Tag Archives: Appendicitis

Appendix is Also a Valuable Organ

Your appendix is a slimy sac that hangs between your small and large intestines. It has long been thought of as a worthless evolutionary artifact, good for nothing except a potentially lethal case of inflammation. But now researchers suggest that your appendix is a lot more than a useless remnant.
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Not only was it recently proposed to actually possess a critical function, but scientists now find it appears in nature a lot more often than they had thought. And it’s possible some of this organ’s ancient uses could be recruited by physicians to help the human body fight disease more effectively.

Your appendix may serve as a vital safehouse where good bacteria can lie in wait until they are needed to repopulate the gut after a case of diarrhea. Past studies have also found the appendix can help make, direct and train white blood cells.

The appendix appears in nature much more often than previously acknowledged. It appears in Australian marsupials such as the wombat and in rats, lemmings, meadow voles, and other rodents, as well as humans and certain primates.

Resources:
Live Science August 24, 2009
Journal of Evolutionary Biology August 12, 2009 [Epub Ahead of Print]

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Simple Appendicitis Test Under Development

Researchers link a chemical in children’s urine to appendicitis. Emergency rooms could test for it, preventing unnecessary surgery and increasing the chance of removing the appendix before it bursts.

……………Appendicitis

Researchers have identified a chemical in urine that is closely associated with appendicitis in children and are working to develop a simple test that could be used to diagnose the condition — a test that would both increase the likelihood of performing surgery before the appendix bursts and prevent unnecessary surgery.

Preliminary results show that the test is highly accurate, producing very few instances in which cases are missed (false negatives) or children are incorrectly diagnosed with the condition (false positives), a team from Children’s Hospital Boston reported today in the Annals of Emergency Medicine.

Appendicitis is the most common childhood surgical emergency. The lifetime prevalence of appendicitis is 9% for males and 7% for females, but the bulk of the cases occur in childhood or adolescence. In the past, diagnosis was made simply from clinical symptoms, such as abdominal pain, and as many as 30% of cases in which surgery was performed revealed a healthy appendix.

Within the last few years, emergency room specialists have begun using CT scans for diagnosis, which reduces the number of unnecessary surgeries to as low as 5%. But in as many as 30% to 45% of those diagnosed with appendicitis, the organ has already ruptured at the time of surgery, leading to a variety of complications that lengthen hospital stays.

There has also been a growing reluctance to use CT scanners on children because of the risk that the radiation will trigger cancer later in life.

Dr. Richard Bachur and his colleagues studied urine from healthy children and those with surgically confirmed appendicitis, and concluded that high levels of one chemical, leucine-rich alpha-2-glycoprotein or LRG, correlated very closely with an inflamed appendix. Tests in 67 children showed that the amount in the urine was correlated to the severity of the inflammation, and the number of false positives and false negatives associated with its use were each less than 3%.

The team is now studying a larger number of urine samples and is working “feverishly” to develop a simple test for LRG that could be used in emergency rooms, Bachur said. “We could take urine and, in minutes, have an answer,” he added.

He cautioned that the team has not yet studied potential markers in adults and they don’t know whether the same test would work. “Adult diseases are a little different,” Bachur said.

Source: Los Angeles Times

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Barium Enema

Alternative Names : Lower gastrointestinal series
Definition:

Barium enema is a special x-ray of the large intestine, which includes the colon and rectum. Before x-rays are taken, a liquid called barium sulfate is placed in the rectum. The liquid is a type of contrast. Contrast highlights specific areas in the body, creating a clearer image. The barium eventually passes out of the body with the stools.

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Because the colon and rectum are normally not visible on x-rays, you need to temporarily coat their inner surfaces with barium, a liquid that does show up on x-rays. This makes the outline of these organs visible on the x-ray pictures. This test is useful for diagnosing cancers and diverticuli (small pouches that may form in the intestinal wall).

How do you prepare for the test?
Tell your doctor if there is any chance you might be pregnant. If you have diabetes and take insulin, discuss this with your doctor before the test.

You will be given very specific instructions to ensure that your colon is completely empty before the test. You may be told to eat only a light breakfast and a liquid lunch and dinner (such as broth, fruit juice, or plain gelatin) on the day before the test. You may also be instructed to drink a large amount of clear liquid between meals and to avoid dairy products. You will need to take a laxative, a medicine that stimulates your intestine to move things through more quickly, so that you have a bowel movement to empty the colon. It is a good idea to stay at home or at least near a bathroom for a few hours after taking the laxative. On the day of the test, do not eat any breakfast.

How the Test is Performed
This test may be done in an office or a hospital radiology department. You lie on the x-ray table and a preliminary x-ray is taken. You will then be told to lie on your side. The health care provider will gently insert a well-lubricated tube (enema) into your rectum. The tube is connected to a bag that contains the barium. The barium flows into your colon.

A small balloon at the tip of the enema tube may be inflated to help keep the barium inside your colon. The health care provider monitors the flow of the barium on an x-ray fluoroscope screen, which is like a TV monitor.

You must completely empty your bowels before the exam. This may be done using an enema or laxatives combined with a clear liquid diet. Your health care provider will give you specific instructions. Thorough cleaning of the large intestine is necessary for accurate pictures.

There are two types of barium enemas:
1.Single contrast barium enema uses barium to highlight your large intestine.
2.Double contrast barium enema uses barium, but also delivers air into the colon to expand it. This allows for even better images.

You are asked to move into different positions and the table is slightly tipped to get different views. At certain times when the x-ray pictures are taken, you hold your breath and are still for a few seconds so the images won’t be blurry.

The enema tube is removed after the pictures are taken. You will be given a bedpan or helped to the toilet, so you can empty your bowels and remove as much of the barium as possible. One or two x-rays may be taken after you use the bathroom.

What happens when the test is performed?

You wear a hospital gown and lie on a table in the radiology department. To administer the enema, a nurse pushes a small tube an inch or two into your rectum, and then uses this tube to fill your colon and rectum with barium liquid. You may find the sensation of the filling of your colon somewhat strange (you might feel like you need to have a bowel movement), but it is not painful.

The x-ray for this test is taken as a video that begins immediately after your enema is started. The x-ray video is taken by a large camera positioned over your abdomen. Usually the room is darkened while the video is taken so that the doctor can watch the pictures on a TV screen. If the doctor wants to save a view in “freeze frame” (developed later for a closer look), you may be asked to hold your breath for a few seconds so that your breathing movement does not blur the image. A few more pictures may be taken after the lights are turned back on. After this, you are asked to empty your bowel in a nearby bathroom.

Usually one picture is taken of your abdomen after you have had your bowel movement, to make sure that the bowel has emptied well.

How the Test Will Feel
When barium enters your colon, you may feel like you need to have a bowel movement. You may also have a feeling of fullness, moderate to severe cramping, and general discomfort. Try to take long, deep breaths during the procedure. This may help you relax.

Risks Factors:
There are no significant risks. You will be exposed to a small amount of radiation during the test. The amount of radiation from a barium enema is larger than from a simple chest x-ray, but still very small — too small to be likely to cause any harm.

Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of the x-ray.

A more serious risk is a perforated colon, which is very rare.

Must you do anything special after the test is over?
In some cases, if some stool was still present in your colon despite your preparation the day before, the test must be repeated.

How long is it before the result of the test is known?
It takes the x-ray department 30 minutes to an hour to develop the pictures from your barium enema, and it will take additional time for a doctor to examine the x-rays and to decide how they look. Typically you can get the results within a day or two.

RESULTS:-

Normal Results: Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.

What Abnormal Results Mean

Abnormal test results may be a sign of:
*Acute appendicitis
*Cancer
*Colorectal polyps
*Diverticulitis
*Irritable colon
*Twisted loop of the bowel
*Ulcerative colitis

Additional conditions under which the test may be performed:
*Crohn’s disease
*Hirschsprung’s disease
*Intestinal obstruction
*Intussusception
*Ulcerative colitis

Resources:
https://www.health.harvard.edu/fhg/diagnostics/barium-enema.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003817.htm

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Helpful Bacteria May be Hiding in Your Appendix

Your appendix is a small dead-end tube connected to a section of your large intestine. It has long been thought to be a vestigial remnant of some other organ, but there is little evidence for an appendix in our evolutionary ancestors. Few mammals have any appendix at all, and the appendices of those that do bears little resemblance to the human one.

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Some researchers now believe that the appendix is a “safe house” for commensal bacteria, the symbiotic germs that aid digestion and help protect against disease-causing germs.

The appendix is isolated from the rest of the gut, with an opening smaller than a pencil lead. In times of trouble, such as an infection that flushes the system, these commensal bacteria could hide out there, ready to repopulate the gut when the danger is past.

Biofilms, colonies of beneficial microbes, form in your large intestine. They aid digestion and protect against infection, while enjoying the protection and nutrition of the human host. Researchers have found biofilms on the epithelial lining of the appendix as well.

Sources:

* New York Times June 17, 2008

* The Journal of Theoretical Biology December 21, 2007; 249(4):826-31

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Oh My Appendix!

Human beings ate raw grass, leaves, bark and uncooked cereals, like rabbits and other herbivorous animals, before they became refined carnivores who cooked and softened their food. And like these animals, we too had a long appendix.

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As the nature of our diet changed, we did not require this organ and it eventually became small and rudimentary. It still nestles in the lower part of the right side of the abdomen, an appendage loosely attached to the transition point between the small and large intestines. The organ does not serve any discernible useful function. But in almost 40 per cent of the population it gives trouble at some time in their lives.

Digested food gets pushed in and out of the appendix during its transit through the intestine. As long as the opening remains patent, this does not pose a problem. Sometimes the opening of the appendix becomes narrowed and obstructed. This can occur because of intestinal worms, a hard stony piece of stool called a fecolith, or even undigested food particles. Contrary to popular opinion, orange pits and other swallowed seeds have not been shown to block the appendix.

The appendix is lined by abundant lymphoid tissue. This can swell and secrete infected fluid if there is a bacterial or viral infection. If this is sufficient to partially or completely block the opening, there is pain and swelling. If the symptoms are neglected, the appendix can “burst”, spilling the infection fluid into the surrounding area. The entire abdominal cavity can then become infected, causing peritonitis. The infection may get localised, forming an appendicular abscess.

Appendicitis initially produces non-specific symptoms like fever, vomiting, diarrhoea and abdominal pain. The pain may eventually localise in the lower part of the right side of the abdomen. There may also be acute pain in an anatomical area called McBurney’s point, situated a little away from the umbilicus.

The presentation of appendicitis may be atypical in the young (less than 10 years) and in the old (more than 60). The pain fails to localise in any particular area of the abdomen and may pose a diagnostic enigma. The symptoms may be confusing and the diagnosis missed if the appendix is situated in an abnormal location, too high, too low or at the back, or on the left side of the abdomen. Houdini, the magician, had an appendix on the left side. The diagnosis was missed and it perforated during a performance. He collapsed on stage, dying shortly afterwards.

Unfortunately, there are no confirmatory diagnostic blood tests for appendicitis as there are for other illnesses like typhoid or urinary tract infections. The suspicion of appendicitis can, however, become a certainty with an ultrasound or CT scan. But these procedures have an inherent latent period (waiting for the facility to become available) and the appendix can rupture in the interim.

Around 45 per cent of women are suspected to have appendicitis during their reproductive years. This is because the pain of appendicitis can be confused with tubal infection (salpingitis), urinary tract infection, ectopic pregnancy or even normal mittleschmerz, the mid-cyclic ovarian pain caused by rupture of the mature ovarian follicle and release of the ovum. In 30 per cent of surgeries, the diagnosis of appendicitis is wrong and a normal organ is removed. The mortality, however, is 50 per cent if the inflamed appendix is not treated surgically.

A laparoscopy clinches the diagnosis. The appendix itself can often be removed at the same time with a minimally invasive, no scar laparoscopic procedure, thus providing an investigation method that also cures. The appendix can also be removed through a classical incision.

Sometimes it is possible to control the infection with antibiotics, allowing the person to opt for an interval appendectomy at a convenient time. Some people have a “grumbling appendix” that causes repeated attacks of pain which can be managed conservatively. This delays the need for surgery. It is not a very wise course of action as the infection can flare up at inopportune moments. Women who have repeated attacks of appendicitis are also likely to develop adhesions and scars. This can distort the anatomy of the pelvic area and result in undesirable relative infertility.

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Appendicitis

Sources: The Telegraph (Kolkata, India)

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