The Incidence and Awareness of Appendicitis among Female Students in Student's Dorm of Mohamed Osman Saror in Almatama Town, 2021

Function of Appendix

For many years the appendix was considered useless, doctor found that patients were apparently healthy after removing their appendix, the image has changed more recently, researchers have found that your appendix plays an important role in boosting your immune system, and helping you recover faster, it also seems to protect against Chrons Disease and common chronic bowel disease [2].

Appendicitis: Mean inflammation of appendix, which a small tube attached to the large intestine.

Symptoms of Appendicitis

• Pain centered around the navel, which progress to a sharp pain in the lower right side of the abdomen,
• Pain in the lower back, hamstring or rectum (less commonly),
• Fever,
• Vomiting,
• Diarrhea or constipation,
• Loss of appetite [3, 4].

Causes of Appendicitis

1. Infection: Infection is one of the most common causes of appendicitis a viral or bacterial infection causes appendix to swell and fill with pus. The inflammation blocks blood flow to appendix, which then start to die; at this point the appendix can develop holes or tears or may even burst if it is not treated, if that happens stool, pus and mucus can leak in to abdominal cavity, resulting in a life threatening infection. 2. Blockage: Sometimes appendicitis can be caused by fecal blockage of the large intestine. Normally the appendix is open to the large intestine; when stool or bacteria from an infection enters the appendix the tube joining appendix to the large intestine becomes blocked, this blocked lead to inflammation and swelling. 3. Tumors: Rarely appendicitis can be caused by tumor, both benign (non cancerous ) and malignant ( cancerous). This tumors are usually discovered when appendicitis removed because appendicitis or during diagnostic tests for other issues. 4. Inflammatory Bowel Disease: Is term that refers to inflammatory disease of the intestines such as Chron’s disease and ulcerative colitis; chronic inflammation can lead to appendicitis. 5. Abdominal Trauma: Though it is fairly infrequent abdominal trauma can lead to appendicitis; this happens when there is a serious injury to the abdomen that causes blockage of appendix [5].

• Obstruction: Appendicitis is caused by obstruction of appendicular lumen; the causes of obstruction include lymphoid hyperplasia secondary to irritable bowel disease, or infection.
• Infection: Various specific bacteria, viruses, fungi and parasites can be responsible agent of infection that affect in the appendix including yersinia species, histoplasma, taenia solium and strongyloides stercoralis.

• Dietary factors: It may be related to westernization of food –a diet rich in meat precipitates causing appendicitis and a diet rich in fiber (cellulose) protects the person from appendicitis [6].

The Following Foods Causes’ Appendicitis

Seeds of Fruits: Eating fruits that contain seeds in them such as grapes, orange and guavas can cause appendicitis. This is because the seeds of the fruits are difficult to digest by the intestines and can eventually clog the appendix. However that does not mean you should not eat these fruits at all, you still eat fruit with seeds after removing the seeds fruits.

Spicy Food: Spicy foods such as sillies and peppers are often referred to as food causes appendicitis; this is because consuming too much spicy food can irritate the gastrointestinal tract, thus triggering appendicitis. In some cases doctors often found chili paprika seeds during appendectomy process; this leads to the assumption that chili and paprika seeds are difficult to digest causing blockage and inflammation of the appendicitis [7].

The Risk Factors for Appendicitis

There is no way to predict who will get appendicitis; but scientists have un covered several risk factors for condition these include:

• Being teenager or in your twenties; most cases of appendicitis occur in this age group.
• 2-Having long –lasting inflammatory bowel disease such as Chron’s disease or ulcerative colitis.
• 3-Studies have suggest that family play role, a study published in 2014 in the western journal of emergency medicine found that among adult at an emergency room who presented with appendicitis that a known family history were more likely to have the condition and study publish in 2001 in the journal of pediatric surgery found that “heredity is a significant factor“ in children who have appendicitis.

There is also link between air pollution in particular high level of Ozone and appendicitis. Scientists are not sure why air pollution is associated with an increase risk of appendicitis; but it may be that high level of Ozone increase intestinal inflammation or susceptibility to bacterial and viral infection. Studies suggest that people get appendicitis more during the summer than at other times of the year; it is not clear why but a review of over 40 years of research published in February 2014 in anal of medical and health sciences research conclude that it is likely due to combination of increase exposure to air pollution and more GI infections during summer months [8].

Types of Appendicitis

• Acute appendicitis: Is finger like, size offshoot from the intestine where the small intestine and colon join in the lower right hand of the abdomen. Identification: pain which may wake the suffer in the right, starting in the middle of abdomen but shifting in a few hours to the right lower quadrant.
• Age: Rare before two years, increasingly common through childhood, peak age 15 years and (18-30) years then gradual decline. Treatment by operation to remove the appendix as soon as possible [9]. The vast majority of patients with (A) present with marked localized pain and tenderness in the iliac fossa. Typically the pain commons as a central peri-umbilical colic with shifts after approximately 6 hours to the right iliac fossa or more accurately to the site of inflamed appendix. Occasionally the tip of the inflamed appendix extend over to the left iliac fossa and pain may localized there [10].

Etiology of (AA)

There is no unifying hypothesis regarding the a etiology of (AA) decrease dietary fiber and increased consumption of refined carbohydrate may be important as with colonic diverticultis, the incidence of appendicitis is lowest in societies with a high dietary fiber intake, in developing countries that are adopting more refined western type diet the incidence continues to rise. No reason has been established for these paradoxical changes; however improved hygiene and change in the pattern of childhood gastrointestinal infection related to the increase use of antibiotics may be responsible. While appendicitis is clearly associated with bacterial proliferation in the appendix no single organism is responsible [11]. The spread of microorganism takes place in the loose of sub mucosa and from there through the muscularis alone the line of the penetrating vessels to the sub serious coat.

By the time the appendix is removed the muscularis and peritoneal surface are usually also inflamed, the appendix is swollen and elongated and bright red in color.

Prevention of Appendicitis

Appendicitis can be prevented by choosing the right food in your diet and having a balanced diet. Foods you should Eat: Food rich in fiber are recommended to prevent disease like appendicitis these include:

• Oats or wheat gram over breakfast cereals
• Whole wheat flour instead of all purpose flour
• Brown rice instead of white rice
• Fresh fruits for dessert Foods You Should Avoid: If you are wondering wheat food can cause appendicitis, here is the list of food that can causes appendicitis:
• Fried food are fatty and can irritate the digestive system.
• Alcohol harms the liver and thus affects digestion Red meat contains a lot of fat and is difficult to digest.
• Cakes, pastries etc. that contain too much sugar [12].

Prevalence of Appendicitis in World

AA is a very common disease with a life time risk of approximately is 8.6% for males and 6.7 for females. (AA) represents the most common abdominal emergency but its diagnosis can be challenge even for experienced surgeon, as its mainly based on anamnesis and older than 50 years, pre hospital admission later than 12 hours; fecal as the a etiology of the luminal obstruction and leukocyte count > 15000 cell/mm 3 where considered as risk factor for perforated acute appendicitis. (AA) is one of the most common acute surgical emergencies with incidence of approximately 100 per 100000 people; its incidence change according to age, geographic location and diet. The pathogenesis of (AA) is believed to reflect an initial insult to the mucosa resulting from luminal obstruction by fecal, a fragment of un digested food, or lymphoid hyperplasia followed by bacterial infection that progressively spread from the mucosa into the wall [13].

Incidence of Appendicitis in the Sudan

According to the latest WHO data published in 2018 appendicitis deaths in Sudan reached 325 or 0.13% of total deaths, the adjusted death rate is 1.17 per 100000 of population rank Sudan 64 in the world [14, 15, 16, 17, 18, 19].