Is it appendicitis or not?
Stomach ache is one of those things. It can be a harbinger of gastrointestinal illnesses, indicate flatulence or constipation or have psychological causes; for example, if your son or daughter doesn't feel like going to nursery or school. This is why very few parents immediately ring the alarm bells when their child complains of a stomach ache. It's different if it points to the right lower abdomen. What was that again? The appendix is on the right and then you have to react quickly - right?
In fact, the symptoms of appendicitis are rather unspectacular. «If the child suddenly cries and writhes in pain, it's almost certainly not appendicitis,» says paediatrician Susanna Kemper, who has her own practice in Zurich. Constipation, flatulence or other intestinal problems are more likely.
There are no preventive measures to avoid appendicitis.
On the other hand, Kemper is alarmed by complaints of diffuse abdominal pain that becomes increasingly severe over a longer period of time. It often starts with a little abdominal pain around the navel, with slight discomfort. Only later does the pain move to the right lower abdomen. The child lies around feeling weak, pale and without appetite, perhaps feeling a little nauseous, possibly with a slight fever (around 38 degrees).
If the abdominal pain persists over a longer period of time and the child walks bent forward to relieve the tension in the abdominal wall because the pain would otherwise be too severe, you should visit a doctor's surgery. There, Kemper and her team will carry out various tests: «Palpate all four abdominal quadrants thoroughly with both hands,» says the doctor, describing the examination.
This is usually not a problem, unless there is appendicitis. In this case, the patient can barely stand the palpation. If the abdominal wall is already hard, Kemper sends her patients to hospital immediately.
Appendicitis quite common in childhood
However, in eight out of ten children and adolescents who come to her practice with suspected appendicitis, the doctor is unable to make such a diagnosis. Nevertheless, the doctor shows the parents how they can palpate their child's abdomen at home.
If the son or daughter continues to complain of abdominal pain, it is important as parents to stay close to the child and observe closely - for example, whether the sensitivity of the abdominal wall increases and the pain becomes more severe. If this is the case, a new medical examination should be carried out to determine whether it is appendicitis after all.
If the pain occurs suddenly, it is almost certainly not appendicitis.
Susanna Kemper, paediatrician
Over five per cent of the population develops appendicitis at some point. It is one of the most common acute diseases of the abdomen. Children and adolescents between the ages of six and twelve are most frequently affected. The appendix is located in the right lower abdomen and is part of the so-called lymphatic system of the intestine. It presumably serves as a reservoir for intestinal bacteria.
Interesting to know: There is an eight-centimetre-long, worm-shaped appendix on the appendix, which doctors call the appendix. It has an entrance but no exit. Strictly speaking, it is not the appendix that becomes inflamed in appendicitis, but the appendix. Doctors therefore speak of appendicitis rather than appendicitis as is popularly known.
The appendix usually becomes inflamed because its entrance is blocked - for example by faecal stones (hardened stool residue), deposits or bacteria that have accumulated there. There are no preventative measures to prevent this inflammation. In most cases, the inflamed section of bowel has to be surgically removed.
Surgery is usually the best choice for appendicitis
«In itself, the operation is a routine procedure,» says Georg Staubli, Head of Department and Chief Physician of the Emergency Department at the University Children's Hospital Zurich. «At the same time, it can be difficult if the inflammation has already spread from the appendix to the surrounding tissue and an abscess has formed.»
If such an abscess forms, the paediatric hospital first tries to treat those affected with antibiotics. The appendix is only removed surgically once the inflammation has healed.
The operation is usually performed laparoscopically - i.e. by means of laparoscopy, which only requires small incisions in the skin. The appendix is separated from the rest of the bowel. Sometimes open surgery is performed for appendicitis - for example, if the inflammation is already spreading. This then requires a larger incision in the abdominal wall.
Patients usually stay in hospital for three to five days afterwards - until the bowel is fully functional again, the patient no longer has to vomit, bowel movements are normal again and regular food intake is possible. The scars do not require any special treatment.
Painkillers have no effect on appendicitis.
Georg Staubli, Head of the Emergency Department at the University Children's Hospital Zurich
Life-threatening breakthrough
If appendicitis is not treated or is treated too late, the inflamed tissue can burst (rupture of the appendix); intestinal contents and bacteria enter the abdominal cavity and this can lead to life-threatening peritonitis. If appendicitis breaks through into the abdominal cavity, the abdominal pain may even subside for a short time, but then become more severe again.
As soon as the inflammation in the abdominal cavity expands, further symptoms such as a hard abdominal wall, a hunched posture with legs drawn up due to severe pain, cold sweat, an increased pulse and light-headedness or even fainting may occur.
Parents are often faced with a difficult decision: What to do if the child suddenly complains of stomach ache in the evening or at the weekend and the paediatrician is not available? Doctor Georg Staubli gives clear advice: give the child a painkiller such as paracetamol or ibuprofen. «Normal abdominal pain will disappear,» he says. «But abdominal pain caused by appendicitis does not. This pain slowly gets worse.»
Normal stomach ache or appendix?
- The abdominal pain is sudden and severe. Appendicitis builds up slowly. The pain becomes increasingly severe over a period of hours and finally usually moves from the umbilical region to the lower right abdomen.
- The abdominal pain disappears as soon as the child takes painkillers (paracetamol, ibuprofen). Medication is of little use in the case of appendicitis. Nevertheless, the pain slowly gets worse
Symptoms that may indicate appendicitis
- The child can hardly bear palpation of the abdomen, the abdominal wall is already hard.
- The vomit has a greenish colour.
- Despite painkillers such as paracetamol or ibuprofen, the abdominal pain does not subside but becomes increasingly severe.
The colour of the vomit
Vomiting can also be a symptom of appendicitis - if the vomit has a greenish colour. «Really green,» Staubli clarifies, «because then it comes from the bile and should definitely be examined quickly.» Yellow vomit, on the other hand, is gastric juice and has many causes - the most common cause in such cases is gastroenteritis. Even if the vomiting does not bring (short-term) relief, it can be a sign of appendicitis.
But the paediatrician can also reassure parents: «If a child has a stomach ache in the afternoon and still has it in the evening, but can sleep reasonably well at night, it's enough to see the doctor the next morning. An appendicitis that comes in at 3 a.m. is no longer operated on anyway.» According to Georg Staubli, a child who is really unwell will of course not be turned away.
