Appendicitis

Appendicitis occurs due to a blockage or obstruction in the appendix. The blockage may be due to a buildup of mucus, parasites, or most commonly, fecal matter. When an obstruction in the appendix occurs, bacteria can multiply quickly inside the organ causing the appendix to become irritated and swollen, thus leading to appendicitis. 
The appendix is located in the lower right side of your abdomen and is a narrow, tube-shaped pouch protruding from your large intestine. If you don't get treatment for an inflamed appendix quickly it can rupture and release dangerous bacteria into your abdomen.
This will result in an infection called peritonitis. It is a serious condition that requires immediate medical attention. A ruptured appendix is a life-threatening situation which rarely occurs within the first 24 hours of symptoms. However, the risk of rupture rises dramatically after 48 hours of the onset of symptoms. It is therefore essential that you recognize symptoms immediately: 

 

Symptoms of appendicitis
Appendicitis causes a variety of symptoms, including:
 1. Dull abdominal pain near the navel or the upper abdomen which becomes sharp as it moves to the lower right abdomen. This is usually the first sign. 
 2. Loss of appetite.
 3. Nausea and or vomiting soon after abdominal pain begins.
 4. Abdominal swelling.
 5. Fever of 99-102 degrees Fahrenheit.
 6. Inability to pass gas.
Almost half the time, other symptoms of appendicitis appear, which include:
 1. A dull or sharp pain anywhere in the upper or lower abdomen, back or rectum.
 2. Painful urination.
 3. Vomiting that preceded the abdominal pain.
 4. Severe cramps.
 5. Constipation or diarrhea with gas.
If you experience any of these symptoms, it is essential that you see a doctor immediately. A timely diagnosis and treatment are imperative. Do not eat, drink or use any pain medications, antacids, laxatives, or heating pads which can cause an inflamed appendix to rupture. It is vital that you take note of the below information:  

1. Abdominal pain
Appendicitis involves a gradual onset of dull, cramping or aching pain throughout the abdomen. As the appendix becomes more swollen and inflamed, it will irritate the lining of the abdominal wall. This will cause a localized, sharp pain in the right lower part of the abdomen. The pain can be described as constant and severe, as opposed to the dull, aching pain that occurs when symptoms start. Some people may have an appendix that lies behind the colon. In such people, this can cause lower back pain or pelvic pain. 
2. Mild fever
Appendicitis tends to cause a fever between 99°F (37.2°C) and 100.5°F (38°C). You may also experience chills. If the appendix bursts, this will result in an infection causing your fever to rise. A fever greater than 101°F (38.3°) and an increase in heart rate may mean that the appendix has ruptured.
3. Digestive upset
Appendicitis can cause nausea and vomiting. You may lose your appetite and may also become constipated or have severe diarrhea. If you have trouble passing gas it may indicate a sign of a partial or total obstruction of your bowel. This may be related to underlying appendicitis. 

What are the symptoms in children?
Children aged two and younger will often show the following symptoms:
1. Vomiting.
2. Abdominal bloating or swelling.
3. A tender Abdomen.
Older children and teenagers are likely to experience:
 1. Nausea.
 2. Vomiting.
 3. Pain in the lower right side of the abdomen. 
What are the symptoms in pregnant women?
Most appendicitis symptoms are similar to the discomforts of pregnancy which include stomach cramping, nausea, and vomiting. But, it is not always clear that you have the classic symptoms of appendicitis, especially in late pregnancy. The growing uterus pushes the appendix higher during pregnancy, which means that pain may occur in the upper abdomen instead of the lower right side of the abdomen. You may also experience heartburn, gas or alternating episodes of constipation and diarrhea. The Do's and Don'ts

Do: Go to the hospital immediately if you or anyone you know has the aforementioned symptoms of appendicitis. Bear in mind that no home remedies will help.
Don't: Avoid over-the-counter medication to treat the symptoms and bear in mind that enemas and laxatives can cause your appendix to rupture. Furthermore, pain medications that mask symptoms may also make it harder for your doctor to make a quick diagnosis. 
How is it treated?
A physical exam will be performed by your doctor asking you about your symptoms. Then, certain tests will be administered to help determine if you have appendicitis. These include blood tests to look for signs of an infection, urine tests to check for signs of a UTI or a kidney stone, an abdominal ultrasound or CT scan to see if the appendix is inflamed. Depending on your symptoms, your doctor may suggest immediate surgery in which case you will receive antibiotics before surgery. 
After the surgery, you may stay in the hospital until the pain is under control and you are able to consume liquids. If you develop an abscess or if a complication occurs, your doctor may prescribe antibiotics for another day or two. Always remember that while its possible for problems to arise, most people make a full recovery without complications. 

Risk factors and prevention
Appendicitis can happen at any time, though it is most likely to occur between the ages of 10 and 30. It is more common in men than in women. You can't prevent appendicitis, but you can lower the risk of developing it. It seems less likely if you have a diet rich in fiber, so opt for fresh fruits and vegetables whenever you can. Increasing your fiber intake can prevent constipation and subsequent stool buildup which is the most common cause of appendicitis. If you suffer from any condition that causes inflammation or infection of the bowels, it is vital that you work with your doctor to prevent appendicitis. 

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Parasites could be lurking in your sushi, doctors warn

Anisakiasis, an illness caused by eating parasite-contaminated fish or seafood, is on the rise in Western countries where eating sushi and other raw or undercooked fish and seafood dishes has gained popularity, according to a report published Thursday in BMJ Case Reports.

The authors draw a portrait of the illness from the experience of a previously healthy 32-year-old man who developed severe upper gut pain, vomiting and fever that lasted a week before he entered the hospital.

Dr. Joana Carmo, lead author and a physician in the gastroenterology department of the Hospital of Egas Moniz in Lisbon, Portugal, and her co-authors say a physical examination indicated tenderness in the abdomen, while the lab results showed an increase in white blood cells, which is a typical sign of infection.

During an interview, the man said he had recently eaten sushi.

Fishing out a parasite
Based on this dietary information, his doctors performed an upper gastrointestinal endoscopy: a non-surgical examination of the digestive tract, using a flexible tube with a light and camera on the end. This inner vision revealed a swollen intestinal membrane with a firmly attached parasite, its end penetrating the stomach.

The doctors removed the larval worm with a special net.

The Roth net is a small plastic net that is usually used to remove polyps from the colon as well as any other foreign body found in the digestive tract — namely parasites, Carmo said.

Analysis revealed the worm to be of the genus anisakis.

“Anisakis can infect salmon, herring, cod, mackerel, squids, halibut and red snapper,” Carmo said. After the parasite was removed from his gut, the patient’s symptoms immediately began to clear.

“A few decades ago, doctors did not know this infection,” Carmo wrote in an email.

The first case of human infection with anisakiasis was described by scientists in the Netherlands during the 1960s. Because this first record occurred after the patient had consumed some lightly salted herring, the infection was originally referred to as “herring worm disease.”

Since then, cases have appeared in many other countries, though “mainly in Japan because of the frequent ingestion of raw fish,” Carmo said.

High numbers in Japan and Spain
Miguel Bao, a doctoral candidate in systems biology at the University of Aberdeen who was not involved in the new study, said Japan sees about 2,000 to 3,000 cases of diagnosed anisakiasis each year.

Yet recent estimates suggest that about 8,000 annual anisakiasis cases may be occurring in Spain due to consumption of raw and marinated anchovies, Bao said. He explained that the cases in Spain are based on a risk assessment, but Japanese cases are based on actual diagnoses, so a direct comparison is “not valid.”

Carmo said that “in European countries, fish infestation is probably more frequent than we thought. One study showed that anisakis simplex (the species most commonly associated with human infections) was found in 39.4 percent of the fresh mackerel examined from different fish markets in Granada, Spain.”
Another study in Spain found that nearly 56 percent of blue whiting fish sold in five chain supermarkets showed infestation, Carmo said.

Cases have begun to appear in the United States, South America, Europe and other areas of the globe, according to the US Centers for Disease Control and Prevention.

Although the CDC does not conduct surveillance of these infections, “rare cases have been identified in the US,” spokeswoman Amy Rowland said.

Bao said scholars generally consider anisakiasis to be both underestimated and underdiagnosed.

“There is a need to better estimate and understand the burden of disease worldwide (especially in those countries where consumption of raw or undercooked fish is common),” Bao said.

The actual infection or illness results when the anisakid nematodes (worms) invade the stomach wall or intestines, causing gastrointestinal symptoms of pain, nausea and vomiting, according to the CDC. Some people will develop complications, including digestive bleeding, bowel obstruction and peritonitis, inflammation of the inner wall of the abdomen.

Once infected, some people may experience an allergic response, including swelling, skin rash or even anaphylaxis, which can cause difficulty breathing and loss of consciousness. It is this allergic response that can be life-threatening, Bao said.

Anisakiasis cannot be transmitted from one person to another.

FDA protections
Although the anisakis parasite can live as a larva for several weeks in a human stomach, it will die before developing into an adult. But before it dies, it produces an inflamed mass in the esophagus, stomach or intestine.

Untreated gastric disease can lead to chronic, ulcer-like symptoms lasting for weeks to months, Bao said.

Though treatment is not always necessary, removal by endoscopy may be necessary to alleviate symptoms. No specific drug has been identified to kill the live parasites, Bao said, adding that “surgical removal is occasionally required.”

There are other ways of getting rid of the worm.

“Some people experience a tingling sensation after or while eating raw or undercooked fish or squid. This is actually the worm moving in the mouth or throat,” reads the CDC website. In such cases, it is possible to cough up the worm or remove it by hand. Sometimes, vomiting expels the worm.

To help reduce the risk of illness caused by eating fish or squid, the Food and Drug Administration has food safety programs and hazard reduction procedures (PDF) that distributors of fish and squid are expected to follow.

“For example, freezing fish to the appropriate temperature and for the appropriate duration can kill parasites,” Rowland said. The European Union follows similar practices, according to Carmo.

Along with avoiding raw fish, the CDC recommends that seafood be cooked to an internal temperature of at least 145° F (about 63° C). Carmo said freezing to minus-20 degrees Celsius for a minimum of 72 hours also kills the parasite.

Some people, though, will never give up eating their beloved sushi or other raw fish delights.

“Properly trained sushi chefs can detect anisakis larvae,” Carmo said. “They are grossly visible in the fish.”

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