American Medical Association Family Medical Guide - American Medical Association [502]
Appendix
The appendix projects from the cecum (the first part of the large intestine) in the lower right side of the abdomen, where the small intestine and the large intestine meet. The appendix is part of the immune system.
Treatment
To treat appendicitis, doctors remove the appendix immediately in a surgical procedure called appendectomy. If ultrasound shows that the appendix is severely abscessed (filled with pus), the appendectomy may be delayed for a few days or weeks until the infection has cleared up with antibiotics and the abscess drained with surgery or by inserting a tube. Because appendicitis is likely to flare up again, the appendix is removed as soon as tests show that the infection has cleared up. Even if the appendix looks normal, the surgeon still removes it because, if the appendix were not removed and the person later develops appendicitis and comes into an emergency department, doctors would recognize the characteristic appendectomy scar and would incorrectly rule out appendicitis as the cause.
Appendectomy
A surgeon can remove an inflamed appendix in a procedure called appendectomy. While the person is under a general anesthetic, the surgeon makes a diagonal incision in the lower right side of the abdomen. He or she clamps the appendix at its base, cuts it off, and sews up the remaining stump.
Diverticulosis and Diverticulitis
Diverticulosis is a common disorder in which small, saclike swellings (called diverticula) develop in the walls of the lowest part of the colon (the longest section of the large intestine). In rare cases, diverticula can develop in other parts of the digestive tract such as the esophagus (pharyngeal pouch; see page 748), stomach, or small intestine. The cause of diverticulosis is unknown. Some doctors think that the condition may result from chronic constipation. Straining during bowel movements increases pressure on the wall of the colon, possibly causing a weak point in the wall to swell. Diverticulosis usually causes no symptoms and is often diagnosed by chance during tests done for another reason.
When one or more of the diverticula become inflamed, the condition is called diverticulitis. Only 10 percent of people with diverticulosis develop diverticulitis. If untreated, diverticulitis can cause an abscess (pus-filled cavity) to form in the intestine. The abscess can rupture, causing inflammation of the membrane that lines the abdominal cavity (peritonitis; see page 759).
Symptoms
Diverticulosis usually causes no symptoms. However, you may have mild abdominal tenderness, cramping in the lower left side of the abdomen (that is relieved after you pass gas or have a bowel movement), constipation, or occasional attacks of diarrhea. The diverticula may bleed, producing blood in the stool or significant bleeding from the rectum.
If you have diverticulitis, you will probably have severe abdominal pain and tenderness in the lower left side of your abdomen that gets worse when you press on the area, although diverticula can sometimes develop on the right side. In some people, the pain becomes disabling within a few hours; in others, the pain is tolerable for a few days before it becomes severe. Other symptoms include nausea and fever. If peritonitis has developed, you will also have a swollen abdomen.
Diagnosis
If you have symptoms of diverticulosis or diverticulitis, your doctor will perform a physical examination and will order a CT scan (see page 112) of your intestines to rule out diverticulitis. He or she may also order blood tests and test your stool for blood.
Treatment
Diverticulosis usually requires no treatment. Your doctor may recommend that you eat more high-fiber foods and drink more liquids to produce softer stools, which will help prevent straining during bowel movements.
Diverticulosis and diverticulitis
Small pouches called diverticula (top) can form in the outer wall of the colon and project into the abdominal cavity. If these pouches don’t cause