Everybody in a lifetime must have heard about the appendix. In medical terminology, any infection of the appendix is called appendicitis. Appendicitis now becomes very common. But although it is very common still people have not aware of this common Pathology. Especially in developing countries like India, it is Still an ill-defined word for many. But believe me, you must know about the appendix, Appendix symptoms, Appendix pain and appendix operation.
I think you must know it because sometimes you need to accompany the patient to the hospital and the doctor explains to about the disease, appendicitis. Then many questions arise in your mind about appendicitis and you do ask to doctor also.
But in a short period of time, without any previous knowledge regarding the appendix, you could not understand it easily. And even you cannot explain to others in your language. In this situation, you could be like any other person who doesn’t know the appendix, appendix meaning, appendix symptoms and appendix operation.
Ok, I think this is enough reason to know appendicitis.
A real patient story
One real-life story I want to share with you how people reacted when they came to know that they have appendicitis.
One 45 years lady diagnosed as appendicitis on ct scan abdomen.
When the patient and relatives came to know that the patient has appendicitis they could not believe it. Despite the investigation report, they left the hospital to take a second opinion regarding the diagnosis. on second opinion it becomes crystal clear that the patient has acute appendicitis.
now the patient did not question the diagnosis of appendicitis but now she was asking the doctor whether it is possible to resolve this appendix with medicine only or not. As the appendix infection was a severe type, the doctor has advised her surgery.
But the lady and her relatives were not ready. On other hand, insisting to start medicine to resolve the infection. After explaining everything regarding the possibility of appendix perforation which could happen if medicine does not work to resolve the attack of the appendix, patient was not ready.
The next day patient has gone into Agony and admitted in the hospital on an emergency basis. That time the pain was so severe that she begged the doctor to get operate as soon as possible.
After surgery, it becomes clear that the appendix was bust and there was pus formation inside the abdominal cavity. And this was because of ignorance and not listening to the advice of the doctor. Due to this patient land up in more agony, more expenditure and more Hospital stay to treat appendicitis.
The message of the story is that you should rely on the suggestion of your consulting surgeon.
In Appendicitis, sometimes drugs work and the appendix get resolved but in severe appendicitis, drugs may not work and if not operated timely, the appendix can burst and that can lead to pus formation inside the abdominal cavity. After that, it becomes mandatory to get operate immediately.
Hence dr advised the patient to get operate on as early as possible. But that patient could not understand the gravity of the problem and continue to her belief that she can be cured of medicine.
Ok, what is the appendix? where it is situated inside our body?
This is a common query of every patient. it is not possible that you must have exact knowledge of the appendix.
The appendix is a small tubular structure of about 3-4 mm diameter, situated inside the abdominal cavity. It is seen as an outgrowth from the caecum of the large bowel.
It arises from the junction of the large and small intestine and remains free in the abdominal cavity. Sometimes it goes behind the caecum and remains attached to the posterior abdominal cavity, that position also known as retrocecal position.
If We want to locate the exact location on our abdomen then you can draw a line from the umbilicus to your rights sided iliac(hip) bone. and the point lower third point on this line can give you the approximate position of the appendix. Broadly you can say it is situated on the right side at the lower abdomen region. That is the exact location of the caecum and appendix. Hence don’t confuse if you have pain on the left side in. Don’t worry, you could not have appendicitis if you have no pain on right side, lower abdomen. Now after knowing the location over our body you must know the exact pathology of the appendix.
Appendicitis meaning
Appendicitis means infection of the appendix. If there is any blockage inside the tubular structure of the appendix due to any type of undigested food or any type of infection, or any type of calculus like material. All these can lead to blockage of the Tubular structure. Due to the blockage, the pressure inside the Tubular structure increased and that causes an intense pen. When such things happen it is called an attack of acute appendicitis.
Sometimes it associated with vomiting, fever. Sometimes it may present as pain only.
This example is enough to you that you must know what is the appendix and what is to be done whenever there is such a situation.
What is the presentation of appendicitis?
Appendicitis can be seen in all types of age groups. The presenting feature could differ according to the age of the patient.
In Childs, pain in the abdomen associated with vomiting and fever. Fever could not be seen always. Generally, children complain of pain in the abdomen on the right lower region of the abdomen, which is off and on. Initially, pain is mild and pain wains off within few hours. The next day child could be fine.
But after repeated painful attacks, the patient develops a severe type of pain which do not subside easily.
Such incidences need to take seriously and need doctor consultation. In the case of the child, the doctor remains always alert, because appendicitis can worsen fastly if not treated properly and timely.
This is because lack of development of omentum, a fat like structre which helps to subside any pathology inside our abdominal cavity.
In the case of old and debilitated persons, the situation of child appendicitis applicable.
But in the case of young and middle age person, the clinical presentation differs.
When the pain started, initially it appears very severe type but after few hours, it can decrease its intensity. Pain decreases due to activation of our omental activity inside the abdomen.
Hence after feeling of decreased pain, the patient may have pain when the doctor presses the abdomen at the right lower region. This is a definite sign of acute appendix infection.
Ok , what are all symptoms of appendicitis
# Pain
#Fever
#Vomiting
#Nausea
#Diarrhoea
#Burning pain in urination ( Micturition)
#Abdominal distention
#Bloating abdomen
When you reach the hospital and the doctor consulted you and reply that you or your patient have appendicitis, which may need surgery. Then you ask your doctor “are you confirm about the diagnosis”?
At this moment doctor could not explain to you whether he is confirm about appendix infection or not.
To get your query solved he will take the help of investigations to see the infection of the appendix. There are 2 investigations called as ultrasonography and CT scan of the abdomen. City scan of the abdomen is considered to be superior to ultrasonography. But whenever there is a problem of affordability or availability of CT scan, ultrasound will also play a major role in the confirmation of diagnosis.
Before the era of ultrasound and CT Scan examination, diagnosis of appendicitis was only the domain of the surgeon. If Surgeon said it is appendicitis, then you must have to believe it because his opinion was based on his clinical knowledge acquired during his lifetime.
When ultrasonography came into practice, everything has changed. Many times when the surgeon diagnosed as the possibility of appendix infection, that turned out to be an ovarian cyst or vesicoureteric junction calculus.
Due to this differential diagnosis, later it becomes mandatory to do ultrasonography in all patients. Still, only ultrasonography diagnosis of appendix infection could not be considered as 100% diagnosis because sometimes ultrasonography gives you a negative report of appendicitis infection. On the ground of clinical examination and all the symptoms pertaining to the disease, the surgeon takes the decision to treat patients as appendicitis. And that proved to be very helpful.
When Ultrasound failed, you can go to see the infection of the Appendix in CT scan abdomen. CT scan abdomen is really superior to ultrasonography scan because it is not an operator-dependent procedure. You can get your abdomen scan and any radiologist all over the world, can opine by viewing the films or monitor images of city scan abdomen. Hence City scan considered to be superior.
Limitation of Ct scan and ultrasonography
But still, there is one problem with both Diagnostic tools. The appendix is very small with little diameter, long tubular structure that could be of any size. It could be 3 centimetres or it may be 10 centimetres.
It remains coiled inside the abdominal cavity or could pass inside upward direction, in the retroperitoneum. It can go down into the Pelvic position. So because of all these possibilities of the situation and very Slender tubular structure less than 5 mm, even ultrasonography and CT scan abdomen could not locate it exactly every time.
Sometimes large colon remains loaded with stool material, sometimes all small bowel filled with gases and fluids. Because of obesity, which make omental fat bulky, a small slender appendix could not be visualised and that makes it is sometimes very difficult to find out in CT scan abdomen also.
The surgeon is the best detector of appendicitis
finally, it is the domain of the surgeon to decide whether the patient has appendix infection or not even though the CT scan abdomen report is positive, negative or whatever it may be.
So finally you must have to respect the opinion of your Consulting surgeon. Do not go with the reports of ultrasound or CT scan unless there is a crystal clear diagnosis, which is matching your clinical symptoms.
Here matching of clinical symptoms means if you have pain in the abdomen and ultrasonography giving the diagnosis that appendix is not visualised. That means your clinical examination and investigation reports are mismatching. Unless there is an opinion of a general surgeon, you must not believe a report of ultrasound for CT scan abdomen.
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