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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Appendicitis is among the commonest surgical presentations, with a slight male preponderence (1.3:1). It can be defined as the acute inflammation of the vermiform appendix, most commonly due to obstruction from a faecolith or infection causing lymphoid hyperplasia. Patients typically present with acute centralised abdominal pain which migrates to the right iliac fossa as diffuse visceral irritation transforms to more localised parietal peritoneal irritation. Important symptoms include fever, anorexia, nausea with or without vomiting and reduced bowel sounds. On examination, important signs to be aware of include:
Acute appendicitis
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
The vermiform appendix is a tubular structure attached to the base of the caecum which can become inflamed, resulting in acute appendicitis. This is generally caused by obstruction of the appendix lumen due to faecoliths (hardened lumps of faeces) or appendicoliths (calcified deposits in appendix) in adults and lymphoid hyperplasia in children. The incidence of acute appendicitis is 52 per 100,000 in the UK and the peak incidence is between 10 and 30 years of age. The overall lifetime risk for developing acute appendicitis is 8.6% in males and 6.7% in females.
Single Best Answer Questions
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
With regard to the vermiform appendix:It is most often situated in a pelvic positionIt receives blood via the right colic branch of the superior mesenteric arteryIt lies at McBurney’s point (halfway between the anterior superior iliac spine and umbilicus)It is unimportant in humansIt is a retroperitoneal structure
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
Acute presentation of an incarcerated femoral hernia constitutes a surgical emergency. Incarceration and strangulation are more common in female patients aged 65 and over. Herniation of the vermiform appendix is not common and difficult to detect preoperatively. CT of the abdomen and pelvis is the most common investigation and the investigation of choice in clinical uncertainty. The procedure of a repair of a De Garengeot’s hernia varies, depending on the clinical expertise of the operating surgeon. There are various surgical approaches described in the literature. The majority of published cases underwent an open procedure via an inguinal or infra-inguinal incision. In case of difficulty accessing the base of the appendix a second incision had to be made. The intraoperative findings are in favor of acute appendicitis, and, thus, the hernia was repaired with sutures. The surgical incision is based upon the surgeon’s preference and experience.
Brief Commentary on the Article “Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis”
Published in Journal of Investigative Surgery, 2019
Appendicitis has always remained the major subgroup among patients suspected of acute abdomen in emergency departments all over the world. Due to the potential catastrophic events that might ensue if left unattended, surgical removal of the vermiform appendix is the ideal treatment in a case of diagnosed appendicitis. However, there are a large number of clinical conditions which can mimic the clinical features of acute appendicitis, especially in the paediatric population. To diagnose a case of acute abdomen as appendicitis requires astute clinical examination skills as well as an array of investigations in the form of blood counts and imaging modalities like Ultrasonography and Computed Tomography(CT). In spite of all the preoperative investigations, a significant percentage of people(as high as 10%) who undergo emergency appendicectomy still turn up negative histology.1 Also, the adverse effects associated with CT scan preclude its routine prescription in all suspected cases, especially in the younger population. Over the years, clinicians have been on the hunt for the right blood marker that can differentiate a case of acute appendicitis from other causes of acute abdomen which don't mandate surgical treatment.
Francis Forster, the last Horseman: A career in academic neurology
Published in Journal of the History of the Neurosciences, 2018
During medical school at the University of Cincinnati, neurologist and neuroanatomist Alphonse R. Vonderahe (1896–1979) taught the sophomore course in neuroanatomy, and through that exposure became Forster’s mentor (Forster, 1980; Pierce, 1982). Forster received a bachelor of medicine degree in 1936 and then his doctorate in medicine in 1937, after completing a rotating internship at Good Samaritan Hospital in Cincinnati. He was generally bored by the rotations, except for aspects that somehow related to the nervous system (Forster 1999b): When I was in the internship, it occurred to me that the only things that really got me excited in medicine were things relative to the nervous system. … I was on surgery as an intern and I didn’t care what kind of incision was made to get out the appendix or what kind of retractors they used. I was intrigued by the referred pain and how it got out to the skin from the vermiform appendix. (Pierce 1982, p. 2)