Appendicitis

Assalamualaikum WBT.

Hi everyone! Have you ever heard about APPENDICITIS?
I'm sure it is quite common to hear worldwide as it is the most common acute abdominal condition the surgeon is called on to treat. But, did we really know what is it all about?

Appendicitis & its pathophysiology.

• Appendicitis is the inflammation of the appendix, which is either acute (most common) or chronic. It is associated with obstruction of the appendix, may be in the form of stool, foreign objects, tumor, or gallstone from the caecum, which enters the appendix and causing blockage

• This stool will hardens, become a rock-like mass. When the blockage occurs, the bacteria will invade the wall of the appendix and causing inflammation.

• Perforation or rupture of the appendix may occur if there is no treatment. This may lead to peritonitis, sepsis, and death. 

• In Neuroimmune appendicitis:  Pain without acute inflammation, increase substance P / VIP, and non-inflammatory. 

How to diagnose?

      1. Laboratory:  - Leukocytosis with Lt. shift
                             - Total WBC count: < 10K/uL
                             - Absolute neutrophil count: < 6750/mL
                             - Hyponatremia
                             - Acidosis

      2. Radiography:  - X-rays (not specific, may shows air fluid)
                               - Calcified stone in appendiceal area
                               - CT scan and ultrasound (more accurate)

      3. Differential diagnosis:
              -Crohn's disease, Psoas abscess, Pyelonephritis, Pelvic abscess,
               ovarian/fallopian diseases, Cholecystitis, Intestinal perforation
               due to obstruction, or in male: Scrotum abscess, Hernia.


How to treat?

* Surgery : by removal of appendix by surgery OR
                 laparoscopic surgery ( less wound and risk, rapid healing)

* Fluid management is critical.


Symptoms & Scoring.

Apparently, all these things were quite complicated for non-medical practitioners to understand, so here it is. Alvorado scoring! It is usually used by the physician on the symptoms and scoring for the possibilities of appendicitis. But now you could self-diagnose yourself at home! (excluding the lab tests)  :)

You may also have

• Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. Or anywhere in the upper & lower abdomen, back, and rectum.
• Loss of appetite
• Abdominal swelling
• Inability to pass gas
• Constipation & diarrhea with gas
• Painful urination
• Severe cramps

So if you have most of the symptoms, quickly go get yourself checked!

We Learn, We Share, We Care

** Sorry for any inconvenience since this is my first post. :)

References: 

Robbins Basic Pathology (8th Edition)

http://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis

http://www.medicinenet.com/appendicitis/page2.htm#what_is_appendicitis_and_what_causes_appendicitis

Analysis of Symptoms (Endocrinology)

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Analysis of symptoms in Endocrinology

Referring to how you analysis a symptom in the last post here are the common clinical features in endocrine disease.

Ask for:

1. Weight Gain - Hypothyroidism, PCOS, Cushing Syndrome
2. Weight Loss - Hyperthyroidism, DM, Adrenal Insufficiency
3. Short stature - Constitutional, non-endoncrine systemic disease e.g. coeliac disease , GH deficiency
4. Delayed Puberty - Constitutional, non-endocrine systemic disease e.g. hypothyroidism, hypopituitarism, primary gonadal failure
5. Menstrual disturbance - PCOS, hyperprolactinaemia, thyroid  disfunction
6. Diffuse neck swelling - Simple goitre, Graves' disease, Hashimoto's thyroiditis
7. Excessive thirst - DM or Insipidus, hyperparathyroidism, Conn's syndrome
8. Hirsutism - Idiopathic, PCOS, Cushing's Syndrome , congenital adrenal hyperplasia
9. 'Funny Turns' -  Hypoglycaemia, phaeochromocytoma, neuroendocrine tumour
10. Sweating -  Hyperthyroidism, hypogonadism, acromegaly , phaeochrmocytoma
11. Resistant Hypertension - Conn's syndrome, Cushing's , phaeochromocytoma ,acromegaly , renal artery stenosis
12. Erectile Dysfunction -  Primary/2ndry hypogonadism, DM, Non-endocrine systemic disease
13. Muscle Weakness - Cushing's syndrome, hyperthyroidism, hyperparathyroidism, osteomalacia
14. Bone fragility and fractures - Cushing's syndrome , hypogonadism, hyperthyroidism
15. Altered facial appearance - Hypothyroidism, Cushing's Syndrome, acromegaly, PCOS

These are few common symptoms to be analysis in an endocrine case :)

References : Macleod's Clinical Examination 12th Edition

History Taking

Assalamualaikum WBT.

Hi guys long time since the last update from TAPMED. Today I would like to talk about history taking. History taking from patients is important to reach a good diagnosis. We can't deny that nowadays there are lots of high-tech work up or investigation that can bring you to a diagnosis. However looking back to years back where there are no such investigation, history taking plays a big role in reaching a diagnosis. So waste no time and lets begin to talk about history taking from patients.

First of all when you are with a patient, make him comfortable and introduce yourself. Tell him/her why you are here. Shake hands if possible try to make the patient know that you are eager to help him/her.

Then start with:

Personal History

Name : Get their full name , if in Egypt get three names like Ahmad Mohammed Ibrahim

Age : Some diseases are age related

Sex :  Some diseases are sex related

Occupation : To look for occupational disease

Residence : Some disease are endemic in specific places

Habit : Special habit of medical importance such as smoking, alcohol intake.

Menstrual History for women : Regularity, Days of Cycle , Amount of bleeding

Complaint (c/o)

Ask the patient what brings him to the hospital.

Make sure that you are writing it down in patients own word. Exclude medical terms

As short as possible (one complaint is enough)

e.g. don't write epixstasis , but write "complaining of nose bleed"

don't forget to write the duration. e.g. complaining of chest pain for 2 days

History of Present Illness

Do it in chronological order. Ask when he was last healthy (symptomless). Write in medical terms.

Then analysis the complaint.

Then ask for symptoms of the related systems then proceed for other systems.

For every symptoms analysis for

Onset/Course/Duration

Association

What will increase or decrease the symptom

Effect of TTT if there is any

Date of last attack

For pain ask for site, radiation and character of the pain.

This is the part where you are playing a big role. Don't let the patient lead you, but you should lead the conversation for this part.

Past Medical History

Ask for any disease such as DM, HPT, TB, I.H.D

Ask for it's duration, manifestation, investigation, ttt and complication

Ask for any surgical history when ,where(site) and out come. Don't forget to ask if any blood transfusion.

Ask also if patients is taking any drugs for treatment.

Family History

Ask for consanguinity, Similar conditions or any related chronic disease like DM/HPT/TB/I.H.D.