Appendicitis

Appendicitis is the commonest abdominal emergency, occurring mostly in people under 30 years old, though it can appear in people of any age. When considering appendicitis as a diagnosis, always ask the patient if he knows whether his appendix has already been removed, and look for the operation scar in the right lower abdomen area.

The illness usually begins with a combination of colicky abdominal pain, nausea, and perhaps mild vomiting. The pain is usually felt in the midline just above the navel or around the navel. Later, as the illness progresses, the pain moves from the center of the abdomen to the right lower quarter of the abdomen. The character of the pain changes: from being colicky, diffuse, and not well localized when it is around the navel, it becomes sharp, distinctly felt, and localized at the junction of the outer and middle thirds of a line between the navel and the front of the right hipbone. The patient usually loses his appetite and often feels ill.

Examine the patient. If he complains of sharp stabbing pain when you press gently over the right lower quarter of his abdomen and especially if you feel his abdominal muscles tightening involuntarily when you try to press gently, you can be fairly sure that the appendix is inflamed. The temperature and the pulse rate will rise as the inflammation increases.

Treatment

Once you suspect a patient has appendicitis get RADIO MEDICAL ADVICE and GET THE PATIENT TO HOSPITAL AS SOON AS POSSIBLE. Do not give a purgative.

If the patient can reach hospital within 4-6 hours, give him no food or liquid and no drugs, as he will probably require a general anaesthetic. Keep him in bed until he is taken off the ship. Keep a record of the patient’s temperature, pulse, and respiration, and send these and your case notes to the hospital with the patient.

If the patient cannot get to hospital within 4-6 hours, put him to bed and the temperature, pulse rate and respiration rate hourly. The patient should have no food, but can have drinks. Treat severe pain according to RADIO MEDICAL ADVICE.

Subsequent treatment

If the patient is still on board after 48 hours, he should be given some fluids such as milk, sweet tea, and soup until he can be put ashore.

Anyone who was thought to have appendicitis but seems to have improved should be seen by a doctor at the next port. Improvement is shown by diminution of pain and fall in temperature.

2. Answer the following questions

1. What signs and symptoms of minor abdominal conditions do you know?

2. What abdominal emergencies exist?

3. What are the symptoms of appendicitis?

4. What should be done if the patient on board a ship cannot get to hospital?

3. Remember the following expressions and make up dialogues using these expressions

Pains