One in seven Americans suffered it. Appendicitis. What is it? Part 2 by Aleksandr Kavokin, MD/PhD

Next they try to image what is going on in your belly. An abdominal x-ray may detect the fecalith as the cause of appendicitis (5%). Free air due to perforation can might be seen on the plain film.

A barium enema may be used. It is an x-ray test where liquid contrast is used from the anus to fill the colon. Sometimes it show an impression on the colon in the area of inflamed appendix. Barium enema also can exclude other intestinal problems that mimic appendicitis.

Ultrasound shows an enlarged appendix or an abscess. Ultrasound is painless, but the appendix can be seen in only half of patients. Ultrasound also is helpful in excluding the problems with ovaries, fallopian tubes and uterus. Ultrasound machine usually looks like a small thumb on wheels that they bring into your room. Technician puts gelly on and drives the probe over you belly.

Often they go straight to CT Scan (computer tomography). Especially if the patient is not pregnant. CT scan gives relatively high irradiation of your body by x-rays. However benefits of prompt diagnose of appendicitis outweigh the risk of radiation. CT scan gives slicing images of your body.

What do they look for? As any inflamation causes edema, the wall of the appendix will be thickened. This is actually a defensive mechanism - by edema the organism try to wall of, to seal off the area of infection and inflamation.

But it is useful for us because we can surely say there is an inflammation. The same goes for ultrasound.

CT scan is expensive - around 1000 dollars in an American hospital, though 40 dollars in Russia.

If the CT scan is taken during the night, CT image may be send to Australia Russia or India.

An American radiologist is paid around 40 dollars to read just an X-ray film. I guess he gets more for reading the CT scan. It is only 5 dollars in India. This is why even such clinics as Harvard and Yale adopt this model of work - they send the CT scans to the cheap labor abroad. Especially during the night. Half an hour later the fax from Australia arrives. "Inflammatory pericecal mass in the right iliac fossa consistent with the diagnosis of severe acute appendicitis." Any doctor can read an x-ray film or CT scan. Radiologists are doctors who specialize in the reading of the films. They may find what was missed by others.

At this point diagnosis is usually clear. In cases if it is not, there is Laparoscopy. Laparoscopy is a surgical procedure. Small fiberoptic tube with a camera is inserted into the abdomen through a small puncture in abdominal wall.

Yet there is no test that will diagnose appendicitis with 100% certainty.

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BIO:

Aleksandr Kavokin, MD1994 Russia,PhD1997 Russia - Immunology and Allergy, postdoc at Cancer Center at Med U of South Carolina, postdoc at Yale - Cardiology, Molecular Medicine. http://www.geocities.com/aging_rejuvenation/ http://www.appendicitis.uni.cc/, http://www.geocities.com/appendicitis_disease/

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