgical removal of the appendix is often recommended in cases of recurrent appendicitis, where the patient experiences multiple episodes of appendicitis.

Recurrent appendicitis can be challenging to diagnose, as the symptoms may be similar to conditions like gastroenteritis, Crohn’s disease, pelvic infection, etc.

However, a clinical diagnosis of appendicitis based on a combination of symptoms, physical exam findings, and imaging tests can guide appropriate treatment.

What Happens During An Appendectomy?

If your surgeon has advised you to undergo an appendectomy, knowing what to expect can help give you peace of mind before your scheduled surgery:

  1. Anaesthesia: The patient is given anaesthesia to ensure they are unconscious and pain-free during the surgery.
  2. Incision: In open surgery, the surgeon makes a small incision in the lower right abdomen to access the appendix. In laparoscopic surgery, several small incisions are made, and a camera and instruments are inserted to visualise and remove the appendix.
  3. Removal of the appendix: The surgeon then identifies and carefully removes the appendix from the surrounding tissues. Sometimes, the appendix may have ruptured, and the surgeon must clean the area to prevent infection.
  4. Closure: The incision or incisions are closed using sutures or staples. In laparoscopic surgery, the incisions are often so small that they do not require sutures or staples.
  5. Recovery: After the surgery, the patient is taken to a recovery room, where they will be monitored briefly before discharge. A doctor may prescribe pain medication to help manage discomfort, and the patient will receive postoperative care instructions.

What You Can Do To Prevent Appendicitis

Appendicitis is not always preventable, but there are some steps you can take to reduce your risk of developing the condition:

  • Eat a healthy diet: Eating a diet that is high in fibre and low in processed foods may help prevent the development of appendicitis. Fibre helps keep the digestive system functioning correctly, preventing blockages that can lead to inflammation of the appendix.
  • Maintain good hygiene: Washing your hands regularly and maintaining good hygiene practices can help prevent the spread of infections that can lead to appendicitis.
  • Seek prompt medical treatment for digestive issues: If you experience symptoms such as abdominal pain, nausea, or vomiting, seek medical attention promptly. Delayed treatment can lead to more severe clinical outcomes.
  • Get standard treatment for appendicitis: If you are diagnosed with appendicitis, it is crucial to get the standard treatment or an appendectomy. Delaying treatment can increase the risk of serious complications, such as a ruptured appendix.

Conclusion About The Stages Of Appendicitis

Recognising the stages of appendicitis is crucial to ensure prompt medical attention and avoid severe and potentially life-threatening complications.

Uncomplicated appendicitis is the first stage, followed by acute (complicated) appendicitis and a perforated appendix. Symptoms such as abdominal pain, nausea, vomiting, and fever can indicate appendicitis and early diagnosis and treatment are essential.

If you suspect you have appendicitis, seek immediate medical attention and consult with a qualified colorectal surgeon. Early intervention can prevent the progression of appendicitis and reduce complications.

Frequently Asked Questions About The Stages Of Appendicitis

Uncomplicated appendicitis is characterised by inflammation confined to the appendix, while complicated appendicitis occurs when inflammation spreads to adjacent tissues. Complicated appendicitis is associated with a higher risk of serious complications, such as abscess formation and peritonitis.

Complicated appendicitis is typically treated with surgical removal of the appendix and antibiotics to prevent or treat the infection. In some cases, drainage of abscesses may also be necessary.

Chronic appendicitis is a condition characterised by recurrent episodes of mild inflammation of the appendix. Symptoms may be less severe than acute appendicitis but can still include abdominal pain, nausea, and vomiting. Treatment typically involves an appendectomy.

Yes, a person can get appendicitis multiple times. Recurrent appendicitis is when a person experiences multiple episodes of appendicitis.

The risk of recurrent appendicitis depends on several factors, including the severity of the initial episode and whether the appendix was removed. Occasionally, recurrent appendicitis may indicate underlying medical conditions, such as inflammatory bowel disease.

Yes, appendicitis can cause long-term complications, such as bowel obstruction, infertility, and chronic abdominal pain.

Yes, Appendicitis can cause abscesses, which are pockets of pus that can form in the abdominal cavity. These will need to be drained in addition to antibiotic treatment.

Suspected acute appendicitis is a term used to describe cases where a person presents with symptoms that suggest appendicitis, but a definitive diagnosis has not yet been made.