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Comment by lightbyte | Hacker News Reader

>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.

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