PRESCRIPTIONS
Don't mistake appendicitis for the flu
By Landis Lum
I had just arrived at a Ward Center restaurant for the birthday dinner of Alisa, my 12-year-old niece from California, but my mother said she was outside with a stomach ache.
I found her with her dad, Bob, sitting hunched over a table with little desire to eat. When I pressed on her stomach, she was most sore in the right lower part, and I told Bob and my sister Linette not to let her drink or eat anything more and to take her to the emergency room.
After arriving at Kapiolani Children's Hospital, she vomited and felt a bit better, but a CT scan of her stomach confirmed my suspicion of appendicitis.
Pediatric surgeon Daniel Robie was superb, and had her appendix out laparoscopically by midnight.
Appendectomies are the most common emergency surgery. Lifetime risk is 8.7 percent in men and 6.7 percent in women, and is most common in the late teens and 20s. The appendix is a small, fingerlike pouch located where the large and small intestines join.
Obstruction of the opening of this closed tube by a piece of stool or lymphoid tissue leads to pressure buildup, reducing the flow of blood into the appendix and causing bacterial overgrowth.
If that's not caught early enough, the appendix can burst, leading to abscesses, infertility or even death. Delays in diagnosis occur most often in the elderly, the very young, and women, who may be diagnosed with STDs, ovarian cysts, or urinary infections instead.
How do you know it's not just the stomach flu? As Dr. Gary Hartman says in the Nelson Textbook of Pediatrics: "The child with appendicitis frequently moves tentatively and slowly, hunched forward, and often with a slight limp. The child may protect the right lower quadrant with a hand and may be reluctant to climb onto the examining table."
Symptoms pointing to appendicitis are pain starting about the belly button and then moving to the right lower abdomen; rigidity or tenseness of the right lower abdomen when you press on it; pain occurring before the vomiting; short duration of pain; and loss of appetite.
The pain may be on the right side of the trunk or the right flank (back) or hip. There may also be mild fever, an elevated white blood count and urinary symptoms.
A CT scan is more accurate than ultrasound in the diagnosis, but does not need to be done if the diagnosis is clear from the symptoms and exam. And not all the above may be present — Alisa never had pain around her belly button first.
Incidentally, Alisa is back in California and is doing just fine.
And hoping for a better birthday next year.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's medical school. Send questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or islandlife@honoluluadvertiser.com.
