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The Informed Parent


by Louis P. Theriot, M.D., F.A.A.P.
Published on Jan. 01, 2000

A few nights ago, my son had a really bad stomach ache. I was worried that it was his appendix, but he was better the next morning. I almost took him to the emergency room, but I'm glad I didn't overreact. For the future, what exactly is appendicitis, and when should I call his doctor?

The appendix is a blind pouch of intestine that is situated at the junction of the large and small intestine. It is typically located in the lower right side of the abdomen. It is a vestigial organ which means it has no real function. It is shaped just like, and is about the size of an individual's little finger.

In appendicitis, the appendix somehow gets plugged, and this allows bacteria to get trapped inside. This causes inflammation of the appendix--it becomes swollen and filled with pus. If not treated in a timely fashion, it can actually rupture. When this occurs, the pus is spilled in the abdominal cavity, and this makes for a very sick patient.

Appendicitis has been called the "great imitator" because it can look like many other conditions. The diagnosis of appendicitis can be a very tricky one. The classic case of appendicitis goes as follows: there typically is a fever, loss of appetite, and pain in the middle of the abdomen. The patient may even vomit once or twice. Shortly thereafter, the pain shifts to the lower right side of the abdomen. The pain is described as a sharp and persistent pain that is localized to the right side. Patients with appendicitis usually don't want to move or be moved, they prefer to lay still. When made to walk, they hunch over as if to "guard" or protect their abdomen. If asked to jump up and down, the pain is increased because of the jostling of the already inflamed abdomen. These patients will jump once...but not a second time.

The above describes the "textbook description" of appendicitis. I cannot stress enough, however, the fact that appendicitis can present in so many different ways. The symptoms can be vague and subtle--very insidious. There are also many other conditions that can look just like an appendicitis. These include: a pneumonia, an ovarian cyst, an inflamed intestinal lymph node, a urinary tract infection etc.---the list goes on.

A high index of suspicion is critical when dealing with a possible appendicitis. It is very important to make an early diagnosis and remove the appendix before it ruptures. If so, the patient is usually home in two to three days. If it does perforate, then a stormy ten to twelve day stay in the hospital is not uncommon.

It is accepted in both the medical and surgical literature that the index of suspicion should be so high, that 10-15% of all appendices removed should be normal. In other words, one wants to error on the safe side, to insure that as few patients as possible are missed.

The best advice that anyone could give you is that if your son has any complaints that make you think it might be an appendicitis, contact your doctor immediately. Discuss the symptoms with him or her, and let the doctor decide what to do next. You should not have to make those kinds of decisions on your own.

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