1-1banner
 
medpundit
 

 
Commentary on medical news by a practicing physician.
 

 
Google
  • Epocrates MedSearch Drug Lookup




  • MASTER BLOGS





    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov




    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.




    "Opinions are like sphincters, everyone has one." - Chris Rangel



    email: medpundit-at-ameritech.net

    or if that doesn't work try:

    medpundit-at-en.com



    Medpundit RSS


    Quirky Museums and Fun Stuff


    Who is medpundit?


    Tech Central Station Columns



    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews

    Review


    Medical Blogs

    rangelMD

    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc

    richard[WINTERS]

    code:theWebSocket

    Psychscape

    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It

    medmusings

    SOAP Notes

    Obels

    Cut-to -Cure

    Black Triangle

    CodeBlueBlog

    Medlogs

    Kevin, M.D

    The Lingual Nerve

    Galen's Log

    EchoJournal

    Shrinkette

    Doctor Mental

    Blogborygmi

    JournalClub

    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House

    .PARALLEL UNIVERSES.

    SoundPractice

    Medgadget
    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day

    BioEdge

    The Business Word Inc.

    Point of Law

    In the Pipeline

    Cronaca

    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station

    Blogcritics

    Overlawyered.com

    Quackwatch

    Junkscience

    The Skeptic's Dictionary



    Recommended Reading

    The Doctor Stories by William Carlos Williams


    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn


    Intoxicated by My Illness by Anatole Broyard


    Raising the Dead by Richard Selzer


    Autobiography of a Face by Lucy Grealy


    The Man Who Mistook His Wife for a Hat by Oliver Sacks


    The Sea and Poison by Shusaku Endo


    A Midwife's Tale by Laurel Thatcher Ulrich




    MEDICAL LINKS

    familydoctor.org

    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info

     



    button

    Tuesday, May 06, 2003

    Not so Obvious: A reader recently emailed wondering about appendicitis, and how hard it is to diagnose. A couple of his friends had recently suffered the consequences of a delay in diagnosis - commonly referred to as a “ruptured appendix.” (It doesn’t really burst like a balloon. It’s just that the infection spreads beyond the appendix to the surrounding organs and abdominal cavity, a much more severe condition known as peritonitis.)

    As it turns out, appendicitis isn’t always as straight forward as it would seem. A textbook case begins as pain around the belly button and progresses to a more localized pain in the right lower abdomen, accompanied by a lack of appetite. Often, there’s also vomiting, constipation, and fever. However, our bodies don’t read the textbooks.

    The appendix, a worm-like appendage of dubious usefulness, usually hangs straight down from the first portion of the large intestine, the cecum. However, like so many other things biological, the position of the appendix, and of the cecum within the abdominal cavity can vary widely. When an appendix sitting in a “normal” position gets infected and inflamed, it causes the classic textbook symptoms of right lower abdominal pain and tenderness. This, however, only happens about fifty percent of the time. An appendix sitting behind the obturator muscle causes a pain sensation in the pelvis, sometimes only detected with a rectal exam. An appendix behind the psoas muscle causes side pain. Sometimes, it hides behind the cecum, causing only mild pain in response to the doctor’s probing hands on the abdomen. In pregnant women, it gets even harder since the appendix can be displaced just about anywhere and shielded from examination by the enlarged uterus.

    And, to complicate matters, most abdominal pain does not turn out to be appendicitis. Ovarian cysts, urinary tract infections, gastrointestinal viruses, and kidney stones, to name just a few, can present in a similar manner. And, since surgery is a risky business, doctors only like to operate if the likelihood of appendicitis is fairly high.

    So, we're constantly searching for something that will increase our diagnostic certainty. Looking for higher numbers of white blood cells in the blood than usual is helpful, but not a certain indicator of appendicitis. Ultrasound can sometimes help to identify an enlarged and inflamed appendix, but it can miss cases, too. The state of the art at the moment is to use helical CT scans when in doubt. They give a high-resolution picture of the appendix that can pick up inflammation in surrounding tissue even at early stages. And, most importantly, they can identify a normal appendix.

    If diagnosed within the first twenty-four to thirty-six hours, the surgical cure is relatively straightforward and simple. These days, it can be done laparoscopically, which means fewer surgical complications and a faster recovery time. Usually, patients go home the day after surgery if all goes well, leaving their appendices behind them.

    (Note: For the medically inclined, here’s a good review article on diagnosing appendicitis. And, although written in 1921, you still can’t beat Cope's Early Diagnosis of the Acute Abdomen for a thorough discussion of the nuances of appendicitis.)
     

    posted by sydney on 5/06/2003 07:31:00 AM 0 comments

    0 Comments:

    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page

    Ads

    Home   |   Archives

    Copyright 2006