Pathology of the General Surgery | Pathologies and health.

• Appendicitis
• Ernie
• Peritonitis

APPENDICITIS

What is and where is Appendix located?

Generally in the lower portion right abdomen (right iliac fossa), the appendix is an extroversion, or large intestine, diverticulum (or rather this initial tract, the blind man), in which he opens. Dead end ends, has a length of 8-14 cm and the diameter of a pencil.

What is the function of the Appendix?

The man has a residual function, while lymphoid organ in the oldest animal species, its importance has increased.

What is appendicitis?

Appendicitis is an inflammation of the mucous membrane, which propagates appendicular others parietal layers and ultimately affect the entire organ. In case of acute inflammation, the appendix can fill with pus; If the inflammation from spreading beyond the mucosa, may result in tissue destruction and drilling. Drilling is a very serious event: determines the infection of the peritoneum and requires emergency surgery.

As you develop appendicitis?

This disease process can be caused by a bacterial infection, or be the result of altered blood flow, caused by stagnation of intestinal contents that blocks the lumen of the Appendix by compressing the blood vessels nearby.

Appendicitis is very frequent?

Is among the most common abdominal disease requiring surgery and can affect individuals of any age, although it is particularly common in childhood and old age.

Appendicitis cases diminishing?

Yes; for reasons still unknown, appendicitis is now less than 20 or 30 years ago.

Appendicitis may be caused by foreign bodies such as fruit pits, gum etc., that have been swallowed by mistake?

No, even if a diet rich in small solid waste and prone to food fermentation (dried fruit) can facilitate the event.

The origin of appendicitis is a hereditary predisposition or a familial tendency to disease?

Not sure, but in some families there is a tendency to get sick, and presented the same symptoms.

In what forms you can have appendicitis?

acute Appendicitis), which usually begins with abdominal pain, nausea, vomiting and subsequent pain in the localization right iliac fossa; These morbid manifestations occur usually within a few hours;
b) chronic appendicitis, characterized by repeated attacks of inflammation, appendicular regress spontaneously and then grow again after a few months or years with more severe symptoms.

How do you know if you have appendicitis?

You should pay attention to the appearance of the entire abdomen pain, accompanied by nausea and vomiting, and localization of pain in the right iliac fossa, these disorders, noticeable for hours for escalation. Often, there is also a slight rise in temperature and an acceleration of the wrist. Frequent symptoms of appendicitis is loss of appetite and constipation.

When you are caught by abdominal pain, you can take a laxative?

Absolutely not; use a laxative is, in such cases, extremely dangerous, because it can cause the perforation of an inflamed Appendix, which is followed by peritonitis.

To soothe the pain, you can use an enema?

No; or rather, only in the case that the doctor, visited the sick, have expressly prescribed a similar remedy.

It is good to intervene surgically just diagnosed appendicitis?

Yes, because the acute form often regress spontaneously and in many cases the inflammatory process may result in perforation and peritonitis.

You can prevent appendicitis?

The only effective hygiene is keeping the intestine.

Appendicitis may be caused by dietary errors?

No, although a copious meal can anticipate the emergence of an acute attack.

The diagnosis of appendicitis can be confirmed with laboratory testing?

Yes, with a blood test (CBC); in the presence of an acute appendicitis, the white blood cell count is almost always higher than the norm.

If the diagnosis of acute appendicitis is short, how long you have to work?

As soon as possible.

What happens in case of perforation of the Appendix?

Escaping from the Appendix, the pus spreads into the abdominal cavity, causing infection of the peritoneum, a serious disease process (see below, paragraph peritonitis).

An attack of acute appendicitis can be treated by applying on the sore ice bags?

No, because it is only symptomatic relief; in some minor cases the disease process regresses spontaneously without any therapy.

After the spontaneous regression of a lightweight, appendicitis may occur after a new attack?

Yes, and the next can be far more serious than the first.

Appendicitis can be treated only with medicines, without surgery?

In a small number of cases, positive results can be obtained with a high-dose therapy of antibiotics. Such treatment, however, is not the most appropriate, as it involves a much greater risk of the operation and does not put away by the appearance of a new attack.

What is the most appropriate therapy for appendicitis?

The surgical removal of the Appendix, or appendicitis.

The appendectomy is a serious operation?

If done during the early stages of the disease process, is no surgery that can even occur in endoscopy, while it becomes if the appendix is perforated and is already in place a peritonitis.

How long does the surgery take?

From a few minutes for the simplest case in one or two hours for a complex case and very delayed.

How likely are you healing in cases of appendectomy?

Today this is well exceeded in almost all cases, unless a peritonitis.

What complications may give rise appendicitis?

The most serious is the appendiceal wall perforation, resulting in development of a peritonitis. In some cases where therapeutic intervention mind, the infection can spread from the appendix to other pelvic organs and cause abscesses.

What type of anesthesia is usually practiced for an appendectomy?

General anesthesia or sometimes.

How long should you stay in hospital?

In the simplest cases, about a week, less if the intervention took place in endoscopy; If it is produced, it may be necessary a hospital stay of several weeks.

Where is the incision for appendectomy classic?

In the right iliac fossa. If the surgeon operates in election, usually affects the skin diagonally for a length of 3-5 cm in McBurney point, located halfway between the antero-superior iliac spine and the pubic symphysis; If it is forced to intervene urgently, normally prefers incision of about 10 cm, along the lateral margin of the abdominal rectus muscle.

The length of the incision is important?

Yes, because it allows the surgeon to operate according to his habits: some prefer to use a short incision initially and later expand it when necessary, while others practice definitely longer incision. However, bear in mind that, whatever the type of incision, the wound heals from a strip to another, so the speed of recovery is entirely independent of the length of the cut.

The appendectomy requires special preparation?

In simple cases, no; instead of being a complicated case, prior to surgery is necessary, under certain conditions, submit the operand to a drip and antibiotics in high doses. In addition, it may be necessary to introduce a tube (nasogastric tube) that, through the nose, stomach, to facilitate the Elimination of liquids and gases that may disturb the normal course of operation.

The post-operative phase is normally characterized in the early days by severe pain?

No, they are modest and localized pain at the skin incision.

Special postoperative measurements are needed?

In normal cases and not complicated, no. In the case of a perforated Appendix, after the operation you may instead submit the need to empty the digestive tract and feed the patient only with drip (parenteral nutrition).
To keep the digestive system and combat intestinal flatulence, often leaves in place for a few days the nasogastric tube.
If you have produced a perforation, trying to thwart the formation of peritonitis using a therapy based on administration of high doses of antibiotics to fight the infection.

How long after the appendectomy patient can stand up?

In simple cases, the day following the operation; If you have produced a peritonitis, you can instead be bedridden for several days or even weeks.

How long does the wound to heal?

In simple cases, without complications, the wound heals within a week.
If there is a drain hose, as in the case of perforated Appendix, wound healing may take several weeks.

The wound of an appendectomy is frequently prone to infection?

Yes; a few days after surgery, the wound will often collect a reddish liquid, the surgeon will drain: an operation that does not cause virtually no disruption.

The convalescence takes particular care and assistance?

In simple cases, no.

The appendectomy has permanent consequences?

No, unless the presence of cutaneous scar.

The scar is disfiguring?

Normally, no; However, infected wounds, or that it was necessary to drain, can leave scars aesthetically bad, that can be corrected with later plastic surgery.

After the appendectomy, return normal bowel functions?

Yes, after some time (after an average of four days).

After an appendix operation, you may experience a recurrence of appendicular attack?

No, if the appendix was removed. In a very small percentage of cases, where the appendix was found or a perforated hardly accessible, the surgeon decided to limit itself to only inflammatory material drainage from the abdominal cavity and to defer to a second surgery excision of the Appendix.

For whatever reason, during the operation at the Appendix, this is sometimes left on site?

In some cases, especially when an abscess has formed clearly delimited, the removal of the appendix may cause the spread of pus into the abdominal cavity. In such cases, there is limited to simple drainage of abscess, which facilitates healing. It must, however, emphasise that the patient undergoes appendectomy later, because a diseased Appendix left
on site, there is the risk of recurrent attacks, which would likely be severe.

Appendix left initially on site must be removed at a later time?

Yes; Once recovered completely from the first attack, the patient should undergo an operation within a period of time ranging from six to ten weeks. The more time you spend leaves and more likely to form a new abscess, which is always a dangerous threat, as it can lead to peritonitis.

After the appendectomy a woman can still get pregnant and have babies?

Yes, unless it formed adhesions (rare case) that interfere with both fallopian tubes.

After the appendectomy, you must observe a special diet?

No, you only need to resume normal power gradually in the first days after the operation.

After appendectomy pain is usually felt in the area where the incision was carried out?

Yes; You may feel slight pain until a few weeks after surgery.
•

ERNIE

What is a hernia?

Is the leakage of an anatomical structure that normally the cavity contains through a passage. Typically a lesion in a cavity wall allows to abandon its normal boundaries and topographical extend to occupy regions that don't compete. For example, a herniated diaphragm (diaphragmatic), the stomach can leave part of the abdominal cavity and enter the chest cavity through an orifice (also called "defect").

What is due?

Most hernias are caused by injury or by structural weakening of the muscles and connective tissues that separate the different cavities or different parts of the body; like for example the chest from the abdomen, or the inside from the outside of the abdomen or the abdomen from the arts. Other hernias occur following trauma that tear muscle or connective tissue.

Hernias can be congenital, too?

Yes; a considerable number of newborns has ernie due to defects in
growth, often with persistence of embryonic origin orifices; they are generally localized to the region of the navel (umbilical hernia) or groin (inguinal hernia).

What are some specific points of the body is more likely to lead to a hernia?

At those points where large enough structures such as bowel tracts or vessels, entering or exiting from a cavity. These points include lassi fabrics which, as a result of stress, can tear and disunirsi.

What efforts or trauma may more easily lead to a hernia?

In Lifting heavy objects);
b) twisting, jerking or sudden muscle tension;
c) weight increases that cause an increase in pressure within the abdomen;
d) growth of a large abdominal tumor displacing neighboring organs;
e) pregnancy, resulting in increased pressure within the abdomen;
f) chronic constipation, which involves continuous and excessive efforts in defecation;
g) repeated attacks of coughing that result in sudden increases in pressure inside the abdomen.

Is a common disease?

Is one of the most common causes of surgical intervention.

Males are more likely than females to hernia?

Yes, hernias that depend on physical effort, such as inguinal hernia.
Women are more prone to umbilical hernia, as a result of repeated pregnancies.

Is hereditary, or tends to recur in the family?

No, but it tends to be the hereditary type of connective tissue and muscle structure of individuals (skinny-asthenic), which represents the predisposing factor.

What are the most common types of hernia?

in): inguinal hernia is the most common type; occurs in the inguinal region and may be unilateral or bilateral, direct, or indirect: umbilical hernia in umbilical region, is one of the most common forms. Babies and women who have had many pregnancies are particularly prone to this type of diaphragmatic hernia: hernia is a very common disease and generally located at the point where the esophagus passes from the chest cavity in the abdomen, across the diaphragm. Other diaphragmatic hernias originate from lack of development of the diaphragm or from traumatic events that interest you. These hernias are characterized by the fact that the abdominal organs, such as a portion of the stomach or colon or small intestine – penetrate through the defect into the chest cavity or gluteal hernia and lumbar hernia ischial are very rare and caused by defects in the muscles of the back or buttocks. Present themselves as bulges detected.

When should a medical therapy rather than surgery in the treatment of hernia strangulated not?

If a hernia) already has relapsed twice or more and sick tissues appear now, it is probably best to desist from attempting a third or fourth intervention: you would most likely encounter a new failure;
b) people too fat, where the hernia does not cause disturbance, should not be made until their weight is not returned in acceptable limits; the reconstructive surgery in these patients are notoriously intended for failure;
c) people with serious diseases, such as emphysema or serious heart problems, it is better to be treated without resorting to surgery, which
always have some risk;
d) persons older than 70 years suffering from small hernias, not too annoying, you are simply better cared for by doctor.

What is the medical treatment of a hernia?

Applying a containment device (trusses) that keeps the herniated viscera inside its cavity. Does not exist for a hernia treatment with pharmacological medicines.

The enclosed can be taken long before having surgery?

In General, no. The Ceaser tend to further weaken the anatomical structures with which they remain in touch, so cost should not be worn for more than a few weeks prior to surgery. The CEUs must be considered completely temporary remedies.

Why the use of cinto is not preferable in any case the operation?

Because the hernia does not heal a hernia; you simply hold the hernial contents and is therefore a symptomatic treatment. Over time the hernia defect widens and becomes increasingly less girdled sufficient to contain the hernia.

You run the risk of neglecting a hernia to operate?

Certainly yes, as there is always the risk of throttling the bowels, which if it occurs it can be lethal.

Therapy with injections is satisfactory?

No. A method is ineffective and dangerous and was therefore abandoned.

The hernia tends to regress spontaneously?

No. Ernie alone that can disappear spontaneously are those tiny, umbilical and inguinal, occasionally, babies.

It is therefore inevitable surgery?

Yes. The only surgery can repair the abdominal wall defects and remedy the radically hernia.

What gives you the surgery?

In the vast majority of cases, the hernia may be accomplished successfully by restoring the integrity of muscle-connective structures maimed, bringing in the right anatomical location offsite bodies and removing the part of peritoneum forming the hernial SAC.

When is the best time to make ernie?

The surgery is elective treatment of hernia and the moment of its execution can be chosen by the patient, after hearing the opinion of the treating physician.
It should not be forgotten that most doors erniarie tends to widen over time, making it more difficult and more likely the risk of a recurrence.

When he practiced emergency?

When the hernia "Sambo", a condition in which the herniated organ, for example a section of intestine, is closed in the hernial SAC and its circulation remains locked. In these circumstances the patient should be operated on immediately; a short delay can result in gangrene of the hernia strangulated with possible death from peritonitis.

The surgeon may postpone the operation if the patient is too fat?

Yes. If the patient is too burly and the hernia is large, reduce the hernia is like trying
putting too many clothes in a small suitcase. If we can close it, reopen soon.

The hernia operation is dangerous?

No. Such interventions are rarely followed by complications, unless it's ernie choked. In these cases, you may have to remove the colon or segments of intestine more or less extensive because affected by gangrene and then becomes quite complex. From a purely superficial and plastic type, the operation becomes an invasive surgery, which involves the opening of viscera.

What do you do when you find a segment of colon or intestine affected by gangrene?

The affected segments are removed and the stumps. So, as said, is quite complex and one of the most delicate of abdominal surgery, although the use of antibiotics and the advances in surgical techniques have greatly reduced the mortality rate.

Is very painful?

No, except local pain at the wound for a few days after surgery.

Inguinal hernia can be performed with endoscopic technique?

Yes, and to reduce the risk of relapse, endoscopic intervention is today associated with the hernia without tension plastic: a network sisntetica is placed, without suture between the muscle and the inguinal ligament, within the inguinal Canal.

Diaphragmatic hernia interventions are particularly dangerous?

No, but they are much more complex than those involving the abdomen. Interventions for diaphragmatic hernia are considered major surgery. Today, however, in some centres working in endoscopy.

How does traditional intervention?

Typically, we practice an incision along the costal arch opening the chest cavity; You then suture the hernia defect of aperture, after bringing in the right venue moved bodies. The same procedure can be followed by making an incision in the abdomen and acting on the diaphragm from below.

The result of the operation is generally positive?

Yes, in most cases.

Are lengthy operations?

A simple inguinal hernia surgery can be completed in minutes 3045; more complicated cases – like a diaphragmatic hernia or an incarcerated hernia, in which the herniated organ is strictly adhering to the walls of the hernial SAC – can take several hours.

What type of anesthesia is used?

In ernie localized in the area below the umbilical area, we use spinal anesthesia, sometimes more often than General, adopted in all other types of hernia.

Should be prolonged hospital stay?

Ten days to two weeks for regular hernias; longer for more complicated ones.

When you can get out of bed?

Despite the current trend toward early walking allows the raising day
following the intervention, prudential rule wait a week to prevent the collapse of the plastic and then relapse; in this case, however, it is appropriate to carry out exercises in bed and change position frequently to prevent thrombosis in the large veins of the pelvis.

Coughing or sneezing can cause a recurrence of the hernia?

No, even though patients say having the feeling that "jump points" when coughing.

How likely is it that a hernia recurrences?

More than 90% of operated heals completely. The majority of relapses you have in very elderly people, or whose muscle tissues or connective tissues are weakened.

How long does, on average, to heal the incision resulting in erniectomia?

Seven to ten days regarding the skin incision, a little more to the deep tissues.

What precautions should be taken to prevent recurrences?

you don't have to) gain weight;
b) avoid as far as possible to drag, lift or carry heavy items (over 15-20 kg);
c) avoid any strenuous exercise for at least 4-6 months after the operation.

If the hernia is relapse, what should I do?

The 80% of hernias can be operated again.

Once operated by hernia, you must bring a trusses?

No, the operation is sufficient.

Commonly understood to feel slight pain, lack of sensation or tingling along the wound or the scrotum for a few weeks, or even months after a hernia operation?

Yes, but sometimes the noise disappear spontaneously.

Inguinal hernia surgery affect sex life?

No. The testicles and other genital organs are not interested in hernia reduction surgery.

At what age can you take action to reduce a hernia?

Infants can withstand exceptionally well to surgery. If the hernia is large or is liable to choke you can operate already in the first days of life.

Inguinal hernia in infant tends to be bilateral?

Yes. You go by extending the use of working bilaterally these children, even if the hernia is detected on one side only. Three out of four handicapped children herniate evident on one side then a second hernia on the other side, even if the latter is currently not detectable at a manual investigation.

Bilateral intervention increases the risks of the operation?

Yes, but irrelevant.

A woman can become pregnant after undergoing a hernia operation?

Yes, but you should wait a few months after surgery.

Hernia surgery a person can resume normal physical activity?

Certainly yes.

After a hernia operation in accordance with the traditional technique, you can:

swim after 10-14 days; leave home after 10-15 days to climb the stairs after 10-15 days to look after the House after 3-4 weeks driving after 5-6 weeks resume intercourse after 4 weeks resume work after 6-8 weeks to resume all physical activities after 3-6 months

After a hernia operation, you have to go to the doctor for checkups?

Yes, every six months for a period of two years, and in any case as soon as symptoms that may suggest a recurrence.
•

PERITONITIS

What is the peritoneum?

A serous membrane, thin, transparent, smooth and shiny that covers the walls of the abdominal cavity and surrounds the organs in it (stomach, intestines, gallbladder, liver, spleen, etc.). This membrane consists of two pieces of paper, or sheets: one of the parietal, the inner surface of the abdominal cavity, the more visceral, enveloping precisely the organs contained in the cavity.

What do you mean by "the peritoneal cavity"?

With this definition indicates the space delimited by the two peritoneal; under normal conditions, this cavity is virtual, while in the presence of morbid processes you can collect fluids, pus or blood. The small amount of serous fluid normally contained in the peritoneal cavity makes scrolling through the two pieces of paper during the active and passive movements of the abdominal organs, that can be hindered by the presence of adhesions.

What is peritonitis?

Acute inflammation, caused by bacteria, the peritoneum, often associated with infection with pus formation in the péritonéale cavity.

What are its most common causes?

in a rig) intraperitoneal organ, for example of the Appendix, small intestine or intestine, gallbladder etc.;
b) an infection spread by an inflamed organ, for example from a fallopian tube or ovary;
c) an injury of the abdominal wall (e.g., gunshot or cut), deep enough to reach to the peritoneal cavity.

What symptoms cause peritonitis?

a Violent abdominal pain);
b) sensitivity and tenderness to palpation of abdominal wall and organs;
c) tension and swelling of the intestines;
d) associated with loss of appetite, nausea and vomiting;
and fever);
f) features, changes detectable radiographic examination.

Acute peritonitis is dangerous?

Yes, because it ends up over the entire body negatively be reflected and serious consequence of pathological changes of blood composition. If left untreated, it is often fatal, as the body of the patient fails to counter the spread of severe bacterial infection.

Is somehow possible to prevent its occurrence?

Yes:
to) paying great attention to the onset of pain in the abdominal region and promptly treating the illness that causes it. If you have appendicitis or cholecystitis, the immediate adoption of an appropriate therapy avoids the risk of complications such as perforation of the organ concerned and subsequent peritonitis;
b) absolutely avoiding the use of laxatives, if you are suffering from abdominal pains.
The indiscriminate use of such preparations has resulted in more cases perforation of the Appendix;
c) treating radically with any female gonorrhea timeliness, to avoid that, besides causing infertility, the infection spreads from the vagina into the uterus, tubes and then into the abdominal cavity.

How to treat peritonitis?

in) through a timely surgery, aimed at removing the original morbid outbreak, for example appendix or gallbladder affected by acute inflammation;
b) sucking the pus from the abdominal cavity and inserting through the surgical incision, a rubber drain to stream outside the pus that may subsequently be formed;
c) If you have peritonitis caused by perforation of an organ (stomach, duodenum or an intestinal loop), you must close the drilling with a timely surgery;
d) using antibiotics in massive doses;
and during most phases) acute peritonitis, introducing (through the nose) a probe in the patient's intestine to prevent bloating, and feeding the patient via a drip.

What chance of recovery for a person suffering from peritonitis?

If the patient undergoes surgery and promptly to antibiotic therapy, the chances of recovery are good.

How long does the healing process?

Depends on the origin of peritonitis, the type of bacteria in the game, the time between the development of inflammatory process and the initiation of therapy and the specific process extension into the abdominal cavity. In cases where the peritonitis is diagnosed and treated in its early stages, healing can be completed within a week; If the inflammation already existed for some time can take several weeks.

Peritonitis can leave lasting consequences?

Usually reaches a complete cure, but in some cases can form adhesions that extended weeks, months or even years after the regression of peritonitis can cause an intestinal obstruction.