Abdominal pain: The story of appendicitis


Understanding the story of acute appendicitis brings us to understand other causes for a belly ache or abdominal pain. Like many other causes of abdominal pain, appendicitis is a blockage of a smooth muscle tube (SMT). We have a lot of these hollow transport tubes in our bodies including: esophagus, stomach, small and large intestines, kidneys, ureters, bladder and urethra, bile ducts, pancreatic ducts and gallbladder, fallopian tubes, the uterus and even the aorta and blood vessels. 

When anything blocks the forward-moving squeezing of one of these SMTs, people have cramping spasm-like pain that lets up and comes again later with nausea or vomiting adding to the misery of the situation. Patients usually can’t find a comfortable position and are all over the bed, moving and anxious. 

While appendicitis is a blockage where the appendix and the large intestine meet, other examples of smooth muscle tube blockage include blocked colon with cancer, blocked kidney or ureter with stones, perforating aortic aneurysm with obstructed flow, infection of the gallbladder with gallstone obstruction and blocked fallopian tube with an ectopic pregnancy.

When appendicitis is just beginning, the pain is around the belly button. As appendicitis worsens, pain moves from the belly button to the lower right abdomen and intensifies until either the blockage is resolved (usually with surgery or antibiotics) or the appendix ruptures, spilling fecal material and infection out into the abdominal cavity. This causes severe infection and inflammation especially affecting the smooth lining that surrounds the abdominal cavity. The lining has plenty of nerves and thus, this causes a new and exquisite type of pain. 

Now we have peritonitis (inflamed peritoneum) which causes the patient to stop moving, to become still, almost frozen to the table or bed, not wanting anyone to touch him. This is a dangerous situation and requires emergency intervention. Other examples of pain from peritonitis include perforated stomach ulcer or ruptured diverticula, gallbladder or ovarian cyst.

Clues as to what is causing either blocked SMT or peritonitis pain come with location of pain, the history of the progression of the illness, and the physical examination. Laboratory and X-ray may also help. People with non-dangerous belly pain, often have recurrent constipation, menstrual symptoms or bladder infections and should seek help at the outpatient clinic. In contrast, some clues to bring one to the emergency room should include progressive, unexplained, severe abdominal pain, shaking chills and blood in the urine or stool. 

Understanding how a blocked SMT or peritonitis happens with appendicitis, helps, in turn, to explain the many possible causes of a belly ache. 

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