When Dr Shiraz went back home that night after a 36-hour long duty followed by a hang-out with his childhood friends over some Middle Eastern cuisine, little did he knew that within few hours he will be back to the hospital, but only as a patient. It was a surprise for his friends to receive the message that the ever energetic Shiraz was going in for surgery soon. So what actually happened within the few hours that led to an immediate hospital admission and an urgent operation? An issue called Acute Appendicitis.
Vermiform appendix (vermiform being a Latin word meaning worm-like) is the closest that human race can get to being an owner of a vestigial organ (an organ that once was useful in an animal’s evolutionary past, but that now is useless or very close to useless). Some theories point towards the appendix as being the storehouse of good bacteria, reservoir of normal gut flora and immunity hub that may come handy especially in the cases where normal good bacteria of the gastrointestinal tract are washed away. However, the lack of any significant side effects, issues or any other positive or negative consequences after its removal, points otherwise.
Present at the right side of the lower abdomen, the appendix is around four-inch long tube connected with cecum, a structure that is present at the junction of the small and large intestines.
A dull pain becomes sharp with time and must be attended to immediately
The appendix is a blind ended tube. Its base is firmly attached to the same place, as compared to the other end, known as the tip, which may be positioned at any of the few common directions within.
Acute appendicitis is the most common emergency condition that is related to the appendix. The condition is manifested by severe pain in the right lower abdomen, along with anorexia, fever, nausea and vomiting. Generally, the pain that is dull in nature begins around the centre of the abdomen and then it shifts to the right lower abdomen with the passage of time, meanwhile increasing its intensity as being severe. During appendicitis, the appendix becomes inflamed, infected and may rupture, sometimes even causing death. This is primarily the reason that acute appendicitis is dealt with as an emergency and most of the time, the patients are operated as the first priority.
Acute appendicitis can be diagnosed very easily. The patient usually turns up at the hospital emergency and the doctor is likely to reach the diagnosis with little clinical examination. The patient displays extreme tenderness and pain in response to different specific manoeuvres applied by the physician during the physical check-up. Other than that, blood test to confirm increased white blood cells due to inflammation, CT scan and / or ultrasound may also be conducted to further supplement the diagnosis.
Children, teenagers and people in their middle ages are more vulnerable to the condition, while it is a rare occurrence among infants and after the middle age. Specific cause for the condition cannot be single out and is highly debated. Decreased dietary fibre and increased consumption of refined carbohydrates may be important. Appendicitis is also connected with bacterial growth of different organisms. Sometime, a mass known as Faecolith, which is usually composed of thickened faecal material, calcium phosphate, bacteria and sometimes a foreign body, may obstruct the appendix lumen. This may lead to appendicitis as well. Occasionally, pinworm and other intestinal parasites may also cause appendicitis.
It is believed that God did not make anything in this universe without a purpose or function to perform. However, there may be a few things that one can do without. For instance, if the Darwin’s theory of evolution is anything to go about, human race let go of the tail as it was of little or no utility at all for them. Appendix occupies the same distinctive edge over the other organs present within our body. Presence or absence of a healthy appendix may not be an issue or a cause of concern for the human beings in general. This is primarily the reason that in case of wrong diagnosis of appendicitis, surgeons utilise this leverage during operation and may still remove a healthy appendix. This removal is generally being done to avoid any future confusion from the incision mark that has already been made. Pregnant females are more susceptible to misdiagnosis for that matter, partly due to the difference in their anatomy within as compared to men.
Published in Dawn, Sunday Magazine, April 3rd, 2016