Caitlin Whyte (Host): Welcome back to BayCare HealthChat. I'm your host, Caitlin Whyte. Today, we're excited to have Dr. Eftechios P. Xanthoudakis, a Board Certified General Surgeon with BayCare Medical Group. He specializes in minimally invasive surgical techniques and has a wealth of experience in treating conditions affecting the abdominal organs. Join us as we dive into the important topic of appendicitis, its causes, symptoms and diagnosis.

Doctor, start our episode off today please, by explaining what appendicitis is and why it's a concern for many people.

Eftechios P. Xanthoudakis, MD: Of course. So, appendicitis is, by definition, inflammation of the appendix, which is a small organ that comes off the first portion of your colon, which is called your cecum. And it's a very common disorder that is seen in about a hundred per a hundred thousand people per year.

Host: And what are the common signs and symptoms of appendicitis that individuals should be aware of?

Eftechios P. Xanthoudakis, MD: So common signs and symptoms to be aware of are abdominal pain. Usually, the abdominal pain can start around the belly button region, and then eventually it can move to the right lower quadrant, along with nausea, vomiting, and loss of appetite. Pain can become worse also with coughing or walking or any sort of movements, so those are things that people should be aware of.

Host: Great. Well, if someone starts to experience these symptoms, what steps should they take immediately?

Eftechios P. Xanthoudakis, MD: Yeah, so, immediately if they start having these symptoms, they should either be seen by their primary care provider or just come directly to the emergency room to be evaluated further.

Caitlin Whyte (Host): Can you discuss also the possible causes of appendicitis? Are there any lifestyle factors that might increase risk?

Eftechios P. Xanthoudakis, MD: Yeah, there aren't really any particular lifestyle factors that'll increase risk for appendicitis because it's a pretty common question where patients are always like, “Hey, is there anything I can do to prevent this?” And really the answer is no, there's really nothing that you can do to prevent it.

But, common causes are blockage of the appendix by stool, which is called an appendicolith. It can also be caused by a tumor, which is obviously more rare, but any sort of obstruction or inflammation of the area can cause appendicitis. Bacterial or viral infections of the GI tract also can lead to inflammation and that can also lead to appendicitis.

So definitely a few different things that can cause appendicitis, but really not a whole lot that anyone can do to prevent them.

Host: So if we're feeling these symptoms, we head to the doctor or the emergency room. But how is appendicitis typically then diagnosed in a clinical setting?

Eftechios P. Xanthoudakis, MD: So usually in a clinical setting, obviously they would get evaluated, and first, obviously they would have their symptoms looked at, you know, what kind of symptoms are they having, then followed by a physical exam, do they have abdominal pain or tenderness in their abdomen and where that is located.

And then followed by labs, so they would check their lab work and see if they have an elevation in their white blood cell count, which is a marker of infection. And then for imaging, they would either get a CT abdomen and pelvis, or an abdominal ultrasound to evaluate. Or for some reason, you know, the patient's pregnant or can't have a CT scan, they can also have an MRI as well.

Host: Could you then explain the typical treatment approach for someone diagnosed with appendicitis?

Eftechios P. Xanthoudakis, MD: Yeah. So typical treatment would be (A) being evaluated and being at a hospital. And usually at that point in time, if there's concern for appendicitis, a general surgeon would be contacted. And the next steps would be to start the patient on IV antibiotics and then discuss about proceeding with appendectomy.

Appendectomy is usually done either laparoscopic or robotically, and usually through three small incisions. Now, the treatment course can change, obviously, if the patient is found to have perforated appendicitis. And so, if your appendix has already perforated, depending on whether or not you have an abscess or a large fluid collection in there will determine whether or not you get an appendectomy immediately or if you need to have antibiotics and possibly a drain placed by radiology prior to having an appendectomy down the line, six to eight weeks later.

Host: Alright. Well, you touched on my next question a bit already. Can you tell us a bit more about those minimally invasive options and how they compare to traditional surgery methods?

Eftechios P. Xanthoudakis, MD: Sure, so the options now are either laparoscopic or robotic with small incisions, usually about the size of a fingertip. The old method used to be to just do it open with a larger incision in order to get down to the appendix and remove it. But with these smaller incisions, you know, recovery is a lot quicker.

It also provides a good operation that's nice and safe and allows us to really see everything when we're in there. And it's pretty much standard of care that, you know, if you need your appendix out, you'll either have it done laparoscopically or robotically, either way, they're both with small incisions.

Host: Great. Well, tell us then about the recovery process after an appendicitis surgery.

Eftechios P. Xanthoudakis, MD: Sure. So recovery, obviously you'll have pain following the surgery, anytime you have incisions or small cuts on your abdomen or belly, that's going to hurt a little bit. Usually the first few days are the worst from a pain standpoint. Every day, the pain gets a little bit better.

And the only restriction that most surgeons will say is just no heavy lifting. Other than heavy lifting, pretty much activity as tolerated. We love lots of walking and, you know, slowly you can increase your activity as you deem fit, except for the heavy lifting part.

Host: So when it comes to appendicitis, is surgery always required or is it something that could be managed with medication alone?

Eftechios P. Xanthoudakis, MD: You know, that's a good question. In America, the standard of care is, for the most part, getting admitted to a hospital, antibiotics, with surgery. That being said, for younger patients, young, healthy patients, there is the ability of, you know, if they were really against having a surgery, that you could just do antibiotics.

The downside with that is, that if you do only antibiotics, there is the possibility of appendicitis recurring. And also if you are found to have a little appendicolith, which is, kind of like a stool ball on imaging, when you're being diagnosed with appendicitis, then you're also at higher risk of having failure with antibiotics.

And so that's why in America we usually stick with the method of, you know, you have appendicitis and you come into the hospital and your appendix gets removed. That way there's no concern of there being any sort of missed tumor or any sort of cancer that's missed and that way you don't have an issue with having a recurrence of appendicitis.

Also, if you are older, so above the age of 40 or 45, there is a higher risk of there being cancer in the appendix or some sort of cancer that causes appendicitis and therefore it's also more recommended at that age as well to proceed with having your appendix removed instead of just going with antibiotics.

Host: All right. Well, to wrap us up today, Doctor, is there anything we didn't talk about that you want to mention when it comes to appendicitis?

Eftechios P. Xanthoudakis, MD: No, I think we touched on all the major things. I think it's, you know, if a patient's concerned with having pain, nausea, vomiting, they should definitely either see their primary care provider or come to the ED.

That way they can get further imaging and get it worked up. And if they have appendicitis, it's a very treatable condition that, you know, every general surgeon is facile at taking care of.

Host: That wraps up this episode of BayCare HealthChat. For more information, and to get connected with one of our providers, head on over to BayCare.org. Remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. And if you found this podcast informative, please share it on your social media and be sure to check out all of the other interesting podcasts in our library. Thank you for joining us today.