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Appendicitis, inflammation of the appendix, more properly known as the
vermiform appendix, a fingershaped sac three to six inches long which
projects from the large bowel, in the lower right quarter of the abdomen.
Infection and inflammation of the appendix are potentially serious because
the infection may spread to the peritoneum, the membranous tissue which
lines the abdomen. Acute peritonitis, or inflammation of the peritoneum, is
a grave development and may be fatal unless treated promptly.
Peritonitis may result from appendicitis in at least two ways. The
peritoneum is shaped to fit over the appendix, just as a glove covers a
finger, and is thus in close contact with it. Accordingly infection of the
appendix may spread to the Peritoneum simply by contact. Moreover, if an
inflamed appendix is left untreated, it may rupture or develop gangrene. In
either case, masses of infected matter will be discharged into the peritoneal
These possibilities demand that the condition be accorded immediate
attention by a physician. Delay often unnecessarily permits the
development of complications, renders treatment more difficult, and may
possibly endanger life. Attempts to diagnose and treat the symptoms of
appendicitis without a physician, by ascribing the symptoms to a
gastrointestinal disturbance and administering a cathartic or laxative, may
have serious consequences. Abdominal pain should never be treated
with a cathartic or laxative without the cause of the pain being first
Appendicitis usually begins with a sick feeling, accompanied by nausea,
lack of appetite, and at first a rather diffuse abdominal soreness. Vomiting
may occur, and a rise in temperature is likely. Gradually the pain tends to
concentrate on the right side of the abdomen below the navel and the
muscles in that region tighten when pressed in examination.
Symptoms indicative of appendicitis can actually arise from nothing more
serious than accumulation of gas or solid matter in a part of the bowel.
However, ordinarily these symptoms disappear with elimination from the
bowel. If they persist, the doctor should be promptly consulted. He will
determine whether or not appendicitis has actually occurred. Examination
of the blood will usually show abnormal numbers of white cells if the
appendix is infected.
Diagnosis is not always easy because of the variety of difficulties which
may manifest similar symptoms. This is especially true of the resemblance
between the early stages of appendicitis and, in some cases, of early
pneumonia. In early pneumonia, inflammation in the lower lungs may
spread to the diaphragm, the large breathing muscle which walls off the
chest and abdominal cavities from each other. Pain is present in the same
part of the abdomen as in appendicitis, and is also accompanied by rigidity
on touch.
Because of the danger presented by an inflamed appendix, surgery is a
common and satisfactory means of eliminating the condition.
Appendectomy is so completely standardized that recovery will usually be
normal, if the operation takes place before the appendix ruptures.
If the appendix has ruptured, or has become gangrenous, however, the
situation is much more serious. Ordinarily, in a simple appendectomy,
the patient will be up in two or three days, and sent home from
the hospital in a week. When complications occur, the condition demands
different considerations and may involve much more time. Fortunately the
antibiotic drugs such as penicillin, terramycin, aureomycin, and others
control peritonitis so that death from this complication is now rare.
The precise way in which appendicitis develops is not fully understood.
Doctors once believed that it was the result of food lodging in the
appendix. Many appendices removed and examined were found to contain
a variety of unexpected objects and materials, such as stones, hair, seeds,
pins, bones, lead shot, and sometimes worms. Many other appendices,
however, did not contain anything foreign. It is now felt that inflammation
and infection are commonly caused by germs.
The structure of the appendix, with its long slender tube, narrow opening
at one end only, and lining of lymphatic tissue, makes it susceptible to
inflammatory swelling and the resulting closure. The organ then cannot
empty its contents. An abscess forms, the swelling increases, and the
accumulating infected and lymphatic matter within the tube cannot escape.
The appendix may then burst or become gangrenous. Gangrene is the
atrophy of the tissues locally affected.
Sudden relief after a period of pain should be considered a potential danger
signal rather than a sign of improvement, for it may signify that
perforation has occurred or that gangrene has begun.

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