Hernia

A Hernia is any structure passing through another which in doing so ends up in the wrong place. Formally, it is defined as the protrusion of a loop or knuckle of an organ or tissue through an abnormal opening.

A Inguinal hernia is most common - these occur in the area of where the skin crease at the top of the thigh joins the torso (the inguinal crease) and appear as a bulge.

Other Hernias:

Femoral hernia - bowel enters the femoral canal presenting as a mass in the upper, inner thigh.
Umbilical - through umbilicus (the belly button area).
Paraumbilical - just above or below the umbilicus.
Epigastric - pass through linea alba (midline abdomen) above the umbilicus.
Incisional hernias - follow breakdown of muscle closure after previous surgery.
Lumbar - through one of the lumbar triangles
Richter's - this is when the bowel wall only, not the bowle opening is involved.
Obturator - through the obturator canal. Typicallly there is pain along the inner side of the thigh in a thin women.


Statistics Summary of Hernia
Groin hernias occur in approximately 2% of the adult population and 4% of infants.

Their relative frequencies are as follows:

Inguinal 80%
Incisional 10%
Femoral 5%
Umbilical 4%
Epigastric <1% Other: <1% Inguinal are approximately 10 times more common in males, while femoral and paraumbilical are more common in women. Predisposing Factors of Hernia

Predisposing factors include;
Increased intra-abdominal pressure: Chronic cough, constipation, urinary obstruction, heavy lifting, ascites (fluid in abdomen), previous abdominal surgery, obesity.

Loss of tissue strength and elasticity (direct inguinal hernia).
Nerve damage with consequent weaknening of the muscles.

Residual embryological channels in the case of congenital herniae (defects that one is born with).

Family History


Progression of Hernia
The natural history of most herniae is that they will slowly increase in size although may remain the same size for an extended period. They do not spontaneously heal and are at risk of the complications described and thus need to be repaired surgically.


Probable Outcomes of Hernia
This depends on whether the patient develops complications (e.g. bowel obstruction, strangulation). Herniae are treatable surgically, although they may recur.

The recurrence of a inguinal herniae after surgical repair may occur but should be less than 2% (10-20% in the case of incisional herniae). Other complications include infection, ilioinguinal nerve entrapment and testicular ischaemia. Testicular ischaemia (lack of blood supply) is rare after initial repair but occurs with a higher incidence after the repair of recurrent herniae.


Diagnosis and Testing for Hernia
Herniae, especially Inguinal herniae are a clinical diagnosis. However, occasionally an ultrasound is used for confirmation.


Treatment Overview of Hernia
Inguinal Herniae:
Elective surgical repair is recommended. They are not an emergency, unless they cause a bowel obstruction, or strangulation of the trapped bowel.

There are two accepted methods in adults:

Lichtenstein repair: involves using mesh to repair the defect.
Shouldice repair: suturing the defect closed without a mesh.

Other herniae:

Femoral herniae need to be repaired surgically more urgently (non-absorbable sutures). They have a higher risk of strangulation.

Umbilical herniae occur in children because of incomplete closure of the umbilical orifice. Surgical repair is only performed if the hernia has not disappeared by the age of three and the defect is greater than 1.5 cm in diameter.

Paraumbilical hernia - high risk of strangulation if there is a narrow neck and therefore treated (excision of the sac and overlapping repair).

Incisional hernia - should be be repaired surgically. In the patient with a large herniae who is unfit for surgery a corset may be worn.

Adapted from: Virtual Medical Centre

Diarrhoea

Food nutrients are absorbed in the small intestine. The waste is pushed into the large intestine (bowel) where water is removed. The resulting faeces is stored temporarily within the rectum then passed out of the body through the anus. Faeces are usually firm, moist and easy to pass. Diarrhoea is the frequent passing of loose, watery and unformed faeces.

The most common cause of diarrhoea is an infection of the intestines, such as gastroenteritis or food poisoning. Viruses are responsible for most cases. The intestinal lining becomes irritated and inflamed, which hinders the absorption of water from food waste. In severe cases, the intestinal lining may even leak water.

Generally, acute diarrhoea resolves after a day or two. Chronic diarrhoea, which lasts four weeks or more, can be caused by a range of conditions that affect the intestines including inflammatory bowel disease (IBD).

Symptoms
The symptoms of diarrhoea include:

Abdominal cramps
Abdominal pains
Urgency to go to the toilet
Frequent passing of loose, watery faeces
Nausea
Vomiting.

Serious symptoms
In most cases, acute diarrhoea is self-limiting and will resolve by itself within a day or two.

However, contact your doctor immediately if you experience serious symptoms including:
Blood in the faeces
Pus in the faeces
Painful passage of faeces
Repeated vomiting
Inability to increase fluid intake
Reduced or absent urination
Fever (temperature greater than 38ºC).

If you have a serious chronic medical condition, such as kidney or heart failure, even one day of diarrhoea can be dangerous. It’s safer to see your doctor as soon as possible.

Diarrhoea can be dangerous for babies and young children
Acute diarrhoea can be life threatening to babies and young children. This is because their smaller bodies are more vulnerable to dehydration.

If your baby or young child develops diarrhoea, seek medical attention straight away.

Causes of acute diarrhoea
A bout of diarrhoea can be caused by a wide range of disorders, infections and events including:
Food poisoning
Gastroenteritis
Tropical diseases, such as typhoid and cholera
Anxiety or emotional stress
Overconsumption of alcohol
Medications, particularly antibiotics.
Common infectious agents

Contaminated food and water are common causes of acute diarrhoea. Some of the infectious agents known to cause diarrhoea include:
Viruses – such as calici virus, adenovirus and rotavirus.
Bacteria – such as E. coli, Campylobacter, V. cholerae, Shigella, Salmonella and Staphylococcus aureus.
Parasites – such as Giardia lamblia, Cryptosporidium parvum and tapeworm.

Causes of chronic diarrhoea
Some of the causes of chronic diarrhoea include:
Coeliac disease – which reduces the intestine’s ability to absorb food.
Chronic constipation – the bowel is blocked by hard, impacted faeces but some liquids manage to seep past the blockage. This condition, called ‘spurious’ or ‘overflow’ diarrhoea, is more common in the elderly.
Hormone disorders – such as diabetes or hyperthyroidism (overactive thyroid gland).
Cancer – such as bowel cancer.
Inflammatory bowel disease – including ulcerative colitis and Crohn’s disease.
Irritable bowel syndrome – symptoms include abdominal pain, bloating, and alternating constipation and diarrhoea.
Lactose intolerance – the inability to digest the milk sugar lactose.
Medications – including antibiotics, antacids that contain magnesium, laxatives, and drugs for treating hypertension (high blood pressure) and arthritis.

Diagnosis methods
Successful treatment depends on diagnosing the cause. Investigations may include:
Medical history.
Physical examination.
Blood tests.
Laboratory analysis of stool sample.
Colonoscopy (the insertion of a slender instrument into the anus so that the doctor can look at the bowel lining).

Treatment options
Always see your doctor if you experience serious symptoms. Babies and young children with diarrhoea need prompt medical attention.

Treatment for diarrhoea depends on the cause but may include:
Plenty of fluids to prevent dehydration.
Oral rehydration drinks to replace lost salts and minerals. These drinks are available from pharmacies. An alternative is one part unsweetened pure fruit juice diluted with four parts of water.
Intravenous replacement of fluids in severe cases.
Medications such as antibiotics and anti-nausea drugs.
Anti-diarrhoeal medications, but only on the advice of your doctor. If your diarrhoea is caused by infection, anti-diarrhoeal drugs may keep the infection inside your body for longer.
Treatment for any underlying condition, such as inflammatory bowel disease.
Risk of spreading infection

Most cases of acute diarrhoea are potentially infectious to others. Viruses are easily spread, mainly through direct contact with vomit or faeces from an infected person or through contact with a contaminated object or surface. Occasionally the virus may be transmitted by airborne particles generated from vomiting and diarrhoea.

People can reduce their chances of getting infected by carefully washing their hands after going to the toilet and before handling food. People looking after a person with the virus must also wash their hands thoroughly.

Anyone with acute diarrhoea should stay at home if possible to reduce the spread of infection. It is strongly recommended not to visit hospitals and nursing homes, and not to swim in public pools.

Dietary adjustments may help
It may help to make a few short-term dietary adjustments while your bowels recover from acute diarrhoea.
Be guided by your health care professional, but general suggestions include:
Limit consumption of fatty, sweet or spicy foods.
Avoid alcohol.
Increase consumption of starchy foods like banana, rice and bread.
Increase consumption of yoghurt containing live cultures.
Diarrhoea in babies and young children can be caused by fruit juice, so limit these drinks.

Things to remember
Diarrhoea is the frequent passing of loose, watery faeces.
In most cases, acute diarrhoea is self-limiting and resolves after a day or two.
Acute diarrhoea in babies and young children can be life threatening due to the risks of dehydration.

Adapted from: Better Health Channel

CYSTIC FIBROSIS

Cystic fibrosis (CF) is a common, genetic (inherited) disease that affects about one in every 3000 babies born. In people with CF, the secretions produced by various glands in the body are thicker and stickier than normal. Usually the respiratory and digestive systems are most affected, but other problems such as osteoporosis (brittle bones) may also occur.

Screening and diagnosis
All babies born in Australia are tested for CF as part of the routine day 4 bloodspot test. This test determines the concentration in the blood of a certain chemical made by the baby’s pancreas. If a high concentration of this chemical is found, then the same blood sample is tested for genes commonly associated with CF. However, while newborn screening has improved the early detection of CF, up to 10 per cent of cases will not be picked up.

Babies with CF may develop a bowel obstruction (meconium ileus) in the first few days of life. In babies who are not diagnosed early with CF, the first signs of the disease are often failure to thrive (where they don’t gain weight normally) and/or recurrent chest infections.

A sweat test (which measures the amount of chloride in the sweat) is used to make the diagnosis of CF.

What problems does CF cause?
Children with CF tend to have recurrent chest infections and breathing problems. As children get older, their lungs may become permanently damaged.

Because the pancreas doesn’t produce the usual enzymes and secretions necessary for digestion, people with CF can have problems with malnutrition. Also, about 40 per cent of people with CF will develop problems with their liver, and 5-10 per cent will develop diabetes.

What treatments are available?
Unfortunately, there is no cure for CF, but there are treatments available to help correct the nutritional problems and prevent and treat respiratory infections.

Most people with CF have to take pancreatic enzyme replacement capsules to aid digestion and correct nutritional deficiencies. People with CF are also encouraged to use antibiotics for chest and sinus infections, and new medications are now available to reduce the stickiness of the sputum in the lungs.

Lung and liver transplants are now being performed in more severe cases.

How is CF inherited?
To have cystic fibrosis, you need to have 2 genes for the disease (one from each parent). It is much more common to have just one CF gene — these people, so-called ‘asymptomatic carriers’ do not have the disease or any symptoms.

If a healthy couple each carry a CF gene, with each pregnancy there is a one in 4 chance they will have a child with CF; a 2 in 4 chance the child will be an asymptomatic carrier; and a one in 4 chance the child will neither have CF nor be a carrier.

myDr 2006

Bowel Cancer

Cancer is the uncontrolled growth and spread of abnormal cells. Bowel cancer is caused by the abnormal growth of cells in some part of the bowel to form a lump or tumour. Bowel cancer is most common in the large bowel which is made up of the colon and rectum.

Normally, the body's cells reproduce themselves in an orderly manner so that growth occurs and damaged or worn-out tissues are replaced. Sometimes, however, cells continue growing into a mass of tissue called a tumour which can be benign (noncancerous) or malignant (cancerous). In some cases, the malignant cells can spread to other parts of the body through the blood or lymph system. New cancers formed in this way are called secondaries or metastases.

Bowel cancer is more common in older people, and is the second most common cancer in NSW with about 3,500 new cases being diagnosed in NSW each year, and around 8,700 Australia wide. About 1 in 22 Australians will develop bowel cancer by the age of 75, and about 4,000 Australians will die from bowel cancer each year.

What are the signs or symptoms?
You should see your general practitioner if you notice any of the following symptoms:

Blood in the bowel motion or in the toilet bowl. If you are over 40 it is a good idea to check the toilet bowl and the toilet paper after each bowel motion.
Changes in your toilet habits lasting more than two weeks.

How can I prevent bowel cancer?
There are a number of factors which increase your chances of getting bowel cancer.

These are:

being over 40 years of age
having bowel polyps or previous bowel cancer
having had ulcerative cloitis or Crohn's disease for more than eight years
having one or more close relatives who have had bowel cancer, especially if they were under 50 years of age

having a member of a family with familial adenomatous polyposis or another family cancer syndrome.

You should ask your general practitioner whether you should have regular tests to check for early bowel cancer if you are in any of the above groups.

There are a number of tests that can be carried out to see whether you have bowel cancer. These include:

digital rectal examination,where the doctor inserts a gloved finger into the anus (back passage) to check the rectum

occult blood test, which tests if there are small amounts of blood in the bowel motion
sigmoidoscopy, where a tube-like instrument called a sigmoidoscope is used by a doctor to look inside the rectum and lower colon

colonoscopy, where a longer flexible tube-like instrument called a colonoscope is used by a doctor to look inside the rectum and whole colon

barium enema, where the bowel is filled with a mixture containing barium, and an X-ray is then taken which gives an enhanced picture of the bowel.

How can bowel cancer be treated?
If a test indicates that cancer is present, a number of treatments are available.

These include:

surgery to remove all the cancer in the hope of a cure. A permanent colostomy bag is rarely used today.

chemotherapy, which is a course of drugs given to kill or control the cancer cells
radiotherapy, which is a course of high energy X-rays given to kill or control the cancer cells. (Chemotherapy and radiotherapy do not cure cancer but may result in long-term control in some types of bowel cancer.)

The type of treatment recommended depends on the size of the cancer, whether it has spread, your general health and also what you want.

Adapted from: NSW Health

Colic

Some babies at some times between the ages of about two weeks and 16 weeks go through a period of having unexplained and regular crying each day. These bouts of crying may last for three hours or more, and occur mostly in the afternoons and evenings. The baby seems to be suffering from abdominal pain. This is commonly known as ‘colic’, and around one in three babies are affected. Usually, cuddling or trying to soothe the baby’s cries does not work.

The cause is unknown, but colic stops - without treatment - after a few weeks. Some studies have found that parents under stress are more likely to consider their child as ‘colicky’, but it must be remembered that colic is very stressful to live with, and it is very important not to blame a ‘stressed’ parent for the crying.

Symptoms of colic
Colic tends to appear in the first two to four weeks of life, and peaks at around six to eight weeks of age. Usually, the baby seems quite happy until the late afternoon or early evening. Symptoms include:

Frowning and grimacing
Reddening of the face
The baby may pull up its legs, suggesting stomach pains
Loud and long screaming fits
Loud tummy rumblings
The baby cannot be consoled
The crying lasts for three hours or more
The baby passes wind or faeces (poo) around the time the crying stops, which could be coincidental
The baby recovers, none the worse for the experience

The cause is unknown
Despite much research into this common condition, the cause of colic remains unknown. There are many theories, however, including:

Maternal diet - certain foods in the mother’s diet may cause symptoms of food allergy or intolerance in her breastfed baby. Some studies have found that particular foods eaten by the mother including cabbage, cauliflower, broccoli, chocolate, onions and cow’s milk can cause an attack of colic in her breastfed infant.

Maternal social drug-taking - caffeine and nicotine in breast milk have been linked to infant irritability, since the baby’s body isn’t able to efficiently get rid of these substances.

Feeling of fullness - babies may overreact to the unfamiliar sensations of gas or fullness, and interpret these feelings as painful or alarming.

General immaturity - babies may take a few months to adjust to life outside the womb.
However, some babies have colic when none of these factors seem to be the cause.

Medication
It is not clear how useful medicines for colic are. Colic gets better by itself, often quite suddenly, whether you use any medicines or not. Medications can also make babies more sleepy, which can be dangerous.

If you use any medications, you should see your doctor first to check your baby’s health.

Gripe water is a generic term for liquids that claim to ease gas, digestion and other ‘colicky’ symptoms. Different formulas contain different ingredients including some herbal ingredients. There is no evidence that gripe water can improve colic in babies, and such products should only be used in consultation with your doctor.

Diet
Changing the diet of a baby is only of proven benefit for colic if the baby has lactose intolerance or cow’s milk allergies. Removing the substances from both the baby’s and the mother’s diet may be helpful. This should only be done with help from a doctor, to ensure nutritional needs of both mother and baby are met.

It may be useful to reduce the amount of caffeine a mother is having through coffee, tea, cola or other drinks and foods. Brewed coffee and energy drinks contain particularly high levels of caffeine.

In recent years there has been a lot of interest in ‘good’ bacteria (such as lactobacillus acidophilus) versus ‘bad’ bacteria in the gut. Babies, especially if they are breastfed, are likely to have plenty of lactobacillus acidophilus. Some infant formulas now have added lactobacillus (probiotics) but this does not seem to make a lot of difference for babies with colic.

Medical diagnosis is important
A crying baby needs to be checked by a doctor, to make sure there is no health problem causing pain or discomfort. There is no test for colic, so the only way to be sure that it is probably ‘only’ colic is to have the baby checked by a doctor.

How to help a crying baby
By holding, stroking or rocking your baby, the infant is learning that you are there for them, even if your baby is not able to calm down yet. Try the following ideas, which may help to calm your baby:

Respond quickly if your baby is crying. This may mean that they will cry less later on.

Crying babies tend to arch their backs and stiffen their legs. Holding them curled in a C (or flexed) position helps to calm them down.

Check that your baby is not too hot or cold or uncomfortable in some way.
Wrapping or ‘swaddling’ in a cotton sheet can be calming.

Many babies soothe themselves by sucking, so a dummy can be helpful, once your breast milk supply is going well.

Rocking and patting can help soothe a baby.

Soft lighting can also help some babies, who may be distressed by harsh lights.
Baby slings are great to provide comfort and contact if the baby needs to be held.
Deep baths and gentle massage relax some babies, but they often don’t help if your baby is already crying.

Soft music or noise that has a beat or rhythm, such as a loud clock, may help.
You may be trying too hard to calm the baby (too much bouncing, patting and burping). Put your baby down somewhere safe for a while and see if they settle.
Take the baby for a walk in a pram or a sling, or for a ride in the car. You might find yourself going out for many rides in the car for a couple of weeks, but this will not last forever and many babies seem to find it helps them calm down. Don’t drive if you are too stressed to drive safely.

You may find a technique that consoles your baby some of the time. If everything has been tried and your baby still cries, try to just hold them. Your baby will sense that you are offering comfort, even if the crying goes on. A rocking chair is great for this.

Distress management
Caring for a screaming baby who can’t be soothed is extremely distressing. If you feel that you are getting too upset, you need to take some time out to calm down.

Suggestions include:
Put your child in a safe place, such as a cot, and leave the room.
Walk around the house or go outside.

Relax your body by dropping your shoulders, clenching and unclenching your fists and stretching your back, arms and legs.

Have a drink (tea, coffee or cool drink) and something to eat, if you can manage it.
Do something physical like running.

Parents need support
While your child is colicky, you need to work out coping strategies. Suggestions include:

Take turns with your partner (if you have one) to look after the baby, and go outside for a break.

When you are ‘off duty’, distract yourself perhaps with music played loud enough to drown out the noise of crying (a portable player with earplugs is good for this).

Ask friends or relatives for support. Let them hold your baby while your baby is crying. They can manage this for a short time, knowing that you are having a break, and that you will be able to take over again soon.

Talk over your experiences with other parents and share coping strategies.
Seek advice from your Maternal and Child Health nurse and doctor.
Remember that colic tends to go away after a few weeks.


Things to remember
Infant colic is regular unexplained crying fits that usually last for at least three hours.

The cause is unknown, but theories include immaturity of the bowel, food allergies and ‘gas’ or ‘wind’.

Colic tends to go away without treatment after a few weeks.

Appendicitis

The appendix is a thin tail, tube or appendage growing out of the caecum, which is part of the large intestine located on the lower right side of the abdomen. The precise function of the appendix in the human body is something of a mystery, although it clearly plays a role in digestion for other animal species.

Appendicitis means inflammation of the appendix. Food or faecal matter can sometimes lodge in the narrow tube of the appendix, and the blockage becomes infected with bacteria. This is a medical emergency. If the appendix bursts, its infected contents will spread throughout the abdominal cavity. Infection of the lining of the abdominal cavity (peritonitis) can be life threatening without prompt treatment. Anyone of any age can be struck by appendicitis, but it seems to be more common during childhood and adolescence. It is less common for anyone over the age of 30 years to develop appendicitis. Treatment options include surgery.

Symptoms
Symptoms of appendicitis include:

Dull pain centred around the navel, which progresses to a sharp pain in the lower right side of the abdomen.
Pain in the lower back, hamstring or rectum (less commonly).
Fever.
Vomiting.
Diarrhoea or constipation.
Loss of appetite.

Causes of blockages
Food or hard faeces can clog the thin tube of the appendix. Once the impacted matter becomes infected, the appendix swells and shuts off its opening to the large intestine, virtually sealing the infection inside a self-contained pocket. Without treatment, the appendix will continue to swell with pus until it bursts. It is believed that low fibre diets may be a factor leading to appendicitis. Without sufficient fibre or 'roughage', food moves slowly through the gut and blockages may be more likely. Occasionally, a pip, seed or some other type of foreign matter becomes lodged in the appendix. Other causes of blockage include swelling of the appendix's lymphatic tissue (as occurs with some viral infections) and parasitic worms.

Perforated appendix
If pus keeps on accumulating, the appendix will eventually burst, flooding the abdominal cavity with infected matter. Bursting, or perforation, can occur 36 hours or so from the onset of infection. The signs of a perforated appendix include a severe worsening of symptoms and collapse. Infection of the lining of the abdominal cavity (peritonitis) is a life threatening complication and requires immediate emergency treatment.

Diagnosis is difficult
Appendicitis can mimic the symptoms of other disorders such as gastroenteritis, ectopic pregnancy and various infections (including those of the kidney and chest). Diagnosis methods may include a thorough physical examination and careful consideration of the symptoms. If the diagnosis is not clear, then laboratory tests and ultrasound or CT scans may be needed. Since appendicitis is potentially life threatening if left untreated, doctors will err on the side of caution and operate, even if there is no firm diagnosis.

Treatment options
Treatment for appendicitis includes an operation to remove the appendix completely. This procedure is known as an appendicectomy or appendectomy. A small incision is made in the lower abdomen. The appendix is cut away and the wound on the large intestine stitched. If the appendix has burst in the interim, the surgeon will insert a tube and drain the abdominal cavity of pus. Antibiotics are given to the patient intravenously to reduce the possibility of peritonitis.

The appendix can sometimes be removed using laparoscopic (keyhole) surgery. The surgeon will use a slender instrument (laparoscope), which is inserted through tiny incisions (cuts) in the abdomen. This eliminates the need for large abdominal incisions.

The typical hospital stay for an appendicectomy is between three and five days. Removing the appendix appears to have no effect on the workings of the digestive system, in either the short or long term.

Things to remember
Appendicitis means inflammation of the appendix, which is a small tube attached to the large intestine.
Appendicitis is a medical emergency.
Treatment includes intravenous antibiotics and surgical removal of the appendix.

Adapted from: Better Health Channel

Abdominal pains - Appendicectomy

Appendectomy is the surgical removal of the appendix, which is located in the right lower side of the abdomen. This operation is usually carried out on an emergency basis to treat appendicitis (inflamed appendix). This may occur as a result of an obstruction in part of the appendix. Some common symptoms of appendicitis are nausea, vomiting, constipation and pain. The pain is initially felt in the centre of the abdomen, and later moves to become a sharper pain in the right lower abdomen. The area is tender to the touch. Occasionally, some of these symptoms may be absent and it becomes necessary to investigate the abdominal cavity to make a diagnosis.

Problems associated with appendicitis
Appendicitis has no single cause, but may be due to:

A bowel adhesion
Swelling of the lymphatic tissue of the appendix due to a viral infection

A foreign body
A faecalith (a small, hard mass of faeces), which causes blockage, inflammation and infection.

If appendicitis is left untreated, it may result in rupture of the appendix. If the appendix ruptures, the infected contents flow into the abdominal cavity, causing a much more serious medical emergency - peritonitis. This is the inflammation of the membranes lining the abdominal wall and organs. Without prompt treatment, peritonitis can be life threatening.

Medical issues to consider
Once in hospital, the temperature, pulse, breathing pattern and blood pressure will be charted. If the surgeon suspects that your appendix shows signs that it may rupture, you will be taken to the operating theatre as soon as possible.

Operation procedure
The two main surgical techniques include open and laparoscopic appendectomy. In open appendectomy, an incision is made through the skin, the underlying tissue and the abdominal wall in order to access the appendix.

Laparoscopic appendectomy involves making three small incisions in the abdomen, through which particular instruments are inserted. A gas is gently pumped into the abdominal cavity to separate the abdominal wall from the organs. This makes it easier to examine the appendix and internal organs. (However, a laparoscopic appendectomy may need to become open surgery if the appendix has ruptured.)

Once the appendix is accessed by either open or laparoscopic surgery, the blood vessels that supply it are clamped and the appendix cut and removed. In laparoscopic appendectomy, the appendix is removed through one of the small 'keyhole' incisions.

Immediately after the operation
After the operation, you can expect:
Nurses will regularly record your temperature, blood pressure, pulse and respiration.

Nurses will observe your wound and level of pain, and give you painkillers as ordered by your doctor.

If there are no complications, you can get out of bed quite soon after the operation.

Early movement is desirable, but caution is needed for climbing stairs so as not to strain the abdominal muscles.

You should be able to eat about 24 hours or so after the operation.
You should be able to leave hospital two to three days after an uncomplicated appendectomy.

If you have external sutures (stitches), you usually have them removed after one week or so. Sometimes, surgeons use dissolvable sutures.

Medical treatment for peritonitis
If your appendix ruptures and you develop peritonitis, you will have antibiotics prescribed. Your surgeon will need to drain out the infected material and disinfect your abdominal cavity. A nasogastric tube may need to be inserted into your stomach for a day or two, and intravenous fluids will be administered into a vein in your arm. You can expect a longer hospital stay.

Possible complications
All surgery carries some degree of risk. One of the most common complications following appendectomy is infection. Around 20 per cent of people who have a ruptured appendix develop an abscess (ball of pus) within the abdominal cavity some two weeks or so after the appendectomy. These abscesses must be surgically drained. Another common type of infection following appendectomy is infection of the wound.

Taking care of yourself at home
Be guided by your doctor, but general suggestions include:

Follow the dietary advice you are given.
You may like to use a mild laxative for the first few days.
Drink plenty of water every day to help prevent constipation.
Make sure you have adequate rest. A fast lifestyle, with inadequate diet, will slow your recovery.

Avoid lifting heavy objects and stair climbing, so that you don't strain your abdominal muscles.

After a few days, slowly resume your normal activities. Include regular, gentle exercise.

Long term outlook
The appendix appears to be a redundant organ, since the human body manages quite well without it. There is no chance of ever experiencing appendicitis again, because the appendix is entirely removed.

Surgery is the preferred treatment for appendicitis. Delaying the operation (in the hope that the appendix will 'settle down') only increases the risk of suffering a ruptured appendix.


Things to remember
Appendectomy is the surgical removal of the appendix, which is usually found in the right lower side of the abdomen.

Appendectomy is usually carried out on an emergency basis to treat appendicitis (inflamed appendix).

A ruptured appendix can cause peritonitis, which is a potentially life threatening complication.

Adapted from: Better Health Channel

Ménétrier's Disease, Rapid Gastric Emptying

Ménétrier's Disease

Ménétrier's disease causes giant folds of tissue to grow in the wall of the stomach. The tissue may be inflamed and may contain ulcers. The disease also causes glands in the stomach to waste away and causes the body to lose fluid containing a protein called albumin. Ménétrier's disease increases a person's risk of stomach cancer. People who have this rare, chronic disease are usually men between ages 30 and 60. The cause of the disease is unknown.

Ménétrier's disease is also called giant hypertrophic gastritis, protein losing gasteropathy, or hypertrophic gastropathy.


Symptoms
Symptoms include pain or discomfort and tenderness in the top middle part of the abdomen, loss of appetite, nausea, vomiting, diarrhea, vomiting blood, swelling in the abdomen, and ulcer-like pain after eating.

Diagnosis
Ménétrier's disease is diagnosed through x rays, endoscopy, and biopsy of stomach tissue. Endoscopy involves looking at the inside of the stomach using a long, lighted tube that is inserted through the mouth. Biopsy involves removing a tiny piece of stomach tissue to examine under the microscope for signs of disease.

Treatment
Treatment may include medications to relieve ulcer symptoms and treat inflammation, and a high-protein diet. Part or all of the stomach may need to be removed if the disease is severe.


Rapid Gastric Emptying
Rapid gastric emptying, or dumping syndrome, happens when the lower end of the small intestine (jejunum) fills too quickly with undigested food from the stomach. "Early" dumping begins during or right after a meal. Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness, and fatigue. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include hypoglycemia, weakness, sweating, and dizziness. Many people have both types.

Certain types of stomach surgery that allow the stomach to empty rapidly are the main cause of dumping syndrome. Patients with Zollinger-Ellison syndrome may also have dumping syndrome. (Zollinger-Ellison syndrome is a rare disorder involving extreme peptic ulcer disease and gastrin-secreting tumors in the pancreas.)

Doctors diagnose dumping syndrome primarily on the basis of symptoms in patients who have had gastric surgery that causes the syndrome. Tests may be needed to exclude other conditions that have similar symptoms.

Treatment includes changes in eating habits and medication. People who have dumping syndrome need to eat several small meals a day that are low in carbohydrates and should drink liquids between meals, not with them. People with severe cases take medicine to slow their digestion. Doctors may also recommend surgery.

National Institute of Diabetes and Digestive and Kidney Diseases