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ransom1538

I found this conversation unnerving at 13 years old:

Doctor: "Does all this make sense? We need to remove your appendix.. now."

Me: "Doctor, ok, so you need to remove my appendix cause if you don't I could get really sick. "

Doctor: "Yes."

Me: "What does the appendix do?"

Doctor: "We don't know."

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Doctor: in your case, kills you in about 24-48 hours.

I had mine out as well. I was 19. My dad drove me to the hospital. Doc slipped his finger up my bum, said, “you have appendicitis. You need surgery. Now.” I was being operated on quickly after that. It had ruptured. So it goes.

A ruptured appendix would not likely be resolved with antibiotics, I'd think. But catching appendicitis before it ruptures would be a less critical issue.

It definitely can, mine fully ruptured and I didn't find out till 4 days later. It requires very strong antibiotics, but did work good. My appendix came out 3 months later in a normal way.

Wow, I find that quite amazing.

Its not that surprising. You don't go removing your arm every time you get a cut.

Once the swelling that caused the rupture has stopped, it can heal. Assuming it wasn't too severe (you don't want to die of internal bleeding in the meantime)

Perhaps I was confusing "ruptured" with "exploding".

>Doc slipped his finger up my bum

Is this a standard way to diagnose appendicitis?

The appendix is a tricky organ, it's position varies a far bit so not all patients with appendicitis get the classical symptoms (pain that begins as dull around the belly button, then moves to the right lower quadrant add becomes sharp and worse on rebound).

Digital (as in finger) rectal examination is meant to help detect some of the atypical cases. It was part of my teaching, although I haven't read up much on it.

I'm a student doctor.

Yeah pressing on the area isn't so bad, but pull your fingers away quickly and oh Jesus! I had appendicitis when I was 8. It ruptured during the visit to my GP, literally shit blood, rushed off to the hospital for an emergency appendectomy. Fun times!

I was in there for a few days. The kid in the bed next to me was hard case. Nurse comes to check on him and he goes "yeah I managed to get all the grass out of my cut, and now it's heaps better"

He'd pulled all his stitches out.

Heh, yeah. It is traditional. And ineffective (of course). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071072/

I was kind of out of it. Maybe there was a lot of pain, but my memory of it was just so much discomfort, what is something minor like that?

That's an excellent article you link - to paraphrase the conclusion: digital rectal examination should not be performed routinely for abdominal pain, but should be considered an investigation to consider when diagnosis is unclear.

Thanks. I guess it isn’t fair to say it is ineffective, it can give some information.

Clinical history, some labs, and imaging are typically used to diagnose. In adults, CT scan has the highest sensitivity and specificity (0.96 and 0.96); better than ultrasound. The difference is not as pronounced in children (smaller abdomen-- easier to visualize using ultrasound), so that is commonly used to save exposure to radiation (though note that an abdominal CT scan is actually a very low dose).
Source: https://effectivehealthcare.ahrq.gov/topics/appendicitis/res...

"The estimated effective radiation dose of abdominopelvic CT is 8 to 10 mSv with standard dose and 2 to 4 mSv with low dose techniques [40]. To put these numbers into context, the effective dose from annual background radiation is 3.1 mSv and from plain abdominal radiography is 0.7 mSv." (from https://www.uptodate.com/contents/acute-appendicitis-in-adul...)

I was taught by a computer game that it's diagnosed by palpating the four quadrants of the abdomen and doing an ultrasound. A lot of the decoy cases were just gas; hold for observation until they fart it out.

This wasn't in the game, but I presume it may also be necessary to do a pregnancy test (ectopic?), urinalysis for urinary tract infection, swabs for genital tract infection, blood draw for white blood cell count, and maybe look for other bowel conditions, kidney stones, gallstones, clots, torsions, cysts, or diverticula with the ultrasound.

Was it "Life & Death"? That game was difficult as a kid. If surgery was involved, the patient always died.

That was it, I think. I could even do the aortal aneurysm surgery without killing the patient. And my boss hardly even yelled at me for mistakes.

It came in a bundle with Beyond the Black Hole, which came with 3D glasses that worked with CRT monitors. The feelies for L&D included a surgical mask. Maybe it came with Chessmaster, too?

There's videos of people doing the surgery, but I've never managed it either

I was 13 when I had it. I had a high fever and puking out an entire day. When I went to the doctor, i think he didnt even look at my face: just poked my abdomen. Even I understood immediately it was appendicitis.

I was taught first year of medical school (2017-2018) that it isn't. Some physicians probably still use it though.

"If you don't put your finger in it, you'll put your foot in it" is still a common aphorism. Enjoy your time on surgical assessment when you get to your clinical years!

Mine was blood test (checking infection), palpating (to see which parts of my gut hurt), and ultrasound. I now feel like I've missed out.

About 10 years ago, one study set forth an interesting hypothesis: The appendix is a place where "good" bacteria can safely hide during infection. I'm not sure if there's been any work since then to confirm the hypothesis, but it sure is an interesting idea.

Source: https://www.nytimes.com/2008/06/17/health/research/17appe.ht...

I think I remember reading at some point that another hypothesis is that it acts as a repository for bad bacteria, so that your immune system doesn't forget how to make antibodies for those bacteria. I think I remember the sinuses being posited as serving the same role.

What if the appendix is an attempt to "tame" bad bacteria into being good? Does giving bacteria access to nutrients from our food and mucus remove the selective pressure to evolve virulence factors?

Oh, yeah, I remember reading about that! I think that's seeped into my head as 'leading reason we think we have an appendix.'

This is the great thing about HN -- there's a very good change somebody will come along and update my intuition.

Papers please. Bacterial edition

Hands and feet are also very useful ... until they turn septic and need to be removed. Antibiotics can treat infections in the early stages if diagnosed well ahead of time. But once an organ is totally taken by infection it may be unrecoverable. Either you remove it or it becomes a lump of dead tissue spreading evil to the rest of the body. By the time someone is in the emergency room due to abdominal pain, by the time they are seen by a doctor and ultrasounded, it will need to come out.

Pretty sure the whole point of this article is that often enough patients arrive in the emergency room at a point where it's NOT too late to treat successfully with antibiotics.

Look at the people in the thread who ruptured. They certainly did not make it in time.

That’s correct. There’s a difference between “often” and “always”. There are also several people posting in this thread who had their appendicitis successfully treated with antibiotics.

Someone mentioned tonsils below, but in the past, we also had bloodletting, trepanation, and various other unnecessary excisions. Foreskin may one day join the list (who knows, though). This all raises the question of why medicine is practiced the way it is, with so much appeal to authority and memorization, rather than something more intrinsically scientific. Why do bad practices persist for so long?

> Why do bad practices persist for so long?

Define "bad". Appendicitis patients invariably survive surgery and go on to live their normal, healthy lives. Until an objectively better solution comes along, we have no reason to not go with what Just Works™. And that's why medicine dislikes change.

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