Talk:Appendicitis/Archive 1

Cause of Appendicitis

The article states that appendicitis is caused by fecal matter getting lodged in the appendix. But the questions remain, "Why does this happen?" and "How can it be cured?"

Clues to the ultimate cause of this disease come from the field of epidemiology. Although the article doesn't mention it, many other sources on the web state that this is a disease of the Western World, virtually unknown in the developing world.

As with diverticulosis, hemorrhoids, colon cancer, inflammatory bowel disease and others, appendicitis recently emerged toward the end of the 19th century, and only in the Western world. All of these diseases have baffled modern medicine for over a century.

In the past 3 decades "dietary fiber" has been considered the explanation for the epidemiological evidence. But many studies, especially on colon cancer, have torpedoed the fiber theory.

According to kidshealth.org: "There are no medically proven ways to prevent appendicitis. Although appendicitis is rare in countries where people eat a high-fiber diet, experts have not yet shown that a high-fiber diet definitely prevents appendicitis."

There is another cultural difference between the developing world and the developed world which directly pertains to colorectal health, but which has been overlooked by researchers. Most of the world uses the squatting position for excretion and childbirth. This is the method the human body was designed to use, and our deviation from it damages the colon (and other organs) in a number of ways.

Regarding the appendix, the use of sitting toilets causes one to put downward pressure on the ascending colon, which can easily force wastes into the appendix.

My website http://www.NaturesPlatform.com/health_benefits.html explains this process in much greater detail, and gives a historical perspective on this disease that corroborates the theory.

Please have a look at it.

Thanks,

Jonathan Isbit

--65.137.138.82 20:36, 4 Jun 2005 (UTC)

Sounds highly speculative. If something has been "overlooked" by researchers you will first need case-control studies to detect whether the type of loo people use actually influences their appendicitis risk. For the moment I would not be too eager to have this in the article. JFW | T@lk 21:44, 4 Jun 2005 (UTC)

And how do you know appendicitis did not happen before the 19th century? Isn't it interesting that abdominal surgery developed around this time, and that previously the acute abdomen was simply a death warrant without a diagnosis? JFW | T@lk 21:46, 4 Jun 2005 (UTC)

---

Dear JFW,

Thank you for your comments.

To answer your second question, please visit the following site: http://www.mja.com.au/public/issues/175_01_020701/hugh/hugh.html

The relevant excerpt from that page follows:

"The epidemiology of appendicitis poses many unanswered questions. Almost unknown before the 18th century, there was a striking increase in its prevalence from the end of the 19th century, with features suggesting it is a side effect of modern Western life. Rendle Short8 and Burkitt1 summarised the rapid emergence of appendicitis in developed countries in the 20th century, and Burkitt noted its rarity in rural areas and in undeveloped countries."

To respond to your first comment, I know that further research is needed. But I believe that I have offered the most plausible hypothesis for a disease that has baffled modern medicine for over a century. An article about a disease that does not address etiology or epidemiology or prevention is incomplete. Presenting the most plausible hypothesis will inspire others to do research. (I am not a doctor, nor am I in a position to get involved with clinical research.)

Sincerely,

Jonathan Isbit --65.137.139.74 15:48, 5 Jun 2005 (UTC)

Thanks for your comments. I agree that there are unanswered questions, but unless there have been serious studies that investigate your hypothesis, this information would not be suitable for Wikipedia due to limitations on original research. You are free to provide a reference to the Hugh & Hugh editorial in the article. JFW | T@lk 20:54, 5 Jun 2005 (UTC)

--- Mr. Isbit, Can you explain why you think that "the use of sitting toilets causes one to put downward pressure on the ascending colon" and "damages the colon (and other organs) in a number of ways"?

The answer is much too involved to take up space here, but it's all explained at this website http://www.NaturesPlatform.com/health_benefits.html . ~ Jonathan

I'll summarize that website in one sentence - it's all pseudoscience. Alex.tan 04:01, 29 March 2006 (UTC)

This is the sort of reaction that is always provoked by challenges to conventional wisdom. The example of Ignaz Semmelweis will be instructive. ~ Jonathan

I'm still waiting for your objective, reproducible evidence. The more outrageous the claim, the more foolproof the evidence has to be. So far, everything that website claims as evidence sadly does not pass the muster of good scientific proof. Alex.tan 01:07, 30 March 2006 (UTC)

p.s. even taking the statements from http://www.mja.com.au/public/issues/175_01_020701/hugh/hugh.html at face value, i.e. that appendicitis was less prevalent before the 18th century, it's a BIG (and unjustified) step to conclude that sitting toilets are to blame. There have been numerous other changes in society as well as that. How about increased sanitation? refrigeration? electricity? microwaves? the internal combustion engine? plastics? There's no evidence that any of these have caused the increase in appendicitis any more than sitting toilets versus squatting toilets. Alex.tan 01:14, 30 March 2006 (UTC)

Microwaves don't force fecal matter into the appendiceal orifice. The Valsalva Maneuver does. The same can be said for refrigeration and all the other factors you have frivolously mentioned. --Jonathan108 21:59, 30 March 2006 (UTC)

I would also call to your attention the following excerpt from the pseudoscience article:

"Some characteristics that are often true of pseudoscience are also true to some extent of all new genuinely scientific work. These include:

1. claims or theories unconnected to previous experimental results;

2. claims which contradict experimentally established results;

3. work failing to operate on standard definitions of concepts"--Jonathan108 16:59, 1 April 2006 (UTC)

Jonathan, one of the crucial differences is the way in which views are supported. What you will need to do with your theory is try to construct a case-control study where all factors are controlled for. Again, your theory sounds great, but so do UFOs and men from Mars. Please find another forum for this. JFW | T@lk 00:06, 3 April 2006 (UTC)

Jonathan - I looked at the website - the information there is wholely unsubstantiated and much of it is false just on a physiologic level. Sell your squatting someplace else.SkinnyB 21:50, 7 June 2006 (UTC)

• Hi guys. I've read this talk page and the websites offered, and updated the main article in a way I hope is fair. I've tried to indicate there are alternate theories with a neutral viewpoint. Claims of pseudoscience and historical prevalences aside, it's worth mentioning that there are other theories. --Kerowyn ^{Leave a note} 21:10, 23 August 2006 (UTC)

Hello all, Although I agree alternative theories of scientific worth may be valuable to discuss, writting them into the body of the article (especially under a Porcalain Throane heading) is a disservice. Epidemiological evidence for cecal emptying through knee compression is pure opinion, not data. Evidence for positive correlations between dietary fiber intake and appendicitis is substantial and worth mentioning, but speculative oppinion not substantiated by scientific evidence should memain in this discussion section of Wikepedia. The article should be restored to the version prior to these entries. The diagram of the location of the appendix is a good addition, however. K.Hobler 28 August 2006

I agree that as an encyclopedia, Wikipedia should endeavor to be as factual as possible. However, this should include the fact that some people believe the "porclain throne" theory. If a theory exists, it ought to be included, if only to point out that it is considered pseudoscience which is not supported by scientific evidence.

Incidentally, if you have any scientific article citations to support the correlations between fiber and appendicitis, I'd love to include them. I just don't have the time to sift through the data myself. --Kerowyn ^{Leave a note} 05:30, 28 August 2006 (UTC)

Excuse me, but the fact that some people propose that toilets contribute to appendicitis rates ought to be mentioned, if only to point out that this is considered highly inaccurate by medical professionals. Kerowyn ^{Leave a note} 20:35, 30 August 2006 (UTC)

The current version is worded better...that is the additions are presented clearly as hypotheses unsupported by good evidence and are not so prominently displayed to suggest otherwise. Could you tell me what (UTC) means? K.Hobler 30 August 2006.

Thanks. I thought this might be a happy medium between the detailed description and nothing at all. UTC is Coordinated Universal Time. Basically a more politically correct way of saying Greenwich Mean Time. When you sign comments with the signature button (the third to last button in the edit bar) it automatically adds a timestamp.--Kerowyn ^{Leave a note} 17:59, 31 August 2006 (UTC)

Thanks. Khobler 20:59, 31 August 2006 (UTC)

Regarding this statement: Most health practitioners accept Dr. Burkitt's first cause as a contributing factor, but dismiss the second since there is no scientific evidence to support it. Most health practitioners have never heard of the the toilet theory. There is no evidence (pro or con) because the researchers who read Burkitt's writings couldn't figure out how to test it. So, the above statement incorrectly implies that most health practioners are familiar with the theory and have dismissed it. I will do an edit that corrects this mistake. --65.151.216.98 01:04, 2 September 2006 (UTC)

Looks good. --Kerowyn ^{Leave a note} 06:19, 2 September 2006 (UTC)

I have added the following line:

There is also a possibilty of being extremely tired, and falling asleep almost instantly when laying down. Severe diahrea may occur as well, after waking up, a person may have to go to the restroom, unable to "hold it in" leaking diahrea before even making it to a toilet.

under symntoms, as this is a symntom, including the other symntoms I had before I found out I had appendicitis from the hospital.

The above symptoms are "atypical", in that "diarrhea" is not a feature of typical appendicitis symptoms. Lethargy and malaise may be a symptom of any acute or chronic illness, and therefore are non specific for the diagnosis of appendicitis. I would suggest therefore removing this latest addition and instead substituting "diarrhea" in the paragraph regarding "atypicial". Diarrhea makes one think of a diagnosis of gastroenteritis rather than appendicitis, but it can be seen in more advanced, atypical cases, especially if the inflammation is producing unremitting irritation of the adjacent colon.Khobler 18:12, 26 December 2006 (UTC) I have converted the lethargy comment, which was somewhat personal, into a generalized statement about the pertinence of lethargy as a general, non-specific symptom of infection and placed it in the atypical category where it is more commonly seen. Khobler 14:20, 5 January 2007 (UTC) Recent revisions have eliminated mention of obstruction as a cause of appendicitis. I think this was probably inadvertent, so I have added it back into causes.Khobler 00:27, 25 January 2007 (UTC)

On 10 Feb 07 a deletion in signs, symptoms and findings occurred (without discussion) and the resultant sentance is non-senesical. I suggest reverting to the 7 Feb 07 version, which makes more sense to me. Khobler 20:34, 21 February 2007 (UTC)

I have rewritten signs, symptoms and finding that I believe represent what most general surgeons experience in everyday practice. If there is disagreement, I would appreciate a discussion in this section.Khobler 19:15, 22 February 2007 (UTC)

• I made some changes to the pathophys. section scrubbing some of what was really not contempoary or widely accepted notions. Speculative theories which have neither been tested nor added to most surgical texts add too many tangents to a relatively simple concept. I re-reviewed several recent texts and the Uptodateonline.com which don't mention some of the ideas that were being featured at all.Droliver 19:16, 23 February 2007 (UTC)

The current revision is, I believe, up to date and a good description of appendicitis.Khobler 04:36, 24 February 2007 (UTC)

• thanks! I think some of the language could be smoothed to make for better reading, but I think content wise it's betterDroliver 22:20, 24 February 2007 (UTC)

I've smoothed up some of the language in treatment, and I hope added a few details of general interest regarding incisions, anesthesia and lengths of stay. We may be just about "there", for now. Khobler 16:44, 26 February 2007 (UTC)

Alcohol consumption is not associated according to my clinical experience and I know of no evidence that it is. Therefore I deleted the statement implicating it causally. Khobler 12:39, 9 April 2007 (UTC)

Every theory stated here gains us insight to prevention of appendicitis. Which is what all of us are aiming for. I find it quite funny that two intellegent people were arguing and throwing thier witts around about a silly matter. It's so obvious that Mr. Isbit wants to work for this encyblopedia company and is very boastful and quick to think that he might know more about this subject. When some of us know that when I come upon this website for research I am looking for information and answers. I am not a doctor or teacher but I do know all information is subject to speculation and should not be taken so heavily. Mr. Isbit's informaiton was very humorous and interesting but everyone should not have even commented on his rude and immature comments about how this information is compiled. I had appendicitis and and appendectomy when I was about 12. So back in the 19th century I would have been given a death warrant and my parents would have been grieving. Science kept me alive in 1990's or was it god??? But now I have 2 children and was looking on here how I can prevent this from happening to them If I was so quick to have had this complication during my lifetime. But toilet duty is above and beyond my control for prevention. How else am I supposed to prevent this other than teach them how to squat and repremand society's preception of batheroom 101 due to slight evidence of Mr. Isbit's knowledge into the depth of incorrect downward movement of our fecal matter???? Michelle:)

Another thing that needs to be pointed out about Mr Isbit's theory is that in fact appendicitis is likely slightly **more** common in the developing world as there is a cause that is only rarely found in the developed world - parasitic infection with helminths and other worms: http://www.springerlink.com/content/64110p6m70824658/ . Additionally, histologically often there is no faecolith found, and the only finding is of lymphoid proliferation close to the base, presumably from a preceding viral infection. Snipergirl (talk) 09:31, 17 October 2011 (UTC)

Occurence / frequency

Am I right in thinking that it is now much less common in UK? - Kittybrewster (talk) 23:26, 28 April 2007 (UTC)

We do need figures as to frequency, which may differ by country/region/diet/etc. -71.162.93.102 (talk) 02:20, 20 July 2008 (UTC)

Physician examination in children

http://jama.ama-assn.org/cgi/content/abstract/298/4/438?etoc JFW | T@lk 23:40, 24 July 2007 (UTC)

Medical Evacuation needs to be defined.

Medical Evacuation needs to be defined. Please create Medical Evacuation article so everyone who want to know what medical evacuation is. If necessary, create the link inside Medical Evacuation article that take you to non-medical (MEDEVAC) page. Medical Evacuation is surgical equipment that evacuate (wash out) entire abdomen and drain entire abdomen's organs. Any patients who underwent this cannot eat any pure solid foods for several days due to lack of a bile and an alkaline(?). I am one of these patients who were forced to undergo medical evacuation during appendectomy at home (MAJOR home surgery) after I suffered short refractory septic shock during MAJOR home surgery and the surgeon detected a generalized peritonitis. I am also forced to be sterilized by a vasectomy during a medical evacuation procedure because my testicles are also infected and vas deferens had to be cut so the contents inside my testicles can be drained and disinfected. The surgeon close vas deferens but not connect them together because he does not have necessary equipment to make vas deferens connection(s). I was offered for sterilization reversal next day following major home surgery and I declined that offer because I will never get married and do not want any babies at all! I had atypical appendicitis in September 1995 and my appendix went burst massively at home due to my parent's fatal error and my old doctor's negligence (My old doctor incorrectly diagnosed me as abdomen flu, though I already confirmed I had an appendicitis). My new (excellent family) doctor finally told my parent by the phone regarding to my atypical appendicitis and extremely shocked them and extremely upset them! They were able to confirm that I am correct! Since my appendix was already burst, "911" operator flagged me as highest emergency level but don't allow my father to drive me to the hospital or dispatch the ambulance because it is extremely too dangerous for me to be transported. I HATED MAJOR surgery (even at home)!!! I was supposed to undergo minor or standard (not MAJOR) surgery at the hospital! Thanks!

UPDATED: Based on my previous medical diagnosis this month, I did not have atypical appendicitis but DID have indirect appendicitis that are caused by localized fulminant colitis. I thought my appendix went burst but turned out to be ascending colon that became toxic megacolon and burst massively! My appendix DID became inflammed but temporary. Therefore, the surgeon in my home did not remove my appendix; only removed partial of my ascending colon. All other events are intact. I still received forced vasectomy.

UPDATED: Finally (really very late) my recent barium enema final result confirm that I do NOT have an appendicitis; I simply had "mimic" appendicitis symptoms caused by fulminant colitis or diverticulitis. No further diagnosis.

Danielcg (talk) 04:10, 26 June 2008 (UTC)

'Jump-Test'

Something interesting gleaned from a pediatrician nearing retirement: before CT scans became common, doctors would have the patient jump up, and if the ensuing pain caused the patient to curl into the fetal position, appendicitis was likely the culprit. Not the most scientific method, but in its time it was fairly effective at diagnosing appendicitis. LeeRamsey (talk) 07:21, 29 January 2008 (UTC)

Toilets? Science? Perhaps not?

I personally believe appendicitis is not caused from squatting toilets vs. sitting toilets. I've used both toilets, the squatting when I was young, and the sitting as of now.

Through experience, appendicitis is pretty darn painful...

But thinking outside the box of science, what if it's love handle squeezing? This may sound weird, but like what I mean is, I'm a little chubby so I have love handles. When my friend squeezed me and made me tickle as a joke one day, I logically flinched.

A few days later after that, I got appendicitis, and after 3 weeks of ruptured infection leaking 8 hours away from meeting the Grim Reaper healing, I was okay. But, after trying it again on me, I didn't even move. I felt the hand, but no flinch.

So, unscientifically, thinking outside the box, is love handle squeezing a possible cause? Thecutnut (talk) 08:13, 5 March 2008 (UTC)

Maybe not a cause, but instead an early diagnosis. Giving pressure by hand to the area over the appendix, followed by sudden release will cause severe pain usually only in cases of actual appendicitis. (Note: I am not a doctor.) --71.162.93.102 (talk) 02:26, 20 July 2008 (UTC)

First sugery

• Lawson Tait was the first to diagnose and remove a diseased appendix in 1880 Seal A. (1981). "Appendicitis: a historical review". Can J Surg. 24 (4): 427–33. PMID 7023636.

Yes, if anyone can, more history would be nice. Edward VI mentions that his appendectomy "was at a time when appendicitis was generally not treated operatively". How was it treated, and when did things change?--Prosfilaes (talk) 00:00, 12 June 2010 (UTC)

Histology

I came to this page looking for microscopic features in acute purulent appendicitis, but there is nothing that I could find. If anybody has time, maybe a description of features at magnification? Like polymorph and macrophage infiltration, mucosal ulceration etc etc.--58.165.50.81 (talk) 04:27, 9 June 2008 (UTC) nbjhcfjgcbn,

Treatment

In Sweden treatment is today usually only with antibiotics and does not involve surgery. A ten year study concluded that the results of both treatments were almost identical with the notably lower number of post-treatment issues with the antibiotics treatment. The number or relapses were about the same. Although I have no inclination to write about this myself, perhaps someone with some free time and a yearning to improve Wikipedia's appendicitis entry would find such a task interesting? The study is probably only published in English so there wouldn't be any language barriers. Best of luck!--83.250.187.190 (talk) 10:02, 17 August 2009 (UTC)

Computed Tomography

This section contains confidence intervals and P-values -- probably not appropriate for a Wikipedia article? I'd fix it but am not sure exactly how. —Preceding unsigned comment added by 216.15.55.53 (talk) 01:26, 12 January 2010 (UTC)

The photo of the enlarged appendix

at the top right is not particularly enlightening without a scale of some sort. — Preceding unsigned comment added by 71.100.187.106 (talk) 02:41, 2 September 2011 (UTC)