Appendicitis

Appendicitis is inflammation of the appendix, the narrow, finger-shaped organ that branches off the first part of the large intestine on the right side of the abdomen. Appendicitis may be acute or chronic.

Acute appendicitis is the most common reason for abdominal surgery in the world. If it is not treated promptly, the inflamed appendix may burst, spilling fecal material into the abdominal cavity. The usual result is a life-threatening infection of the abdominal cavity's lining (the peritoneum) that is peritonitis - a serious inflammation with rather high rate of mortality unless it is treated quickly with strong antibiotics.

Appendicitis is caused by obstruction of the appendix. The appendix may become obstructed by a lump of feces, calcium salts and fecal debris or tumors, leading to inflammation and infection.

Acute appendicitis is known to begin with vague discomfort or tenderness near the navel (early in an attack) or suddenly with sharp pain which is at first felt in epigastrium but then becomes generalized in the abdomen. The pain becomes worse on movement, deep breathing in and coughing, it does not radiate but is accompanied by constipation, nausea and vomiting, retention of gases, possibly alternating with diarrhea. The temperature is normal or subfebrile. A high fever (possibly accompanied by chills) may indicate an abscessed appendix. Abdominal swelling or bloating, especially in infants may be occasionally observed.

Diagnosis of an acute appendicitis is based on patient history (symptoms) and physical examination. Physical examination is necessary to rule out other disorders that produce symptoms similar to those of appendicitis.

· A rectal examination may be performed.

· Blood and urine samples should be taken for analysis.

· CT (computed tomography) scan or an abdominal x-ray may be necessary.

Chronic appendicitis may appear with mild abdominal tenderness, pain, and malaise or lethargy. Often, individuals with chronic appendicitis are undiagnosed until an acute episode of appendicitis occurs. Diagnosing chronic appendicitis can be difficult because the symptoms can be similar to those occurring with other conditions, including gastrointestinal disorders such as constipation or diarrhea.

The treatment of an acute appendicitis is surgical. The surgical procedure for the removal of the appendix is called an appendicectomy.

Laparotomy is the traditional type of surgery used for treating appendicitis. This procedure consists in the removal of the infected appendix through a single larger incision in the lower right area of the abdomen. The incision in a laparotomy is usually 51 to 76 mm long. This type of surgery is used also for visualizing and examining structures inside the abdominal cavity.

A traditional appendectomy is performed under general anesthesia. The entire procedure should not last longer than an hour if complications do not occur.

The newer method to treat appendicitis is the laparoscopic surgery. This surgical procedure consists of making three to four incisions in the abdomen, each 6.4 to 12.7 mm long. This type of appendectomy is made by inserting a special surgical tool called laparoscope into one of the incisions. The laparoscope is connected to a monitor outside the patient's body and helps the surgeon to inspect the infected area in the abdomen. The other two incisions are made for the specific removal of the appendix by using surgical instruments. Laparoscopic surgery also requires general anesthesia and it can last up to two hours.

Full recovery from appendectomies takes about four to six weeks, but can be prolonged to up to eight weeks in case of the appearance of complications, such as the rupture of the appendix.

Exercise 7 Answer the following questions:

1. What is appendix?

2. What is the cause of appendicitis?

3. What types of appendicitis are there?

4. What are the manifestations of acute appendicitis?

5. What is the difference of acute and chronic appendicitis?

6. Why is it difficult to make a diagnosis of chronic appendicitis?

7. What complications can occur in case of untreated acute appendicitis?

8. How can acute appendicitis be treated?

9. How can acute appendicitis be diagnosed?

10. What is the difference in laparotomy and laparoscopy?

Exercise 8. Match the following Ukrainian words and word combinations with the English ones:

Exercise 9. Say whether the sentences are true or false:

1. Appendicitis can be of acute and chronic form.

2. Laparoscopy consists of the removal of the appendix through one incision in the lower left part of the abdominal cavity.

3. Acute appendicitis begins with pains in substernal area.

4. The pain is accompanied by fever, perspiration and discharge of sputum.

5. An acute appendicitis is treated with antibiotics.

6. The rupture of appendix can lead to the infection of the peritoneum.

7. It is difficult to diagnose chronic appendicitis because symptoms are vague.

8. A high fever in acute appendicitis may indicate inflammation of the abdominal cavity's lining.

Exercise X. Match the following terms with their definition:

Exercise 11. Translate the words given in italics into English. Translate the whole sentences into your native language:

1. The patient complained of the pain that супроводжувалася нудотою.

2. Закреп was relieved with the administration of laxatives.

3. The operation on acute appendicitis проводилася under загальна aneasthesia.

4. Закупорка of the appendix lumen was the cause of nausea, pains and vomiting.

5. The surgeon видалив the appendix to prevent its розрив.

6. Suppurative appendicitis may cause ускладнення such as peritonitis.

7.Peritonitis is загрозлива для життя інфекція with високим рівнем смертності.

8. Acute appendicitis usually починається з хворобливістю in the abdominal cavity.

Exercise 12. Put the words from the box instead of synonyms in the sentences:

1. The blockage of the appendix lumen caused unbearable pains and fever.

2. Cardiovascular diseases are one of the leading factors of deaths in the world nowadays.

3. The disease is accompanied by severe soreness in the abdominal cavity.

4. One of the most frequent complications of an acute appendicitis can be the burst of appendix that can lead to peritonitis.

5. Retention of feces is one of the symptoms of acute appendicitis.

6. The patient with indigestion complained of retching and diarrhea.

7. Sickness can be a side effect of many medications including cancer chemotherapy, or morning sickness in early pregnancy.

8. Full convalescence of acute appendicitis can occur after four - six weeks of treatment.

Exercise 13. Read and translate paying attention to modal verbs:

1. The environment must be provided with the proper amount of oxygen for the growth of aerobic microorganisms.

2. The doctor ought not to have told him that the disease is incurable. He should have encouraged him.

3. The doctor had to palpate the patient’s abdomen and make an abdominal X-ray to exclude the possible diagnosis of an acute appendicitis.

4. The students may watch the operation on acute appendicitis in practical classes.

5. Appendicitis in this patient must have resulted from obstruction of the appendix with a tumour.

6. Everyone should remember that most viruses are destroyed at the temperature 500-600 within 30-60 minutes.

7. Acute appendicitis should be treated surgically either by laparotomy or laparascopy.

8. Fat-soluble vitamins can be stored for long periods of time in the body’s fatty tissue and the liver.

Exercise 14. Fill in the blanks with suitable modal verbs in a proper form and translate the text:

At about 2 o’clock in the cold winter morning a man telephoned a doctor and asked him if he ….. come at once. “You …. hurry”, he said. The doctor …. drive 7 miles to this call. When he reached the place, the man who had called him in said: “Doc, I ….. strained myself (втомився). I haven’t got any pain or anything, but I have a terrible feeling that I …. die soon.” The doctor examined the patient, felt his pulse and took the temperature. “Have you made your will? (заповіт) he asked at last. – Why, no, doctor.” The man looked frightened. – You … done it long ago, ” said the doctor. “ Have you got a family? ” – “Yes” said the patient. – “You …. send for them immediately. And your parents ….. be called too.” – “Do you really think I’m going to die? ” – “No, I don’t” replied the doctor. “But I don’t want to be the only one whom you made fool of that night.”

Exercise 15. Translate into English the parts of the sentences given in brackets using modal verbs:

1. The ambulance (змоглa дістатися) to the hospital within 10 minutes despite a traffic jam.

2. I don’t remember that I saw such symptoms and so I (не зможу) help you in making a diagnosis.

3. Full recovery from appendectomies (може відбутися) after 4 to 6 weeks of treatment.

4. I’ll write you the prescription that you (слід дотримуватися) to achieve full recovery.

5. I suppose that this medicine (повинно допомогти).

6. (Нема чого хвилюватися). The operation was performed successfully.

7. He has a scar in the lower right area of the abdomen. He (можливо зробили) laparotomy.

8. You (не слід) get out of bed before the doctor allows you to do it as the stitches (можуть) not hold.

Exercise 16. Put questions to the underlined members of sentences:

1. Acute appendicitis is due to the obstruction of the appendix with fecal debris.

2. The rupture of appendicitis may cause peritonitis.

3. Treatment of acute appendicitis consists of surgical intervention.

4. There may be no acute symptom of chronic appendicitis at all.

5. Anorexia is commonly noted early in the morning.

6. The patient with ruptured appendix will be operated immediately.

7. On admission to the hospital the patient complained of a severe pain in epigastrium.

8. Cases of appendicitis have been noted even in infants.

Exercise 17. Open the brackets and put the verbs in a correct tense:

1. The surgeon (to perform) this operation from 10 till 11 o’clock.

2. Two hours ago, a patient with acute pains (to bring) to the reception ward.

3. Eye drops may (to use) for the prevention of ocular infection.

4. The patients (to examine) by a doctor in charge now.

5. If the patient has TB bacilli in the sputum, he (to stay) in the hospital for six or eight months.

6. The patient cannot be discharged from the hospital because he not (to recover) yet.

7. When we came, the solution (to boil) in the water-heater system.

8. After the injection, given an hour ago, the patient (to feel) much better.

Exercise 18. Translate into English:

1. Гострий апендицит — одне з найпоширеніших гострих хірургічних захворювань органів черевної порожнини.

2. Найчастіше гострий апендицит викликається обструкцією червоподібного відростка каловими камінням.

3. Для правильної діагностики гострого апендициту лікар зобов'язаний провести ретельне обстеження хворого.

4. Початок хвороби характеризується тупим ниючим болем у правій здухвинній ділянці.

5. Основний тип лікування гострого апендициту є хірургічне втручання.

6. Перитоніт (запалення очеревини) виникає при некрозі та перфорації в стінці червоподібного відростка, з наступним витіканням кишкового вмісту в вільну черевну порожнину.

7. Апендикулярний абсцес– виникає коли відбувається локалізація процесу, тобто запалення обмежується лише зоною відростка та прилягаючими тканинами.

8. Після видалення червоподібного відростка його функцію на себе беруть інші органи шлунково-кишкового тракту, що дозволяє організму людини повноцінно функціонувати.

Завдання для самостійної роботи студентів

Test

1. Appendicitis is a condition characterized by …………….

A) inflammation of the stomach B) inflammation of the appendix

C) ulcers in appendix D) infection of the peritoneum E) Adhesions in appendix

2. Mortality is high because of the risk of rupture leading to ……………...

A) Gastritis B) peritonitis C) angina pectoris

D) tumours E) lung abscess

3. Suppurative appendicitis may lead to complications such as …………...

A) Gastric ulcer B) rupture, abscess C) tumour

D) pyelonephritis E) nephritis

4. Acute appendicitis is treated ……………….

A) by antibiotics B) surgically C) by sulfanilamides

D) by antipyretics E) by homoeopathy

5. Acute appendicitis seems to be the end result of ………………..

A) erosions in the appendix mucosa B) obstruction of the appendix lumen C) inflammation of the intestines D) inflammation of the peritoneum

E) inflammation of the bile ducts

6. The appendix is removed to prevent its rupture which may result in ……….

A) Pyelonephritis B) peritonitis C) nephrolithiasis

D) gastritis E) urosepsis

7. The pain in acute appendicitis is accompanied by ………………….

A) Diarrhea, belching B) nausea, retention of stools and gases

B) vomiting, heartburn D) infection E) bleeding, belching

8. The appendix may become obstructed by ……………...

A)a stone B) a lump of faeces C) mucus D) calculus E) food debris

9. Symptoms of acute appendicitis are …………..

A) Pains, heartburns, retention of gases B) acute pains, nausea, retention of gases C) diarrhea, high fever D) coughing and sneezing

E) pains, mucopurulent sputum, belching

10. Full recovery from appendectomies takes about ………….

A) 4 to 6 weeks B) up to 8 weeks C) no more than 3 weeks

D) a month E) about 10 days

Exercise 1. Learn the new words:

Exercise 2. a)Read the following word-combinations and translate them:

Treatment: emergency treatment, effective treatment, immediate treatment, inpatient treatment, long-term treatment

Diagnosis: correct diagnosis; definite diagnosis; delayed diagnosis, initial diagnosis

Inflammation: severe inflammation; painful inflammation; acute inflammation; to reduce inflammation; signs of inflammation

Substance: dangerous substance; harmful substance; toxic substance; pure substance; soluble substance

b) Make up short sentences using the above given word combinations:

Exercise 3. Translate the following word-combinations:

Obstruction of the cystic duct; accumulation of bile; swelling of the gallbladder; normal blood flow; insufficient oxygen; delayed diagnosis; morbidity and mortality; intense pain; umbilical area; tender and distended; cold perspiration; severe tenderness; irritation of the peritoneum; slight jaundice of sclerae; greasy, fatty, or fried foods; to result from the effect of toxic substances; several small incisions; surgical site infection

Exercise 4. Read and translate the text: