Title: Appendicitis
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 1 - Ethiopia (Full)

Appendicitis

Appendicitis is an acute condition which occurs as a result of inflammation of the appendix. The appendix is a small tube, closed at one end, which is found at the junction between the small and the large intestine (Figure 8.1). It has no known function in digestion. The appendix can become inflamed when pieces of food get trapped in it and infection develops in the rotting food.

Figure 8.1 The digestive tract or gastrointestinal system is the tube-like passage from the mouth, through the stomach and intestines to the anus, together with the organs that connect with it (e.g. the liver, spleen and pancreas). (Source: The Open University, 2006, Living with Diabetes, Figure 2.1)

Acute appendicitis commonly affects adolescents and young adults, but it can occur at any age. The typical symptoms and signs that make you suspect someone has acute appendicitis include:

- Pain around the navel (belly button) which later shifts to the lower abdomen, particularly on the right side. Notice in Figure 8.1 that the appendix is on the lower right side of the abdomen.
- Fever (body temperature above 37.5ºC)
- Nausea and vomiting
- Tenderness and rigidity of the abdominal muscles guarding the affected internal organs.

If you see a person with the above symptoms which have only recently begun, refer them to a health centre or hospital for assessment. You can give two paracetamol tablets with a small cup of water to help to relieve the pain, but tell the person not to eat or drink anything else until they have been seen by a doctor. If they have acute appendicitis, the appendix will have to be removed surgically by an operation to the abdomen. Reassure the patient that this type of surgery is straightforward and they will soon recover afterwards.

Can you remember why eating or drinking is not advised for a patient who is being referred for possible surgery?

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You learned in Study Session 7 that the reason the stomach should be empty before surgery is to avoid the patient vomiting food or drink and obstructing their lungs when they are unconscious due to the anaesthetic.

If the affected person comes to you several days after the onset of appendicitis, the infection may have spread outside the appendix into the rest of the abdomen. Widespread infection in the abdomen is called abdominal sepsis and it can lead to septic shock, which is manifested by low and falling blood pressure, fast pulse, rapid respiration, fever and extreme abdominal pain. Without urgent surgery to remove the inflamed appendix and antibiotic treatment for the infection, a person with septic shock will soon die. If you have been trained to do so, insert an intravenous (IV) cannula into a blood vessel in the person's arm and begin fluid therapy with a litre of Normal Saline or Ringer's Lactate solution. Make sure the fluid infusion continues during the journey to a health centre or hospital.

Refer a person with acute abdominal pain urgently! If they develop septic shock, death will soon follow.