The biology behind appendicitis
The appendix is a tube-shaped, small pouch located at the end of the large intestine. It is present in the lower right-hand side of the abdomen. Researchers haven’t been able to figure out its exact use yet. Though, many hypothesize that it has a role to play in recovering from inflammation, diarrhoea, and other infections occurring in the large as well as the small intestine. It may sound very heavy, but the body can perform adequately without the presence of an appendix.
When the appendix swells up, bacteria start multiplying to generate a lot of pus. The pus and bacteria build-up can cause extreme pain near the belly button which later spreads towards to lower right part of the abdomen. Coughing and walking will turn the situation worse. Diarrhoea, vomiting, and nausea can also be experienced.
It is extremely crucial for the patient to seek medical attention as soon as the symptoms of appendicitis start showing up. If the patient is not treated, the appendix can burst inside releasing bacteria and other harmful materials inside the abdominal cavity. This can turn into a life-threatening situation which will require a longer hospital stay as compared to the appendicitis surgery.
Types of Appendicitis and Procedure of Appendectomy
The type of surgery to be performed will depend on certain factors like the patient’s medical history and severity of the problem. When the surgeon is ready to begin the procedure, he can use either of the two common types of appendectomy. They are:
Open Appendectomy – This procedure is more of a “traditional” approach of removing the infected appendix. In this procedure, the surgeon will make an incision in the belly in order to locate the inflated appendix. It is then cut and removed from the large intestine. The site of incision is sealed with the help of stitches.
Laparoscopic Appendectomy –This surgical method makes use of a tiny video camera known as the laparoscope which helps surgeons look inside the body. The laparoscope has a thin tube which is inserted by making a small incision which is taken to the appendix by the surgeon. Other incisions are made for taking medical instruments to the site. The entire procedure is conducted with the help of a TV monitor.
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Appendicitis Treatment Procedure
The steps involved in an appendectomy are:
Step 1 – When the appendix becomes inflated, it starts causing extreme distress to the patient. As doctors don’t know any clear function of the appendix, for preventing diagnostic confusion, the doctor surgically removes it to avoid the chances of appendicitis in the future.
Step 2 – For removing the appendix, separating it from the mesentery (a tissue delivering blood to the site) is important. With the help of electric current from bipolar forceps (an instrument), the blood vessels are sealed to prevent bleeding.
Step 3 – Here the appendix is freed from the mesentery using scissors. The appendix is separated from the tissues surrounding it such as that the only connection it has is with the colon.
Step 4 – In this step, the base of the appendix is crushed with the help of a clam. Then it is moved towards the appendix’s end to position a pre-tied suture at the lower end of the appendix for tying it off.
Step 5 –After the suture is tightly secured just similar to a fisherman’s knot, it wouldn’t loosen up by itself.
Step 6 – The surgeon will cut the suture with a pair of scissors just above the knot.
Step 7 – Here, the surgeon will cut the appendix using scissors below the clamp but right above the knot for preventing any form of contamination.
Step 8 – This is the final step. Here, the surgeon along with his/her team inspects the area for the final time to make sure there is no internal bleeding.
Factors affecting the Cost of Appendectomy
The cost of appendectomy will vary significantly with respect to hospitals and countries. The cost will depend on several other factors, such as:
The hospital chosen by the patient
The room selected by the patient with the type of facilities
Diagnostic procedures and tests
The fee of the doctor and the team
Follow-up care along with the costs when the procedure is over
A Laparoscopic Appendectomy will cost higher than the traditional one because of the investment made in the technology and equipment.
Diagnosis for Appendectomy
The patient will experience sudden pain near the abdominal area which will be difficult to bear. The pain usually moves from the middle to the lower right side of the abdomen. The pain might fluctuate in the beginning, but will be quite sharp and persistent. Some of the other symptoms of appendicitis are:
When the patient visits the doctor for abdominal pain, the doctor will:
Try to figure out the characteristics and features of the pain
Conduct physical examination
Conduct further tests and exams
Finally endoscopy and surgery
The procedures and tests applied for diagnosing appendicitis are:
Physical exam to assess the pain: The doctor will put gentle pressure at the site that is painful. After releasing the pressure, the pain usually becomes worse in appendicitis which indicates having an inflamed peritoneum. The doctor will also look for abdominal rigidity and muscle stiffening response to abdominal pressure. A lubricated, gloved finger can be used for examining the lower rectum (also called digital rectal exam). Women in the childbearing age may also have to undergo a pelvic exam for potential gynaecological problems.
Blood test: This is to check the white blood cell count to show any potential form of infection.
Urine test: This is to make sure that a kidney stone or urinary tract infection is not the cause of the pain
Imaging tests: The doctor may also ask for an abdominal X-ray, ultrasound, or CT (computerized Tomography) scan to confirm the existence of appendicitis.