Appendicitis and preventive care

There are still 15,000 to 20,000 deaths a year in this country from appendicitis and its complications. Naturally, it is of the utmost importance to reduce the possibility that an inflamed appendix will rupture. There- fore, if symptoms are equivocal after 8 to 12 hours of observation, the physician will be inclined to operate rather than risk rupture. 

The patient's role in preventing rupture is important. Delay in diagnosis or improper treatment greatly increases the risk. The guidelines are simple:

1. Do not treat any abdominal pain lasting for 3 to 4 hours with cathartics, enemas or local heat. Laxatives and enemas increase contractions in the large intestine and cause pressure to develop in the appendix, increasing the chance of rupture. With each dose of laxative, the risk of rupture and death increases greatly. Local heat may obscure symptoms and may also hasten rupture.

2. Consult a physician as soon as possible.

3. Do not eat or drink anything. Recurrent attacks of acute appendicitis are uncommon but can occur. Chronic appendicitis-that is, appendicitis causing pain for weeks or months-does not occur; this type of pain is indicative of other medical or surgical problems.  

 It most frequently affects the joints of the fingers, wrists, knees, ankles, and toes, alone or in combination, although all joints may be involved. One hallmark of the disease is that usually both sides of the body are affected; that is, both hands and both ankles, for example, are involved at the same time. 

Appendix and appendicitis

A more complex question is whether a person who plans to be away from civilization for a period of time should have his appendix removed as a prophylactic precaution. With modern means of communication and travel, this is probably not necessary unless the person will be extremely isolated (as on a Pacific island or in an unexplored jungle area). 

The best secondary preventive measure is prompt diagnosis and treatment of an inflamed but still un-ruptured appendix. The problem here is that the initial symptoms of appendicitis may be mimicked by so many other conditions-pneumonia with abdominal pain, gallbladderdisease, ruptured ovarian follicle, tubal pregnancy, or just plain gastroenteritis-that the diagnosis of appendicitis can tax the most astute physician. The symptoms usually are nausea, abdominal pain, and loss of appetite, and sometimes fever, constipation or diarrhea. 

Typically, the pain of appendicitis will become most severe in the lower right side of the abdomen where the appendix is usually located. Since the appendix in some individuals may be located in an unusual position, pain may localize elsewhere. Careful history-taking and physical examination with close attention to where the pain is located are the most useful diagnostic measures. As noted, the pain of appendicitis is typically much localized; to pinpoint it further, a rectal orvaginal examination is of value. Suggestive clues such as in- creased white blood cell count, fever, and failure of symptoms to subside help confirm the diagnosis.

Treatment is surgical removal, and with good anesthesia and modern surgical techniques, the risk of surgery is virtually zero, while problems encountered after an appendix ruptures are formidable. After removal of an intact inflamed appendix, the patient is usually out of bed next day and home from the hospital in five to seven days. 

Further convalescence is ordinarily uneventful. Even those suffering from other ailments such as heart disease usually come through the surgery and anesthesia very well. In contrast, a ruptured appendix calls for intravenous feeding, antibiotics, strict bed rest sometimes for several days before surgery can even be performed. Recovery from surgery may involve several weeks of hospitalization because, even with antibiotics, peritonitis is still a difficult and dangerous medical problem.