Monthly Archives: November 2016

All About Appendicitis

Appendicitis is a painful medical condition in which the appendix becomes inflamed and filled with pus, a fluid made up of dead cells that often results from an infection.

Appendicitis is the leading cause of emergency abdominal operations in the United States, according to the National Institutes of Health (NIH).

The appendix is a small, finger-shaped pouch attached to your large intestine on the lower right side of your abdomen.

It’s not entirely clear what role the appendix plays in the body, but some research suggests that it isn’t the useless organ it was once thought to be.

Though people can live perfectly normal lives without their appendix, inflammation of this abdominal organ can be a serious, life-threatening condition.

If not treated promptly, appendicitis may cause the appendix to burst, spreading an infection throughout the abdomen.

When people discuss appendicitis, they’re typically referring to acute appendicitis, which is marked by a sharp abdominal pain that quickly spreads and worsens over a matter of hours.

In some cases, however, people may develop chronic appendicitis, which causes mild, recurrent abdominal pain that often subsides on its own — these patients usually don’t realize they have appendicitis until an acute episode strikes.

Prevalence and Risk Factors for Appendicitis

Acute appendicitis now affects about 9 in 10,000 people each year in the United States (roughly 300,000 people annually) — this prevalence is higher than it was just 20 years ago, according to a 2012 report from the Journal of Surgical Research.

People of any age can get the condition, though appendicitis is most common among children and teenagers between 10 and 19 years old, according to the 2012 report.

It affects males more often than females, but scientists have yet to identify why this is the case.

Appendicitis is more common in Western societies, and may be more common in urban industrialized areas, compared with rural communities.

The typical “Western diet” that’s low in fiber and high in carbohydrates is thought to be behind this pattern.

It also appears that having a family history of appendicitis increases the risk of getting the condition for both children and adults.

The NIH estimates that almost 400 people die in the United States each year from appendicitis.

Causes of Appendicitis

It’s not always clear what causes appendicitis, but the condition often arises from one of two issues: A gastrointestinal infection that has spread to the appendix, or an obstruction that blocks the opening of the appendix.

In the second case, there are several different sources of blockage. These include:
Lymph tissue in the wall of the appendix that has become enlarged
Hardened stool, parasites, or growths
Irritation and ulcers in the gastrointestinal tract
Abdominal injury or trauma
Foreign objects, such as pins or bullets
When a person’s appendix becomes infected or obstructed, bacteria inside the organ multiply rapidly. This bacterial takeover causes the appendix to become infected and swollen with pus.

Symptoms of Appendicitis

At the onset of appendicitis, people often feel an aching pain that begins around the belly button, and slowly creeps over to the lower right abdomen.

The pain sharpens over several hours, and can spike during movement, deep breaths, coughing, and sneezing. Other symptoms of appendicitis may follow, including:

Nausea
Vomiting
Constipation or diarrhea
Inability to pass gas
Loss of appetite
Abdominal swelling
Fever
Diagnosing Appendicitis

Because the symptoms of appendicitis are very similar to other conditions, including Crohn’s disease, urinary tract infections (UTI), gynecologic disorders, and gastritis, diagnosing appendicitis is no simple matter.

After learning about a patient’s medical history and recent pattern of symptoms, doctors will use a number of tests to help them diagnose appendicitis.

They may:

Conduct an abdominal exam to assess pain and detect inflammation
Take a blood test to determine white blood cell counts, which could indicate an infection
Order a urine test to rule out urinary tract infection and kidney stones
Perform a bimanual (two-handed) gynecologic exam in women
Use imaging tests, including computerized tomography (CT) scans, abdominal X-rays, ultrasounds, or magnetic resonance imaging (MRI) scans to confirm the appendicitis diagnosis or find other causes of abdominal pain
Treating Appendicitis

In rare cases, doctors will treat appendicitis with antibiotics, but the infection needs to be very mild.

Most often, appendicitis is considered a medical emergency, and doctors treat the condition with an appendectomy, the surgical removal of the appendix.

Surgeons will remove the appendix using one of two methods: open or laparoscopic surgery.

An open appendectomy requires a single incision in the appendix region (the lower right area of the abdomen).

During laparoscopic surgery, on the other hand, surgeons feed special surgical tools into several smaller incisions — this option is believed to have fewer complications and a shorter recovery time.
If a person’s appendix isn’t treated in time, it may burst and spread the infection throughout the abdomen, leading to a life-threatening condition called peritonitis, an infection of the peritoneum (the lining of the gut).

In other cases, abscesses may form on the burst appendix.

In both these cases, surgeons will usually drain the abdomen or abscess of pus and treat the infection with antibiotics before removing the appendix.

More Information About Marijuana Users at Risk for Early Psychosis

Psychotic illness occurs significantly earlier among marijuana users, results of a meta-analysis suggest.

Data on more than 22,000 patients with psychosis showed an onset of symptoms almost three years earlier among users of cannabis compared with patients who had no history of substance use.

The age of onset also was earlier in cannabis users compared with patients in the more broadly characterized category of substance use, investigators reported online in Archives of General Psychiatry.

“The results of this study provide strong evidence that reducing cannabis use could delay or even prevent some cases of psychosis,” Dr. Matthew Large, of the University of New South Wales in Sydney, Australia, and co-authors wrote in conclusion.

“Reducing the use of cannabis could be one of the few ways of altering the outcome of the illness because earlier onset of schizophrenia is associated with a worse prognosis and because other factors associated with age at onset, such as family history and sex, cannot be changed.”

Psychosis has a strong association with substance use. Patients of mental health facilities have a high prevalence of substance use, which also is more common in patients with schizophrenia compared with the general population, the authors wrote.

Several birth cohort and population studies have suggested a potentially causal association between cannabis use and psychosis, and cannabis use has been linked to earlier onset of schizophrenia. However, researchers in the field remain divided over the issue of a causal association, the authors continued.

Attempts to confirm an earlier onset of psychosis among cannabis users have been complicated by individual studies’ variation in methods used to examine the association. The authors sought to resolve some of the uncertainty by means of meta-analysis.

A systematic search of multiple electronic databases yielded 443 potentially relevant publications. The authors whittled the list down to 83 that met their inclusion criteria: All the studies reported age at onset of psychosis among substance users and nonusers.

The studies comprised 8,167 substance-using patients and 14,352 patients who had no history of substance use. Although the studies had a wide range of definitions of substance use, the use was considered “clinically significant” in all 83 studies. None of the studies included tobacco in the definition of substance use.

The studies included a total of 131 patient samples.

Substance use included alcohol in 22 samples, cannabis in 41, and was simply defined as “substance use” in 68 samples.

Alcohol use was not significantly associated with earlier age at onset of psychosis.

On average, substance users were about 2 years younger than nonusers were. The effect of substance use on age at onset was greater in women than in men, but not significantly so. Heavy use was associated with earlier age at onset compared with light use and former use, but also not significantly different, the authors reported.

Substance users were two years younger at the onset of psychosis compared with nonusers. Age at onset was 2.7 years earlier among cannabis users compared with nonusers.

Acknowledging limitations of the study, the authors cited the lack of information on tobacco use and its association with earlier age at onset of psychosis, and the lack of data on individual patients inherent in all meta-analyses.

Despite the limitations, the authors said the findings have potentially major clinical and policy implications.

“This finding is an important breakthrough in our understanding of the relationship between cannabis use and psychosis,” they wrote in conclusion. “It raises the question of whether those substance users would still have gone on to develop psychosis a few years later.”

“The results of this study confirm the need for a renewed public health warning about the potential for cannabis use to bring on psychotic illness,” they added.

Should Know If Walking Helps Heart and Brain

Regular aerobic exercise such as walking may protect the memory center in the brain, while stretching exercise may cause the center — called the hippocampus — to shrink, researchers reported.

In a randomized study involving men and women in their mid-60s, walking three times a week for a year led to increases in the volume of the hippocampus, which plays an important role in memory, according to Dr. Arthur Kramer, of the University of Illinois Urbana-Champaign in Urbana, Ill., and colleagues.

On the other hand, control participants who took stretching classes saw drops in the volume of the hippocampus, Kramer and colleagues reported online in the Proceedings of the National Academy of Sciences.

The findings suggest that it’s possible to overcome the age-related decline in hippocampal volume with only moderate exercise, Kramer told MedPage Today, leading to better fitness and perhaps to better spatial memory. “I don’t see a down side to it,” he said.

The volume of the hippocampus is known to fall with age by between 1 percent and 2 percent a year, the researchers noted, leading to impaired memory and increased risk for dementia.

But animal research suggests that exercise reduces the loss of volume and preserves memory, they added.

To test the effect on humans, they enrolled 120 men and women in their mid-sixties and randomly assigned 60 of them to a program of aerobic walking three times a week for a year. The remaining 60 were given stretch classes three times a week and served as a control group.

Their fitness and memory were tested before the intervention, again after six months, and for a last time after a year. Magnetic resonance images of their brains were taken at the same times in order to measure the effect on the hippocampal volume.

The study showed that overall the walkers had a 2 percent increase in the volume of the hippocampus, compared with an average loss of about 1.4% in the control participants.

The researchers also found, improvements in fitness, measured by exercise testing on a treadmill, were significantly associated with increases in the volume of the hippocampus.

On the other hand, the study fell short of demonstrating a group effect on memory – both groups showed significant improvements both in accuracy and speed on a standard test. The apparent lack of effect, Kramer told MedPage Today, is probably a statistical artifact that results from large individual differences within the groups.

Analyses showed that that higher aerobic fitness levels at baseline and after the one-year intervention were associated with better spatial memory performance, the researchers reported.

But change in aerobic fitness was not related to improvements in memory for either the entire sample or either group separately, they found.

On the other hand, larger hippocampi at baseline and after the intervention were associated with better memory performance, they reported.

The results “clearly indicate that aerobic exercise is neuroprotective and that starting an exercise regimen later in life is not futile for either enhancing cognition or augmenting brain volume,” the researchers argued.

The study was supported by the National Institute on Aging, the Pittsburgh Claude D. Pepper Older Americans Independence Center, and the University of Pittsburgh Alzheimer’s Disease Research Center. The authors said they had no conflicts.