Appendicitis (ER)

“Can you
show me where your tummy hurts?” asks Dr. Lonnie King, “Are
you hurting right now?”

What do you do when your child suddenly complains of stomachaches and
pains, begins running a low fever and becomes nauseated? While these complaints
could signal a number of ailments, quite often an inflamed appendix, known
as appendicitis, is the culprit. Appendicitis can be treated, but if it is
not diagnosed promptly, an inflamed appendix can burst, resulting in infection
or even death.

According to the Mayo Clinic, the appendix is a small, finger-shaped
pouch that projects out from the right side of the colon. The organ
has no known purpose and is not necessary for life, but if it becomes
infected, it can cause serious damage to the body.

The cause of appendicitis is unknown. Some experts speculate that the
disease may occur after a viral infection in the digestive track or
when an opening in the large intestine becomes blocked by food waste.
While it affects people of all ages, appendicitis most commonly occurs
in those aged 10 to 30.

Diagnosis of appendicitis can be difficult, as the illness
often disguises itself as another condition. According to the Nemours Foundation,
currently no laboratory tests specific to diagnosing appendicitis exist. Therefore,
It is extremely important that as a parent you are aware of the signs and symptoms
of appendicitis to ensure early diagnosis.

Appendicitis can cause a number of different symptoms that may change
over time. Often, the first and most obvious symptom is an aching pain
that begins around the navel and shifts to the lower-right abdomen.
As the inflammation spreads, the pain may become sharper and more severe.
Later, the pain may move downward and to the right to a location known
as McBurney’s point. The pain may continue to move around to
different locations of the abdomen, especially in young children. The
National Digestive Diseases Information Clearinghouse recommends watching
for the following additional symptoms in your child:

• Nausea
• Vomiting
• Constipation
• Diarrhea
• Inability to pass gas
• Low fever that begins after other symptoms
• Abdominal swelling
• Anorexia

After the abdominal pain begins, a child with appendicitis may develop
a slight fever, lose his or her appetite, feel nauseous, or even vomit.
Experts at the Nemours Foundation say that the fact that abdominal
pain begins before nausea and vomiting rather than after is often a
clue that the condition may be appendicitis rather than an intestinal
infection.

If your child begins exhibiting any of the symptoms previously mentioned,
it is important that you contact your child’s physician immediately.
The doctor will more than likely want to examine your child to determine
whether his or her appendix is inflamed. You and your child can expect
the following procedures to take place during such an examination:

• Your child’s doctor will likely take his or her temperature
  to determine if your child is running a fever.
• An abdominal exam will be performed and gentle pressure will be
  applied to the area that hurts. Often with appendicitis, when pressure
  is released the pain may increase.
• A blood sample may be taken for testing to determine if your child’s
  white blood cell count is high. A high count could signal an infection.
• A urinalysis (urine sample) may also be taken to rule out the
  possibility of a urinary tract infection.
• Your child’s doctor may also recommend an ultrasound scan
  to help confirm appendicitis.

If a diagnosis of appendicitis is not certain, a child with symptoms
and signs may be watched and sometimes treated with antibiotics. Those
with definite appendicitis have surgery to remove the appendix, which
is called an appendectomy. Doctors may use laparoscopic surgery for
an appendectomy, which includes making several tiny cuts in the abdomen
and inserting a miniature camera and surgical instruments. The surgeon
then removes the appendix with the instruments.

If your child’s doctor determines that he or she needs an appendectomy,
you and your child may become frightened at the thought of surgery
and a stay in the hospital. In fact, any time a child needs surgery,
parents should take their time to explain what will happen. Just remember,
some surgeries may be an emergency and you may not have much time to
spend with your child prior to the event. In the case that time does
permit, Saint Joseph’s Hospital suggests the following tips for preparing
your young child for any surgical event:

• Ask your child what he or she thinks will happen.
• Have your child color a picture about his or her upcoming operation
  and explain what it means (if time permits).
• Discuss feelings, fears and/or misconceptions with your child.
  Explanations should be simple and brief. Most important is that your
  child needs to understand that it is not his or her fault that he
  or she needs surgery. Explain that your child has not been bad and
  is not being punished. Helping him or her understand the need for
  surgery prevents guilt and shame.
• Using dolls, puppets or stuffed animals, let your child “act
  out” what he or she thinks will happen at the hospital. Then,
  clear up obvious misconceptions.
• Using medical toys also can assist your child in “acting
  out” hospital situations.
• Reading books from the library in regards to taking a trip to
  the hospital or having an operation also can help your child prepare
  for the event.
• Encourage your child to start a scrapbook, including everything
  he or she receives from the hospital and possibly taking pictures
  as some of the events take place.