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what is chronic appendicitis? MASTER DATA JOBS
Type 2 Diabetics Meal Planning  

One in seven Americans suffered it. Appendicitis. What is it?

It's 10 pm. Severe pain in your belly. Youtreatment. It happens in elderly patients.
are in ER. Previous day you had a nice partyThe patients may come to the hospital with a
with your friends. Then pain started aroundlump or a mass in the right lower abdomen
your umbilicus (navel). You thought first:looking like tumor.Diagnostic problem with
aha, probably you ate something bad, it willappendicitis is that some other conditions
go away. But it doesn't. You have vomitedmay mimic it.Abdominal cavity is packed with
once and lost appetite. Pain did not improvedifferent organs. Other sources could cause
but worsened. After a day of suffering youpain in right lower quadrant. Females may
decided to visit the hospital. Long taxihave ovarian torsion or tuboovarian abscess
trip. Pain is shooting every time the caror extrauterine pregnancy (this is why
bumps into a pot. Nurses ask you bunch ofdoctors persistently ask: when was your last
questions and place in an available room.menstrual period? Are you taking
There is a confused 90 something years oldcontraceptive hormones? Did you have vaginal
women in the neighbor room. She mumblesbleeding?), etc. They also check your
something incomprehensibly. The woman haschorionic hormone, trying to find if you are
come from a nursing home. She sufferspregnant.Scrupulous doctor asks your
Alzheimer disease and yells every night forpermission to perform rectal exam. Many
the past 7 years. She has history of multiplepeople refuses to do it. I can understand
medical problems. They brought her in the ERthat. Who would like that somebody sticks
after she developed fever. Nurses draw yourfingers into his ass. I wouldn't. But the
blood. You pain is getting gradually worse.rectal exam gives a lot of information.
Change your position, pull your legs. PainRectum - is the part of gut that is closest
doesn't go away. When the ... doctor comes?to the back orifice. Back orifice is named
At last ER physician sees you. He writes H+Panus in Latin or anal canal. Surgeons say
and ER orders. A stretcher is rolled in. Theythat there are only two contra-indications
take you to a radiology department and putfor avoiding rectal exam: 1. patient does not
into a big machine looking like a gate.have anus 2. Surgeon does not have
Everybody leaves you and the machine drivesfingers.Rectal exam in appendicitis is
you into the big metal doughnut. They bringusually unremarkable. Maybe you can cause
you back into the ER.Surgical intern comes.pain by palpating the side wall of the rectum
He did not rest since 5 AM. He asks bunch ofthat is close to the appendix. But the rectal
the same questions again and pokes yourexam allows to distinguish other disorders.
belly. A tired resident comes. He pokes yourDuring the rectal exam you may palpate
belly again. You still wait, become bored,hemorrhoids, uterus, nodules in prostate or
complain on delay, call your relatives. It'senlarged prostate, you may feel fluid in
already 2 AM. At last the resident discusslower part of peritoneal cavity, etc. You may
your symptoms with attending over the phone.see blood on the finger telling you about
He tells you that you have appendicitis andinternal bleeding. You may check the stool
CT scan confirmed it. History and physicalsfor small amount of blood (named fecal occult
are written. Admission orders are written.blood test - FOBT - or Guaiac test by the
Pre-op orders are written. Antibiotics arename of the dye that turns blue in the
prescribed. IV fluid is running 80 ml anpresence of blood. At last rectal exam may
hour. You sign consent for operation.help in dis-impaction of rectum. That is when
Transporting guys take you upstairs -hard stool causes bowel obstruction.Usually a
depending on severity of your symptoms -rectal exam is more or less normal. But every
straight to or to the floor. Attending willsurgeon will tell you a war story about how
operate you first thing in theonce in while, once in five years he found
morning.Classically appendicitis starts as asomething significant on rectal exam,
pain that began in the periumbilical regionsomething that every other doctor missed.
(around navel - you belly pot). Then painJust by putting the finger into the butt. I
moves to the right lower quadrant of thesaw how a surgeon put a finger into an old,
abdomen. Nausea and vomiting often presentdemented women and pulled out a pessarium. It
after the onset of the pain. Classically,was an apple-size pink plastic membrane ,
patient has low grade fever (this meansthat should go into vagina, but somebody (at
around 37-38 C or 101-102 F), positive psoashome?) put it (by mistake?) into the rectum
sign (you stretch your leg and this movementof that woman. You really need to push hard
increases your pain), positive Rovsing signto get such big object into the anus. The
(Doctor pokes in your left lower quadrant ofpoor lady suffered bowel obstruction for a
the abdomen, and you fill the pain in youweek and would probably die if it stayed long
right lower quadrant), Leukocytosis.enough.OK, lets return to appendicitis. So,
Leukocytes are the white blood cells - WBC.doctors will check you White Blood Cell Count
Usually there are around 4000-9000 whiteAny infection or inflammation may cause this
cells per micro liter of you blood. When youcount to be abnormally high. It is not
have inflammation in you body the count goesspecific for appendicitis, but it confirms
up.Your pain during appendicitis classicallyother findings.Next, doctors check Urinalysis
localizes in Mc Burney's point. That is one- microscopic examination of the urine. That
third between your umbilicus and anteriordetects red blood cells, white blood cells
superior iliac spine (this is the bony pointand bacteria in the urine. When there is
that is sticking most prominently from yourinflammation or stones in the kidneys or
pelvis - you can palpate it yourself on thebladder, the urinalysis is abnormal. A normal
side of your belly). For confirmation aurinalysis is more characteristic to
doctor also may try to elicit obturator signappendicitis.Next they try to image what is
- he will ask you to bend you knee and bringgoing on in your belly. An abdominal x-ray
your heel to your groin - this manoeuvermay detect the fecalith as the cause of
increases the pain during appendicitis.appendicitis (5%). Free air due to
Similar test is the raising of the leg whileperforation can might be seen on the plain
you lie on the stretcher. That movement alsofilm.A barium enema may be used. It is an
increases your pain.Appendicitis is thex-ray test where liquid contrast is used from
inflammation of appendix supposedly due tothe anus to fill the colon. Sometimes it show
narrowing of this lumen. That narrowing mayan impression on the colon in the area of
be caused by hyperplasia of appendix (meansinflamed appendix. Barium enema also can
too big growth, overgrowth of the tissue) .exclude other intestinal problems that mimic
That variant happens in children mostly.appendicitis.Ultrasound shows an enlarged
Another variant - is fecalith (small stonyappendix or an abscess. Ultrasound is
fecal material) that impacts into thepainless, but the appendix can be seen in
appendix lumen. That is seen in young adultsonly half of patients. Ultrasound also is
mostly.Appendix itself is a small part of guthelpful in excluding the problems with
. It is pencil-size sticking out gut. Gut isovaries, fallopian tubes and uterus.
a continuos tube. Mouth is entry. Anus isUltrasound machine usually looks like a small
exit. Appendix sticks out from the wall andthumb on wheels that they bring into your
ends blindly. It has only one entrance.room. Technician puts gelly on and drives the
Appendix is attached to the Caecum (part ofprobe over you belly.Often they go straight
gut - literally means blind colon in Latin).to CT Scan (computer tomography). Especially
Appendix of ruminating animals (animals thatif the patient is not pregnant. CT scan gives
chew grass, like cow) is very long and big.relatively high irradiation of your body by
Appendix in humans is reduced to thex-rays. However benefits of prompt diagnose
pencil-size. However it doesn't disappear.of appendicitis outweigh the risk of
There is a theory that appendix plays role inradiation. CT scan gives slicing images of
immune response. The walls of appendix areyour body.What do they look for? As any
actually filled with lymphatic tissueinflamation causes edema, the wall of the
containing lymphocytes (those are subtype ofappendix will be thickened. This is actually
White Blood Cells). Lymphatics is responsiblea defensive mechanism - by edema the organism
for immunity.The removal of appendix doesn'ttry to wall of, to seal off the area of
really change immunity significantly.infection and inflamation.But it is useful
Nonetheless, it is not something redundant.for us because we can surely say there is an
Unless it is inflamed there is no good reasoninflammation. The same goes for ultrasound.CT
to remove it .Now, acute appendicitis is thescan is expensive - around 1000 dollars in an
acute inflammation of appendix. SuffixAmerican hospital, though 40 dollars in
"-itis" means inflammation in Latin.Russia.If the CT scan is taken during the
Appendicitis is also the most common cause ofnight, CT image may be send to Australia
acute abdomen. Acute abdomen in surgery is aRussia or India.An American radiologist is
condition in abdomen that requires urgentpaid around 40 dollars to read just an X-ray
actions, usually surgical.To diagnosefilm. I guess he gets more for reading the CT
appendicitis you need to have right lowerscan. It is only 5 dollars in India. This is
quadrant pain.The pain should be presentwhy even such clinics as Harvard and Yale
together with either appropriate history (alladopt this model of work - they send the CT
those classical signs and lack of appetite)scans to the cheap labor abroad. Especially
or Leukocytosis (increase in white bloodduring the night. Half an hour later the fax
cells in the blood).Patients often askfrom Australia arrives. "Inflammatory
questions: Can I avoid surgery? Can you treatpericecal mass in the right iliac fossa
me with antibiotics alone? You told me thatconsistent with the diagnosis of severe acute
it is possible to treat the appendicitis withappendicitis." Any doctor can read an x-ray
antibiotics alone. Please, I do not wantfilm or CT scan. Radiologists are doctors who
surgery, my mother (father, brother, fiancee)specialize in the reading of the films. They
said that I can avoid surgery.The answer is:may find what was missed by others.At this
you can try to avoid it probably, but thepoint diagnosis is usually clear. In cases if
odds of death are much higher if you treatit is not, there is Laparoscopy. Laparoscopy
appendicitis without surgery. Untreatedis a surgical procedure. Small fiberoptic
appendicitis may lead to perforation in lesstube with a camera is inserted into the
than a day. Sun rises. Sun sets. Appendixabdomen through a small puncture in abdominal
bursts. So, the prompt surgical interventionwall.Yet there is no test that will diagnose
is the main solution. On occasion, theappendicitis with 100% certainty.The position
surgeon may even find a normal-appearingof the appendix may vary. If it is longer
appendix and no other problem explaining thethan normal, appendix may go deep down into
symptoms. He may remove the appendix anywaythe pelvis. It also may move behind the colon
because it is better to remove a(called a retro-caecal appendix). From one
normal-appearing appendix than to miss mildhand it is better because retro-caecal
case of appendicitis.To cool down theappendix has less chances to burst into
infection before surgery doctors useperitoneal cavity, from the other it is
antibiotics. Antibiotics may convert acutedifficult to diagnose and it is difficult to
appendicitis into more chronic type. Howeverapproach surgically. Inflammation of other
the removal of the appendix is theorgans, for example, female pelvic organs,
choice.With modern technology it becomes muchmay resemble inflammation of the appendix.
easier to distinguish appendicitis and otherPregnant women may have appendix pushed up in
causes of pain in right lower quadrant. Yetabdomen by the enlarged uterus. Athletic
there is no 100% proof diagnostics. Sometimeyoung adults may tolerate more pain and may
doctors treat with antibiotics alone, whenhave not so obvious symptoms of appendicitis.
they are not sure. Though, modern CT-scanOld patients may have vague symptoms as
shows appendicitis almost close to 100%.Whatwell.Other inflammatory problems may mimic
would happen if you miss the appendicitis andappendicitis. Surgeons often observe patients
appendix bursts? You will get one of the mostwith suspected appendicitis for a period of
dreaded surgical complication - peritonitis.time to see if the problem will resolve or
Again, "-itis" equals inflammation.suggest appendicitis more strongly versus
Peritoneum means the peritoneal cavity.It isanother condition. Conditions that mimic
difficult to describe the shape of theappendicitis are:1) Meckel's diverticulitis.
peritoneal cavity . That shape is very2) Pelvic inflammatory disease -infection of
complex. Simple explanation: peritonealtube and ovary. It is treated with
cavity is like a closed bag. It is completelyantibiotics alone 3) Fluids from the right
closed in malesFemale have small holes in theupper abdomen may drip into the lower abdomen
peritoneum. Oocytes (future babies) go fromand cause inflammation resembling
ovaries first to peritoneal cavity. The holesappendicitis. Then, for example, patient has
in the peritoneum allow oocyte to go intogallbladder disease or liver abscess, but all
Fallopian tubes. Fallopian tubes lead intosymptoms suggest acute appendicitis. 4)
the uterus (womb in English or hyster inDiverticulitis that occur on the right side.
Latin or uterus in Greek). Organs that are5) Inflammation of right kidney. 6) Crohn's
covered by peritoneal cavity linings aredisease or ulcerative colitis 7) Yersinia
named intra-peritoneal. There are alsoenterocolitica infection - the bacteria that
melo-peritoneal, extra-peritoneal orcomes form certain food - like unpasteurized
retro-peritoneal organs that coveredmilk. - may cause appendicitis 8) passing
partially or not covered at all. It lookskidney stone 9) ectopic pregnancy 10) ovarian
like the main function of peritoneumcyst rupture. And so on. There are some other
(peritoneal cavity) is to give someconditions.Appendectomy is performed urgently
lubrication to your guts. Though there areusually. Thomeo is Latin for dissect or cut.
other functions as well.Now, take a plasticLapar - is abdomen (belly) in medical Latin.
bag, pour a little bit of water or oil intoLaparotomy is opening of belly. Appendectomy
it and seal. Put one hand on one side of theis cutting of appendix. Laparoscopy is
bag, another hand - on another side of thelooking (by scope) into belly. Antibiotics
bag and rub against each other. You can seealmost always are given prior to surgery as
your hands slide easily. This is the idea ofsoon as appendicitis is suspected.Few
peritoneum - you bowels slide easily againstpatients have mild "confined appendicitis"
each other even when they are stretched bylocalized to a small area. These patients may
food and when they are pushing the digestedimprove during several days of observation
food down. When a bowel is puncturedwhen treated with antibiotics alone. Doctors
(perforated), the content of the bowel willmay or may not removed the appendix later.
go into the peritoneal cavity. Colon (lower,Chances are you are not one of this
bigger bowl) has the fecal material. Fecalpatients.If a person has not seen doctor for
material consists of bacteria on 2/3 (yeah,many days while appendicitis ruptured (yeah,
there are so many of them). Now, that smallsometime happens; there are some tough guys),
puncture in one part of the gut will causean abscess may form, and the perforation may
spillage of the bacteria all around thatclose. Initially it can be treated with
closed bag of peritoneum.Guts on inside haveantibiotics; however, that will require
several mechanisms protecting from bacteria.drainage later. A drain is guided under
Peritoneal cavity doesn't' have such aultrasound or CT scan and appendix is removed
protection.Small puncture in one part of gutafter the abscess resolves.In modern days
will cause all of you guts be inflamed onsurgeons offer laparoscopic appendectomy.
outside non-protected side (for the gut it isThey insert laparoscope (it is like a small
outside, but for the peritoneal cavity it istelescope with a video camera) and remove
the inside). This is the peritonitisappendix with special instruments through
(diffuse). This what the surgeons are afraidsmall puncture wounds.If you had this type of
of. Look at you. You belly is like half ofsurgery, you will probably have four 1-cm
you body. So it is like half of you body issize scars and you will go home in one or two
severely inflamed. Eventually it may lead todays.But if your case is complicated or there
sepsis, a condition in which bacteria enteris just no laparoscopy in the hospital, they
the blood and infect other parts of the body.will do classical appendectomy. Surgeon cuts
This is life-threatening10-cm incision in the area of the appendix.
complication.Sometime inflammation staysAppendix is removed form the right lower
local and seals off forming an abscess.abdomen or where it is. Area is checked for
Abscess is the walled off accumulation ofother problems. In the case of abscess the
pus. Pus is the mixture of dead and alivepurulent stuff will be drained with rubber
bacteria, dead white blood cells (leukocytes;tubes through the skin. With that kind of
leukos = white, cyte = cell) that fought thesurgery you will probably stay for four to
infection and honorably died, and deadseven days. Antibiotics will help to resolve
tissue, that was digested partially bythe abscess.This is why you sign the consent:
bacteria and partially by the stuff from"laparoscopic appendectomy, possible
leukocytes. Inflamed peritoneum (the liningconversion to an open appendectomy".The most
of the peritoneal cavity is also namedcommon complication of appendectomy is wound
peritoneum) easily adhere to each other andinfection. If it is severe, the surgeon will
may seal of the infection - there will bepostpone incision closure for several
local peritonitis. Any adherence may causedays.Ok, now you have those four small scars
problems in the future - guts do not slideor one big scar, you go home and visit that
easily anymore and food or stool sticks.party that you missed.Aleksandr Kavokin,
Blockage of the intestine may occur in acuteMD1994 Russia,PhD1997 Russia - Immunology and
appendicitis as well. This is partiallyAllergy, postdoc at Cancer Center at Med U of
responsible for the nausea and vomiting.South Carolina, postdoc at Yale - Cardiology,
Sometimes, when antibiotics are used,Molecular Medicine.
appendicitis goes away without surgical



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