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| | Title: | Appendicitis. Part 4. | | Article: | Diagnostic problem with appendicitis is that some other conditions may mimic it. Abdominal cavity is packed with different organs. Other sources could cause pain in right lower quadrant. Females may have ovarian torsion or tuboovarian abscess or extrauterine pregnancy (this is why doctors persistently ask: when was your last menstrual period? Are you taking contraceptive hormones? Did you have vaginal bleeding?), etc. They also check your chorionic hormone, trying to find if you are pregnant.
Scrupulous doctor asks your permission to perform rectal exam. Many people refuses to do it. I can understand that. Who would like that somebody sticks fingers into his ass. I wouldn't. But the rectal exam gives a lot of information. Rectum - is the part of gut that is closest to the back orifice. Back orifice is named anus in Latin or anal canal. Surgeons say that there are only two contra-indications for avoiding rectal exam: 1. patient does not have anus 2. Surgeon does not have fingers. Rectal exam in appendicitis is usually unremarkable. Maybe you can cause pain by palpating the side wall of the rectum that is close to the appendix. But the rectal exam allows to distinguish other disorders. During the rectal exam you may palpate hemorrhoids, uterus, nodules in prostate or enlarged prostate, you may feel fluid in lower part of peritoneal cavity, etc. You may see blood on the finger telling you about internal bleeding. You may check the stool for small amount of blood (named fecal occult blood test - FOBT - or Guaiac test by the name of the dye that turns blue in the presence of blood. At last rectal exam may help in dis-impaction of rectum. That is when hard stool causes bowel obstruction. Usually a rectal exam is more or less normal. But every surgeon will tell you a war story about how once in while, once in five years he found something significant on rectal exam, something that every other doctor missed. Just by putting the finger into the butt. I saw how a surgeon put a finger into an old, demented women and pulled out a pessarium. It was an apple-size pink plastic membrane , that should go into vagina, but somebody (at home?) put it (by mistake?) into the rectum of that woman. You really need to push hard to get such big object into the anus. The poor lady suffered bowel obstruction for a week and would probably die if it stayed long enough.
www.kavokin.com | | Author: | Aleksandr Kavokin, MD, PhD | | System: | Appendix | | Subject: | Appendicitis | | Abstract: | Scrupulous doctor asks your permission to perform rectal exam. Many people refuses to do it. | | Website: | http://www.kavokin.com | | Time: | 12:16 | | Reference: | http://www.rdoctor.com | | Reference 2: | http://www.symptomat.com |
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Articles by Aleksandr Kavokin, MD, PhD
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