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As in many previous posted conditions, appendicitis has been linked to the consumption of refined foods. Quite rare in rural Africans, this acute situation is seen most commonly in individuals obtaining little dietary roughage. The pain of appendicitis usually comes on suddenly, and is associated with nausea and vomiting. A low grade fever develops, with rapid loss of appetite. The pain may at first be localized to the region of the stomach. It then migrates to the umbilicus, and finally localizes in the right lower quadrant of the abdomen. Deep pressure over the area will reveal a point of maximum tenderness. Stand the person on his or her toes, and ask the person to drop suddenly on the heels. This usually aggravates the pain if the appendix or a related internal organ is inflamed. Usually there is no bleeding or diarrhea.

Although some appendicitis cases can heal with simple measures, it is wise to obtain the counsel of a physician who can order the appropriate blood tests. If his pain does not subside promptly, surgery is necessary. Rupture of the appendix is a serious complication. Intestinal contents laden with germs may then contaminate the abdominal cavity, raising fever, increasing the pain, and becoming life threatening unless surgical drainage is accomplished promptly. Mortality is much lower for appendicitis than it was in previous years, but prompt diagnosis and treatment are still necessary to save lives.

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The veins of the rectum frequently become enlarged or tender, with sudden onset of brisk red bleeding. Called hemorrhoids, these annoyances are due primarily to our sedentary lifestyle, with the modern emphasis on refined foods containing little fiber. Sitting for prolonged periods or straining with bowel movements increases the venous pressure in the rectal area with the consequent development of these protruding veins.

External hemorrhoids are clusters of veins at the opening to the rectum (anus). They may develop a clot or thrombosis. These become excruciatingly painful and usually show an area of purplish or dark discoloration. Although gradual resolution will occur in 2-3 weeks with sitz baths, the most prompt relief is obtained by the incision of the thrombosed hemorrhoid, removing the offending clots. This can be done with local anesthesia. Recurrence is uncommon.

Treatment of the internal hemorrhoid, which more commonly bleeds and ulcerates, is usually conservative. Hot and cold sitz baths are given, described in the chapter on Hydrotherapy. In combination with a high fiber diet, they will usually allow the condition to subside. At least two tablespoons of bran, with an abundance of fresh fruits and vegetables, are advisable to keep the stool soft. Aim at producing one or more substantial soft bowel movements daily.

Surgical treatment of refractory hemorrhoid disease was formerly a very painful and costly procedure. The development of the band ligation has changed this. A small rubber band is placed around the hemorrhoid high above the area of sensation, completely obliterating the hemorrhoid (varicosity). Two or three treatments in the office are necessary to complete this treatment. They are spaced at least three weeks apart to avoid excessive scarring. Rectal suppositories provide some relief from the pain of hemorrhoid disease, and may be purchased over-the-counter at most pharmacies. However, complications such as prolapse of the rectum or malignancy may present. The final decision on hemorrhoids is best handled by a physician.

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There are several types of hernias, sometimes called ruptures, which arise from weaknesses in the abdominal wall. These out-pouchings of the abdominal (peritoneal) lining occur primarily in the groin, but are also found on the front wall of the abdomen and in the area of the diaphragm. The typical groin hernia occurs from a congenital weakness in the structures comprising the inguinal ring.

That is the connecting opening between the abdomen and the groin canal. The hernia first presents itself with a bulge in the groin. They frequently occur in infancy or early childhood. Although some hernias may disappear, it is critical to have infant hernias evaluated. Usually they need prompt surgery to avoid complications.

When an intestinal loop enters the hernia sac a bulging occurs, often associated with pain. If it is impossible to replace this protrusion within the abdominal cavity, the bowel is said to be incarcerated or trapped. Prolonging this hazard may lead to strangulation, in which the blood supply is compromised. Unless prompt surgery is done, rupture or abdominal (peritoneal) infection may ensue.

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Because most operations today are performed in hospitals, it is well for family members to know how best to aid the recovery of their convalescing relatives. Undue visiting should be discouraged. The frequent recital of a person’ s own operation and details of hospitalization can help to depress and confuse the individual recovering from surgery. Visiting just to “chit chat” in the hospital should be kept to a minimum. Well wishers should either send cards or reserve their condolences for later. A devoted family member or trained nurse, however, can be of incalculable value to the convalescing surgical patient.

Immediately after major surgery the incision should be cooled with an ice pack applied over the dressing. This will reduce swelling (edema fluid), lessen the likelihood of bleeding, and modify impressively the pain responses. Avoid excessive movement of the involved area, while maintaining activity in remote portions of the body. And especially encourage deep breathing. This will aid the rapid emergence from anesthesia, while minimizing the sensation of severe pain.

After the initial recovery phase is ended, moist warm compresses can be applied over most incisions, except in areas where the blood supply is compromised or at the distal extremities. In the latter case cold packs may be used. Over the chest and abdomen, however, frequent applications of moist warm packs, such as fomentations or electric heating devices will significantly reduce the pain, while promoting rapid healing of the involved area.

At this stage the healing processes will occur more rapidly in the presence of warmth, since all enzyme reactions as well as the growth of new cells are speeded up by mild heat. Usually the moist hot pack can be applied every three to four hours, enabling the convalescing patient to relax in between, gaining the necessary rest that promotes recovery. From the very first, the incision should be protected from undue moisture and kept clean and dry. Daily changes of the sterile gauze dressing are helpful in allowing air to reach the incision and dry the sutured area.

Adequate fluid intake is important. After abdominal surgery intravenous feedings are often used until the intestinal tone returns. This manifests itself by the passage of gas, and a sensation of hunger. One can hear “bowel sounds” when listening to the abdomen with a stethoscope. At this stage, the patient may be given sips of water or ice chips. If these create no problem, clear liquids such as herb teas, apple juice, vegetable jello, grape juice, and vegetable broth may be added.

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The removal of a tissue for accurate pathologic diagnosis is called biopsy. If the lesion is large and only a small part is to be removed, the surgery is called an incisional biopsy. Usually a small portion of normal adjacent skin is excised with the lump under question. When it is possible to completely remove the growth and obtain a margin of normal tissue around it, the procedure is termed an excisional biopsy. These are very useful procedures, not only for the diagnosis and treatment of blemishes and abnormal growths of the skin, but also for lumps beneath the skin in accessible organs, such as the breast.

A breast biopsy can often be performed without general anesthesia or hospitalization when the surgical skills are present and the necessity for tissue diagnosis exists. More commonly, skin biopsies are used to determine the presence or absence of cancer and to excise unsightly or irritating growths that have developed in areas amenable to their removal.

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