SURGICAL CONDITIONS

Infections and Inflammations

An infection is the condition of multiplication of parasitic organisms or microorganisms within the body. An inflammation is the reactions that occur in the affected blood vessels and adjacent tissues in response to an injury or abnormal stimulation caused by a physical, chemical, or biologic agent. Many people use the terms interchangeably since they have several symptoms in common and usually are treated similarly.

Appendicitis :: Pancreatitis :: Hepatitis :: Cholecystitis
Oesophagitis :: Peritonitis

Appendicitis

Appendicitis is an inflammation of the appendix, a small worm-like pouch attached to the large bowel. It can happen at any age but most cases are between 8 and 25 years of age. For young people, appendicitis is probably the most common cause of stomach pain requiring emergency surgery.

Causes

In most cases, the specific reason for the inflammation is not known but it is due to blocking of the opening connecting the large intestine and appendix. In many cases it is caused by small pieces of hardened stool (faecaliths) that get stuck in the appendix.

Symptoms

The first sign is usually a pain or discomfort in the centre of the abdomen. The pain usually begins near the umbilicus and moves down and to the right. This pain comes and goes in waves and increases on movement. Pain is often thought at first to be a simple stomach upset.

• nausea
• vomiting
• constipation
• diarrhoea
• inability to pass gas
• low fever that begins after other symptoms
• abdominal swelling
• anorexia

Diagnoses

• The doctor takes a medical history from the patient and checks their temperature.
• Blood and urine tests are performed to look for infection.
• The doctor examines the patient by pressing on the lower right part of the abdomen and sometimes by inserting a finger in the anus (back passage) in order to exclude other causes of pain.
• Women are often given a vaginal examination.

There is no one test that will diagnose appendicitis with certainty, usually doctors use CT scan or ultrasound to see whether the appendix looks inflamed. Surgery is performed on the basis of the doctor's examination and results of the tests. Many diseases can cause the same symptoms as appendicitis.

Course of illness

The inflammation can cause infection, a blood clot, or rupture of the appendix. Because of the risk of rupture, appendicitis is considered an emergency. Anyone with symptoms needs to see a doctor immediately.

Treatment

• Surgical removal of the appendix (appendicectomy) is the most common procedure. A 3-6cm horizontal incision is made in the lower part of the abdomen on the right side, through which the appendix is removed.
• In some hospitals, the appendix is routinely removed by a keyhole operation or the insertion of a three-fibre optic camera through the stomach (laparoscopy).

In uncomplicated cases, a two to three day hospital stay is typical. The person can go home when their temperature is normal and their bowel starts to function again. The stitches are removed 10 days after the operation. A return to ordinary daily life within four to six weeks is usual.