Appendicitis

Disease: Appendicitis (Appendicitis, Appendicitis)

1) Disease Description (Causes and Symptoms)

• Definition and pathophysiology: When the lumen of the appendix is obstructed, mucus and secretions accumulate, increasing intraluminal pressure and causing reduced blood flow and ischemia. Bacterial proliferation and inflammation then progress, and in severe cases may lead to perforation, peritonitis, and abscess formation.
• Main causes: Fecalith, overgrowth of lymphoid tissue (especially in children/adolescents), foreign bodies, parasites, tumors, or inflammation of adjacent organs.
• Typical symptoms: Vague pain around the navel (upper abdomen) initially → migration to the right lower quadrant (RLQ) within several hours, loss of appetite, nausea and vomiting, fever, localized tenderness (especially at McBurney’s point), rebound tenderness, Rovsing’s sign, etc.
• Atypical symptoms: Depending on the location of the appendix (retroperitoneal, pelvic, etc.), symptoms may include flank pain, urinary or diarrheal symptoms, or constipation. In children, older adults, and pregnant women, symptoms may be vague or the risk of perforation may be higher.
• Referenced risk level (reported in the literature): Perforation has been reported to occur in approximately 20% of cases within 24 hours after inflammation begins and approximately 70% within 48 hours; prompt diagnosis and treatment are therefore recommended. (Based on the provided material)

2) Treatment Methods and Precautions

• Standard treatment
  • Surgical treatment: Appendectomy is the standard treatment. Laparoscopic surgery is recommended as the first choice when possible (with advantages such as faster postoperative recovery and less pain).
  • Antibiotics alone: May be considered in selected patients with mild symptoms and uncomplicated disease on imaging (no perforation or abscess). However, because there is a risk of recurrence (an annual recurrence rate exists), the advantages and disadvantages and the patient’s preferences should be discussed with a doctor.
  • When complications (perforation, abscess, etc.) are present: Emergency open surgery is required if peritonitis is severe. When an abscess has formed, inflammation may be controlled with percutaneous drainage followed by antibiotics, and an interval appendectomy may be performed later (e.g., after 6–12 days).
• Antibiotics
  • During the perioperative period and conservative treatment, antibiotics covering gram-negative bacilli and anaerobic bacteria are used (e.g., piperacillin–tazobactam or ceftriaxone + metronidazole). The treatment duration varies depending on the circumstances; for uncomplicated cases, a single preoperative dose may be used, while for complicated cases treatment may last 5–7 days or longer, or may be extended depending on the course after drainage.
• Emergency signs — Immediate emergency-room visit required
  • Rapid worsening of pain, persistent high fever, generalized abdominal rigidity (signs of peritoneal irritation), signs of shock (hypotension and tachycardia), or inability to drink fluids due to persistent vomiting, etc.
• Precautions after surgery and treatment (self-care)
  • Keep the incision clean and contact the hospital if fever, swelling, or severe pain occurs.
  • After laparoscopy, walking and returning to simple daily activities are usually possible within a few days; heavy lifting and strenuous exercise should be restricted according to the doctor’s instructions.
  • Adverse effects of antibiotics (allergic reactions, gastrointestinal symptoms, etc.) should be reported.
• Risk of complications
  • After surgery: Wound infection, intra-abdominal abscess, intestinal obstruction (adhesions), fistula formation, etc.
  • With conservative treatment: Treatment failure may delay surgery, increasing the risk of perforation and peritonitis; recurrence is possible.

3) Checkpoints and Items to Prepare Before an Outpatient Visit (Hospital Visit)

• Items/information to prepare
  • A list of current medications (including prescription drugs, over-the-counter drugs, herbal medicines, and supplements) and any medication allergies.
  • The time symptoms began, the nature of the pain (changes in location/intensity), whether antipyretics or painkillers were taken, and the response to them.
  • Recent temperature records (whether fever was present and the highest temperature), and any vomiting, diarrhea, or changes in bowel movements.
  • Information about previous surgeries and chronic diseases (cardiovascular disease, diabetes, use of anticoagulants, etc.).
  • For women, whether pregnancy is possible (pregnancy status needs to be confirmed).
  • If possible, copies of previous abdominal imaging (ultrasound or CT) or test results.
• Examples of medical-history questions during the visit
  • When did the pain begin, and how has it progressed (does it stay in one place or move)?
  • Are there any positions or activities that affect the pain (movements that worsen or improve it)?
  • Are there vomiting, loss of appetite, bowel problems, blood in the urine, or other symptoms?

4) Examples of General Questions to Ask the Doctor

• "Is surgery absolutely necessary in my case, or can I be treated with antibiotics alone?"
• "What are the advantages and disadvantages of surgery (laparoscopic versus open), and what is the expected recovery period?"
• "What are the main side effects of the antibiotics to be used, and how should an allergic reaction be managed?"
• "How likely are recurrence and complications, and what is the prognosis?"

5) Examples of Disease-Specific Questions

• "If the imaging results (ultrasound/CT) show perforation or an abscess, is immediate surgery necessary, or is it possible to drain it first and wait?"
• "If my symptoms improve with antibiotics alone, do you recommend an appendectomy later? Please explain while taking the recurrence rate, advantages, and disadvantages into consideration."

Note: Diagnosis and treatment vary depending on the patient’s condition and the results of imaging and blood tests. Emergency surgery or conservative treatment will be determined based on the doctor’s assessment; if you have emergency symptoms, please visit an emergency room immediately.