Acute abdominal pain accounts for 7–10% of all admissions in the emergency department. Acute Appendicitis and Cholecystitis are the most common causes of acute abdomen requiring emergency surgical intervention in both children and adults in the day-to-day surgical practice. Both these conditions affect human beings irrespective of age, nationality and religion [1].

Appendicitis is an inflammation of the appendix which is a finger-shaped pouch that projects from the colon on the lower right side of abdomen. The characteristic features of acute appendicitis are periumbilical abdominal pain that migrates towards  right lower quadrant (RLQ), loss of appetite , nausea, fever, and RLQ tenderness. As inflammation worsens, appendicitis pain typically increases and eventually becomes very severe.

Although anyone can develop appendicitis, it occurs most often between the ages of 5 to 45, with the mean age of 28. Its incidence is approximately 233/100,000 people. Males have a slightly more predisposition of developing acute appendicitis compared to females, with a lifetime incidence of 8.6% and 6.7% among men and women respectively.

Acute Appendicitis (AA) is a emergency that almost always requires surgery as soon as possible to remove the appendix. The rate of perforation varies from 16% to 40%. Appendiceal perforation is associated with increased morbidity and mortality compared with non-perforating AA.

Similarly, Cholecystitis is inflammation of the gallbladder. In most cases, gallstones blocking the tube leading out of the gallbladder cause cholecystitis. Other causes include bile duct problems, tumors, serious illness and certain infections. Signs and symptoms of cholecystitis include severe pain in upper right or center abdomen, pain that spreads to right shoulder or back, tenderness over abdomen when it's touched, nausea, vomiting, fever etc.

Worldwide, the incidence of acute cholecystitis is approximately 6,300 per 100,000 in individuals under 50 years of age and 20,900 per 100,000 in individuals over 50 years of age. Risk factors for gallstones include gallstones, female gender, increasing age, pregnancy, oral contraceptives, obesity, diabetes mellitus, ethnicity, rapid weight loss etc.Treatment for cholecystitis often involves gallbladder removal.

If left untreated, acute cholecystitis can lead to serious, sometimes life-threatening complications, such as a gallbladder gangrene or perforation, which can be life-threatening.

Despite the advances in diagnostic and therapeutic techniques, both acute appendicitis and Cholecystitis  still remains the major causes of morbidity and mortality due to delay in recognition of its signs & symptoms by  people  and lack of awareness about treatment options which cause delay in hospitalization [2].

Upon literature review, there is paucity of studies assessing the knowledge of general public regarding acute appendicitis and cholecystitis. Hence, this study was undertaken with the objective to assess the awareness regarding causes, symptoms and treatment options for acute appendicitis and cholecystitis among patients attending GMC Anantnag

Objectives of the Study

To evaluate the awareness regarding causes, symptoms and treatment options for acute appendicitis and cholecystitis among patients attending GMC Anantnag.

• Research approach: Descriptive

• Study design: Cross Section Hospital based study design

• Setting of the study: GMC Anantnag

• Study duration: between May-September 2021

• Study population: OPD patients in GMC Anantnag

• Sample size-400 OPD patients assuming 50% patients had adequate knowledge regarding acute appendicitis and cholecystitis a, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling technique: Random sampling technique

• Sampling criteria: Everyday Ten patients attending the different OPDs of GMC Anantnag were selected randomly till the completion of sample size after explaining the purpose of the study. Informed consent/assent was taken from them and confidentiality  of the selected  participants was also maintained 

• Inclusive criteria: Patients attending the different OPDs of GMC Anantnag during the day of data collection and were willing to participate in the study.

• Exclusion criteria: Patients who were not willing to participate in the study 

• Development of tool-knowledge related questionnaires

Description of Tool

• Section A: Socio-demographic characteristics of the patients (age, gender etc.)

• Sections B: Questions regarding causes, symptoms and treatment options for acute appendicitis and cholecystitis

• Validity of tool - by the experts in this field

• Permission- obtained from the concerned authorities of  GMC Anantnag

• Data collection by myself and patients  was given 5 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with appropriate statistical test in terms of frequencies and percentage.

The present study was non-experimental descriptive study carried out to evaluate the awareness regarding causes, symptoms and treatment options for acute appendicitis and Cholecystitis among patients attending GMC Anantnag.

Table 1: Knowledge About Causes of Appendicitis

Table 2: Knowledge about Symptoms of Appendicitis

Table 3: Knowledge about Treatment Options of Appendicitis

Table 4: Knowledge About Causes of Cholecystitis

Table 5: Knowledge about Symptoms of Cholecystitis

Table 6: Knowledge about Treatment Options of Cholecystitis

In the present study 35% (140) of the patients fall were below 40 years   of age while 65% (260) were above 40 years.  54% (216) of patients were male and 46% (184) were female.

In the present study,   most of the participants 235(58.75%) told that infection in the appendix is the major cause of acute appendicitis followed by Blockage in the appendix by 189 (47.25%) participants, Chronic constipation  by 108(27.0%), Lack of fruits / vegetables/ fibers in the diet by 101 (25.25%) ,Abdominal injury or trauma by 85(21.25%), Excessive intake of spicy, junk & fast  food by 79(19.75%), Growths inside the appendix by  49(12.25%), Stone in the appendix  by 23 (5.75%) and  intestinal worms in the appendix by 13(3.25%) participants.Still ,198(49.5%) participants didn’t know about the cause of appendicitis.

Among the total, 301(75.25%) study participants told that Pain and swelling at right lower abdomen is the  major symptom of Appendicitis  followed by Sudden  pain at right lower abdomen  by  278 (69.5%) participants, High grade fever  by 268(67.0%), Nausea or vomiting by 165 (41.25%), Abdominal bloating by139(34.75%), Painful or difficult peeing by 97(24.25%), Blood in stools by 46(11.5%), Constipation or Diarrhea by  22(5.5%) and Inability to pass gas by 13(3.25%) participants. Still, 95 (23.75%) didn’t know about any symptom of Appendicitis.

In the present study, 235(58.75%) participants told that Surgical removal of appendix is the main treatment option followed by Admission to hospital by 213 (53.25%) participants, Painkillers by 209 (52.25%), Less intake of food/only liquid diet/ no diet for few days by 194 (48.5%), Antibiotics and Painkillers by 187(46.75%), Bed rest for few days by 170 (42.5%) and Hot fomentation by 125 (31.25%) participants. Still, 153 (38.25%) participants didn’t know about any treatment options of Appendicitis.

In the present study, 280(70.0%) participants told that Stone in the gall bladder is major cause of Cholecystitis followed by Blockage in the gall bladder  by 265(66.25%) participants, infection in the gall bladder by 259 (64.75%), Excessive intake of spicy, junk & fast  food by 202 (50.5%), Chronic acidity by 187 (46.75%), Obesity by  166 (41.5%), Lack of fruits / vegetables/ fibers in the diet by  153 (38.25%), Growths inside the gall bladder by 102 (25.5%) and Chronic constipation  by 25 (6.25%) participants. Still, 114 (28.5 %) participants didn’t know about causes of Cholecystitis.

Among the total, 303(75.75 %) participants told that the Sudden  pain at right upper  abdomen is the major symptom of Cholecystitis followed by Pain and swelling at right upper abdomen  by 289(72.25%) participants , High grade fever by  278(69.5%), Acidity/heartburn by 260(65.0%), Pain while eating food  by 196(49.0%), Frequent vomiting   by 187(46.75%), Jaundice  by 102(25.5%), Blood in vomiting and  stools by 101(25.25%) and Abdominal bloating by  101(25.255) participants. Still, 94(23.5%) participants didn’t know about the symptoms of Cholecystitis.

In the present study, 287(71.75%) participants told that the surgical removal of gall bladder is the best treatment option for Cholecystitis followed by Painkillers by 274(68.5%) participants, Antibiotics & Painkillers by 266(66.5%) Antacids capsules and syrups by    238(59.5%),Less intake of food/only liquid diet/ no diet for few days   by 203 (50.75%) , Bed rest for few days by 139(34.75%) , Hot fomentation by 102(25.5%) and Admission to hospital  by 92(23.0%) participants. Still, 103(25.75%) participants didn’t know about any treatment option for Cholecystitis.

Acute appendicitis and Cholecystitis are among the most common causes of abdominal pain leading patients to attend the emergency department and the most common diagnosis made in patients admitted to the hospital with an acute abdomen [3].

In the present study, almost half of the participants knew while half of participants didn’t know about the causes, three fourth knew while one fourth didn’t know about any symptom, almost three fifth knew while two fifth participants didn’t know about any treatment options of Appendicitis. Similarly, almost three fourth participants while one fouth didn’t know about causes, symptoms and treatment options of Cholecystitis.

The diagnosis of appendicitis and Cholecystitis are largely based on the person's signs and symptoms but the clinical presentation of both diseases varies and is inconsistent. Approximately 40% of people do not have these typical symptoms. The standard treatment for acute appendicitis and Cholecystitis are surgical removal. Surgery decreases the risk of side effects or death associated with rupture. Antibiotics may be equally effective in certain cases of non-ruptured cases [3-4].

General public must be educated regarding causes, symptoms and medical/surgical treatment options of both these diseases , complications if left untreated. Early recognition reduces the delay in treatment, complications and mortality.

The level of knowledge and awareness about the causes, symptoms and treatment options for acute appendicitis and cholecystitis among study participants were found to be unsatisfactory and require further improvement through educational workshop and training sessions. Clear understanding of both these diseases helps in early recognition and prevention of complications.

1. Cervellin, G. et al. "Epidemiology and outcomes of acute abdominal pain in a large urban emergency department: retrospective analysis of 5,340 cases." Annals of Translational Medicine, vol. 4, no. 19, 2016, p. 362.

2. Gandhi, J. and Tan, J. "Concurrent presentation of appendicitis and acute cholecystitis: diagnosis of rare occurrence." BMJ Case Reports, 2015, bcr2014208916.

3. Humes, D.J. and Simpson, J. "Acute appendicitis." BMJ, vol. 333, no. 7567, 2006, pp. 530–534.

4. Federico, C. et al. "Conservative treatment of acute appendicitis." Acta Bio Medica: Atenei Parmensis, vol. 89, suppl. 9, 2018, p. 119.