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WHAT  IS  APPENDICITIS?

The appendix is a small, thin out pouching of the large intestine, about the size and shape of your child's little finger. It lies in the lower right side of the stomach and it is not thought to have any function. Appendicitis is inflammation of the appendix.

• Normally the liquid contents of the intestine pass into and out of the appendix quite freely. However, sometimes the narrow mouth of the appendix becomes blocked either by a hard piece of faecal matter or swelling of the tiny 'lymph follicles' in the intestinal wall.
• When the appendix is blocked, faecal substances get trapped inside and the appendix becomes inflamed and swollen. This swelling is made worse by the action of the millions of bacteria that are present. Eventually the appendix may burst, allowing bacteria to enter the abdominal cavity, and cause peritonitis, which is a serious infection
• Most cases of appendicitis occur in children aged between six and 10. Appendicitis is uncommon in the under-fives and rare in infants of less than two years. Appendicitis is more serious in young children because the appendix has often burst by the time a doctor operates to remove it.
• You cannot prevent your child getting appendicitis, although it may be linked with a diet low in fibre.

Signs and symptoms

Appendicitis is difficult to diagnose as the symptoms may be present in other conditions, but look out for the following:

Stomach pains: these may start as a constant, dull ache in the region of the tummy button; later this may worsen and move to the lower right side of the abdomen.

Nausea: with or without vomiting.

Loss of appetite: your child may lose his appetite and refuse food.

A fever: this will be low grade at first, but will increase if the appendix bursts and infection spreads within the abdominal cavity

Constipation or diarrhoea: the infected appendix can irritate the neighboring intestine.

Tenderness: pressing gently on the tummy, especially on the lower right, may identify a sore area; the tummy may even feel hard as the muscles contract to protect the painful area.

Frequent urination: irritation of the bladder by an inflamed appendix may make your child want to pass urine more frequently than usual.

Diagnosing appendicitis

When you take your child to your up, the doctor will try to diagnose whether your child has appendicitis.

• The doctor will ask you about your child's symptoms, particularly about the pain. Encourage your child to tell you how she feels while the doctor listens
• The doctor will need to feel your child's tummy gently while she is lying down. This may hurt if there is inflammation, so don't tell her that it won't hurt and be ready to comfort her.
• The doctor may want to take a sample of urine from your child to check for a bladder infection.
• If appendicitis is suspeded, you will be asked to take your child to the hospital. The doctors there will make the final decision and decide whether or not to operate.

Appendicitis is a condition that can be difficult to diagnose. A doctor will feel your child's tummy gently while asking her questions.

Dos  and  Don'ts

If you have any reason to suspect that your child has appendicitis, you must seek medical help straightaway.

• Do keep your child cool by sponging him with tepid water, if there is a fever.
• Do act quickly and seek urgent medical advice, if necessary by going to the accident and emergency department of your hospital.
• Don't give anything to ease the pain, as the location and severity of the pain are important clues in the diagnosis of appendicitis.
• Don't give your child anything at all to eat or drink in case he needs an operation.

Treatment of Appendicitis

The only sure way of treating appendicitis is to remove the appendix, in an operation known as an 'appendicectomy'. This is usually a straightforward operation.

• There are two ways to do an appendicectomy. The first is the 'open' method, which involves an incision, or cut, in the tummy. The second is 'keyhole' surgery, where a telescope is used and only two very small cuts are needed. The doctor will discuss with you which is the most suitable.
• In either case your child will be given a general anaesthetic and so will be asleep during the surgery.
• During the operation the appendix will be removed and then the wounds stitched up again.
• Your child will probably be given some antibiotics to kill any infection, especially if the appendix has burst because this can be dangerous

The removal of the appendix is a simple operation, but your child will be monitored closely in hospital.

Recovery in hospital

After surgery your child will probably be in hospital for three to five days, depending on how quickly he recovers. You will be encouraged to stay with him.

• Any general anaesthetic can leave a child feeling a little forgetful, tearful and 'groggy' for around 24 hours.
• Your child may have a’ drip' in his arm to give him fluid.
• A tube may be coming out of the skin near the wound to help drain tissue fluids from under the skin.
• The wound may be held together with clips or stitches and will be covered with a dressing, which the nurses will change regularly
• Your child may need some mild painkillers to help with discomfort.
• Your child will be up and about fairly soon, probably just climbing gently out of bed on the first day and spending much of second day up.
• He should pass urine within 12 hours, but may not have a bowel movement for two to three days.

Recovery  at  home

Young children usually get better from an appendicectomy quite quickly, although the recovery time may be longer after a burst appendix. Your child will be back to normal in about six weeks.

1.   The wound can be gently cleaned in the shower or bath, using just soap' and water.

2.   You can expect your child to be tired for a week or two as a result of the surgery. She will perhaps need more daytime naps than she did before.

3.   In two weeks your child may go back to nursery or school, although she must not be allowed to lift; anything heavy or be involved in 'rough and tumble' play for another two weeks.

4.   When you leave the hospital you will be told about arrangements for removing the stitches and any follow-up treatment.

5.  The wound should heal fairly quickly, although it may look bruised for a time.

For  More  Information:  Please  consult  your  physician  on  your  next  visit.