APPENDICITIS&IT' S TREATMENT

Appendicitis Overview

The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in a condition termed appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the rupture of the appendix (perforated or ruptured appendix).

The American Journal of Epidemiology study found that appendicitis was a common condition affecting approximately 6.7% to 8.6% of the population. IN the U.S. 250,000 cases of appendicitis are reported annually. Individuals of any age may be affected, with the highest incidence occurring in the teens and twenties; however, rare cases of neonatal and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating potential cases of appendicitis is critical in the very young and elderly, as this population has a higher rate of complications. Appendicitis is the most common pediatric condition requiring emergency abdominal surgery.

Appendicitis Causes

There is no clear cause of appendicitis. Fecal material is thought to be one possible cause of obstruction of the appendix. Bacteria, viruses, fungi, and parasites can result in infection, leading to the swelling of the tissues of the appendix wall. The various infecting organisms include Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Swelling of the tissue from inflammatory bowel disease such as Crohn's disease also may cause appendicitis. Appendicitis is not a hereditary disease and is not transmittable from person to person.

Appendicitis Symptoms and Signs

Appendicitis typically begins with a vague pain in the middle of the abdomen often near the navel or "belly button" (umbilicus). The pain slowly moves to the right lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain may be accompanied with nausea, vomiting, lack of appetite, and fever. All of these symptoms, however, occur in fewer than half of people who develop appendicitis. More commonly, people with appendicitis have any combination of these symptoms.

• Symptoms of appendicitis may take 4-48 hours to develop. During this time, a person developing appendicitis may have varying degrees of loss of appetite, vomiting, and abdominal pain. The person may have constipation or diarrhea, or there may be no change in bowel habits.
• Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of the stomach and intestines). Many people admitted to the hospital for suspected appendicitis leave the hospital with a diagnosis of gastroenteritis; initially, true appendicitis is often misdiagnosed as gastroenteritis.
• Children and the elderly often have fewer symptoms, or cannot adequately describe their symptoms, which makes their diagnosis less obvious and the incidence of complications more frequent.

When to Seek Medical Care

Call a health care practitioner if there are acute symptoms of middle/lower or right/lower abdominal pain with fever and/or vomiting.

If symptoms of abdominal pain continue for more than four hours, an urgent medical evaluation should be performed at the health care practitioner's office or a hospital's emergency department.

Appendicitis Diagnosis

Appendicitis is diagnosed by the classic symptoms of appendicitis and physical examination (the health care practitioner's examination of the patient's abdomen).

• Lab work: Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the white blood cell count, which is typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urinalysis may be ordered to exclude urinary tract infection (or pregnancy) as the cause of the patient's symptoms.
• Imaging tests: Imaging tests are ordered when the diagnosis is not readily apparent. Most medical centers utilize a CT scan of the abdomen and pelvis to assist in evaluating abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is commonly used in small children to test for appendicitis in order to avoid exposing the child to radiation from CT scans.

Other conditions that cause abdominal pain may mimic the symptoms of appendicitis making the diagnosis more difficult. These conditions include kidney stones, urinary tract infections, hernias, gallstones and gallbladder problems, colitis, diverticulitis, and ovarian or testicular problems.

Appendicitis Treatment

Appendicitis Self-Care at Home

There is no home care for appendicitis. If appendicitis is suspected, contact a health care practitioner or go to an emergency department. Avoid eating or drinking as this may complicate or delay surgery. If you are thirsty, you may rinse your mouth with water. Do not use laxatives, antibiotics, or pain medications because these may cause delay in diagnosis that increases the risk of rupture of the appendix or mask the symptoms, which makes diagnosis more difficult.

Surgery (Appendectomy)

The best treatment for appendicitis is surgery to remove the appendix (appendectomy) before the appendix ruptures. While awaiting surgery, the patient will be given IV fluids to keep well hydrated. The patient will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery.

Surgery is commonly performed via laparoscopy, a minimally invasive procedure where small "keyhole" incisions are made in the abdomen and the appendix is removed with the assistance of a small camera guided by the surgeon. However, in some cases it may be necessary to do an open abdominal procedure to remove the appendix.

Occasionally, surgery for appendicitis reveals a non-inflamed appendix (negative appendectomy), with high rates in infants, the elderly, and young women. However, the use of imaging studies (CT scans, ultrasounds) appears to have reduced the negative appendectomy rate to 7%-12%. The difficulty in making a definite diagnosis of this medical problem and the risk of missing an acutely inflamed appendix (and the patient becoming very ill due to perforation) makes a certain rate of misdiagnosis inevitable. Women in particular have a high rate of negative appendectomy as ovarian and uterine problems make the diagnosis more difficult. CT scanning prior to surgery has been shown to decrease this percentage to closer to 7% to 8% in women.

Appendicitis Follow-up

After an uncomplicated appendectomy, recovery time can vary from 2-6 weeks. The individual may gradually resume a normal diet with restriction in physical activity for at least two to four weeks. The health care practitioner will inspect the incision the following week to look for possible wound infection.

Appendicitis Prevention

There is no way of predicting when appendicitis will occur or prevent it from occurring.

There are no proven risk factors for appendicitis. It has been suggested that potential risk factors may include a diet low in fiber and high in sugar, family history, and infection.

Appendicitis Prognosis

• With uncomplicated appendicitis, most people recover with no long-term complications.
• If the appendix ruptures, there is a greater risk of complications, including death. This increase in risk generally is found in the very young, elderly, and those with weakened immune systems, including people with diabetes.
• Whether a perforated appendix is a significant risk for infertility has not been well established. Some experts recommend that this be considered in young women who might be at risk.

WHAT IS PILES?

Hemorrhoid Overview

Hemorrhoids are enlarged veins located in the lower part of the rectum and the anus. They become swollen because of increased pressure within them, usually due to straining at stools and during pregnancy because of the pressure of the enlarged uterus.

Internal hemorrhoids are located in the inside lining of the rectum and cannot be felt. They are usually painless and make their presence known by causing bleeding with a bowel movement. Internal hemorrhoids can prolapsed or protrude through the anus.

External hemorrhoids are located underneath the skin that surrounds the anus. They can be felt when they swell and may cause itching or pain with a bowel movement, as well as bleeding. A thrombosed external hemorrhoid occurs when blood within the vein clots, and can cause significant pain.

Hemorrhoid Causes

Hemorrhoids are associated with constipation and straining at bowel movements. Pregnancy is also associated with hemorrhoids. These conditions lead to increased pressure within the hemorrhoidal veins causing them to swell. Other conditions, for example damaged liver, may also cause increased venous pressure and may be associated with hemorrhoid formation. Hemorrhoids are very common and are estimated to occur in up to one-half of the population by age 50.

 

Hemorrhoid Symptoms

The most common presentation  from hemorrhoids is painless bleeding. There may be bright red blood on the outside of the stools, . The bleeding usually is self-limiting.

 While hemorrhoids are the most common cause of bleeding with a bowel movement, there may be other reasons

Prolapsed Internal Hemorrhoids

Prolapse of an internal hemorrhoid occurs when the internal hemorrhoids swell and extend from their location in the rectum through the anus. A prolapsed internal hemorrhoid:

• can be felt as a lump outside the anus;
  
• can be gently pushed back through the anus, this may resolve the problem of prolapse but does not fix the hemorrhoid itself;
  
• may enlarge and swell even more if they cannot be pushed back;
  
• may become entrapped, which requires medical attention.

Hemorrhoids may also cause  itching around the anus, and a constant feeling of needing to have a bowel movement.

Thrombosed External Hemorrhoids

Thrombosed external hemorrhoids are a painful condition. These occurs when a blood clot  develops in the hemorrhoid causing swelling .

• When a blood clot occurs in a hemorrhoid, the hemorrhoid will become even more swollen. This swelling leads to increased pain.
  
• The pain is usually worse with bowel movements and may increase with sitting.
  
• Thrombosed external hemorrhoids often need medical care and treatment.

 

When to Seek Medical Care

When to call the doctor

• Bleeding from the rectum or anus is never normal and although hemorrhoids are the most common reason to have blood in the motion, it should be discussed with yoursurgeon.
• Medical care should be sought urgently if a person is taking anticoagulation medication such as warfarin ,clopedogrell (Plavix),
• 
  
• Hemorrhoids do not cause abdominal pain; should this be present with bleeding, medical care should be accessed immediately.
  
• Prolapsed hemorrhoids that cannot be pushed back through the anus require medical care.
  
• Thrombosed external hemorrhoids may cause significant pain and medical care may need to be sought.

  Hemorrhoid Treatment

Self-Care at Home

basic treatment for hemorrhoids can be done at home.

Warm Sitz Bath

• Sitting in a few inches of warm water three times a day for 15-20 minutes may help decrease the inflammation of the hemorrhoids.
  
• It is important to dry off the anal area completely after each Sitz bath to minimize irritation of the skin surrounding the anus.

Dietary Changes

• Increased fluid intake and dietary  fiber (roughage) will decrease the potential for constipation and lessen the pressure on the rectum and anus during a bowel movement, minimizing further swelling, discomfort, and bleeding. Dietary fiber supplements may also help bulk up the stools

Stool Softeners

• Stool softeners may help but once hemorrhoids are present, liquid stools may cause inflammation and infection of the anus. 

Activity Suggestions

• Individuals with hemorrhoids should not sit for long periods of time and may benefit from sitting on an air or rubber donut available at most local pharmacies.
  
• Exercise is helpful in relieving constipation and in decreasing pressure on the hemorrhoidal veins. Individuals should be encouraged to have a bowel movement as soon as possible after the urge arises. Once that urge passes, stools can become constipated and straining with a bowel movement may occur.

Medical Treatment

Prolapsed Internal Hemorrhoids

• Most prolapsed internal hemorrhoids can be pushed back into the anus but occasionally your care provider may need to reduce them by gently pushing them with constant pressure.
  
• If the hemorrhoids remain swollen and trapped outside the anus and nothing is done about it, the hemorrhoid tissue may not receive enough blood and can become infected. In such situations, surgery may be required to resolve the problem.

Thrombosed Hemorrhoids

• Thrombosed external hemorrhoids can be painful and are associated with a hard lump that is felt at the anus and cannot be pushed back inside. Most often the clot within the hemorrhoid will need to be removed with a small cut .
  
• After local anaesthetic  is placed under the skin surrounding the hemorrhoid, a scalpel is used to cut into the area and the clot is removed. There is almost instant relief of the sharp pain but a dull pain may continue.
  
• There may be some mild bleeding from the hemorrhoid for a couple of days. Sitz baths and over-the-counter pain medicines  may be recommended.
  
• The use of a rubber or air rubber donut may help with the pain as well. Preventing constipation is also a priority.

 

 

Surgery

A variety of surgical options exist for persistent pain or bleeding.

Rubber band ligation: Rubber band ligation of internal hemorrhoids can be done in the office. The doctor places a couple of tight rubber bands around the base of the hemorrhoidal vein causing it to lose its blood supply. There may be some fullness or discomfort for 1-2 days after the procedure and a minor amount of bleeding may be experienced.

Sclerotherapy: Sclerotherapy describes a procedure when a chemical is injected into the hemorrhoid causing it to scar.

Laser therapy: Laser therapy can be used to scar and harden internal hemorrhoids.

Hemorrhoidectomy: Hemorrhoidectomy is a surgical procedure done in the theatres with an anesthetic agent (general, spinal or local with sedation) where the whole hemorrhoid is removed (ectomy=removal). This is the most aggressive approach and there is a markedly decreased chance of the hemorrhoids returning. 

Stapled hemorrhoidectomy: Stapled hemorrhoidectomy is the newest surgical technique for treating hemorrhoids, and it has rapidly become the treatment of choice for third-degree hemorrhoids. Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but, rather, the abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward. Stapled hemorrhoidectomy is faster than traditional hemorrhoidectomy, taking approximately 30 minutes. It is associated with much less pain than traditional hemorrhoidectomy and patients usually return earlier to work.

Regardless of the surgery, Sitz baths and dietary suggestions for increased roughage are usually recommended.

 

Prevention

The risk of hemorrhoids can be decreased by eating a fibre diet , staying well hydrated, getting regular exercise, and trying to have a bowel movement as soon as possible after the urge arises.