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 (faecoliths) 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. Other symptoms may include:

• nausea
• vomiting
• loss of appetite
• constipation
• diarrhoea
• fever
• abdominal swelling

Diagnoses

• The doctor takes a medical history from the patient.
• The doctor examines the patient by pressing on the abdomen.
• Blood and urine tests are performed to look for infection.

There is no one test that will diagnose appendicitis with certainty. Sometimes doctors will use CT scan or ultrasound scans to see whether the appendix looks inflamed. A negative scan does not always exclude appendicitis but sometimes identifies other causes for the pain. 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. Laparoscopic or key-hole surgery enables the appendix to be checked and also look and exclude other causes of pain.

Course of illness

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

Treatment

• Surgical removal of the appendix (appendicectomy) is the main treatment. Antibiotics may also be required. The procedure is usually performed by laparoscopic (key-hole) surgery which has the benefits of accurate diagnosis and exclusion of other causes of pain, smaller incisions, less pain and faster recovery.

In uncomplicated cases, a two to three day hospital stay is typical. The person can go home when their temperature is normal and they are able to eat, drink and walk.