What cause Acute Appendicitis?

There is a lot of myth surrounding the cause of Acute Appendicitis.

Many people will attribute some kind of foreign body stuck in the lumen of the Appendix giving rise to Acute Appendicitis.

In fact, they are half correct, whereby most Acute Appendicitis do arise from something stuck in the lumen.

But instead of some weird kinds of foreign bodies imagined like chili seeds and the likes, most often what is found stuck in the lumen is patients own feces.

Feces of varying consistency from soft to hard is regularly discovered during Appendectomy like the case in the picture.

The Fecal Stone(Faecolith) is the dark object shown next to the Appendix.

Total Thyroidectomy For Thyroid Cancer

This is an intact specimen of the whole thyroid gland after Total Thyroidectomy.

There is a tumour in the centre part of the gland which is called the Isthmus.

The tumour happens to be a Thyroid Cancer which is diagnosed by a biopsy technique called Fine Needle Aspiration Cytology.

Although the cancer just involve the isthmus, but to effectively treat thyroid cancer, a total Thyroidectomy is necessary.

Post total Thyroidectomy, patient will be rendered Hypothyroid, which means the thyroid hormone level is below normal. In order to sustain normal living,patients have to consume daily thyroxine hormones for life.

Quite often patients will ask what happen if they unwittingly forget to take the hormone tablets. Since the half-life of thyroxine is about 1 week, missing tablets for one or two days is of no consequent as long as its not more than 1 week.

It is noted that many surgeons are not keen to perform Thyroidectomy, especially Total Thyroidectomy in the private sector setting for 2 main reasons;

1. (Total) Thyrodectomy carries real risk of Recurrent Laryngeal Nerve injury which may affect voice changes postoperatively

High Level of Fats in the Blood

...this may happen if you eat too much fats within a short period of time...

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Large Haemorrhoids Need Haemorrhoidectomy

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The above three pictures depict a large prolapsed and thrombosed Haemorrhoids which were removed by operation called Open Haemorrhoidectomy.

Haemorrhoids are very common among young adults.

It is related very much with constipation. Some patients have symptoms worsen by hot chilies.

In the initial stages, Haemorrhoids can just be treated with medications.

At later stages, when the Haemorrhoids get bigger, some form of procedures need to be done.

Large Haemorrhoids like in this picture will almost always need surgery because of associated prolapsing tissues and thrombosis. In this situations, if the Haemorrhoids are not operated, quite often tissues will ulcerate and cause infections. 

Infections in the perineal area is potentially dangerous as they can cause Portal Pyemia ie. Blood infection of the Gut system.

Rare Clinical Symptoms for Duodenal Ulcer

The picture above shows the endoscopic view of a Duodenal Ulcer in the first part of duodenum(=Duodenal Bulb=D1)

Typically, it's being thought to medical students and also assumed by patients that Duodenal Ulcer presents with Upper Abdominal symptoms such as pain, discomfort or bloatedness.

Like many other diseases, Duodenal Ulcer sometimes present with atypical symptoms.

The patient above initially presented to the Urologist in our hospital with Left abdominal pain. The initial clinical impression was Left Renal Colic.

However, thorough investigations of the Kidney systems from Urine analysis to CT Urography were all normal.

The Urologist then referred to for Colonoscopy to assess the Colon especially the Left Colon.

However upon thorough clinical history appraisal, the left-sided abdominal pain was deemed to enclose the whole of the left abdomen from the left upper part to the left lower part.

As such, I had decided to also examine the stomach and duodenum apart from colonoscopy.

The Duodenal Ulcer above was discovered at Upper Gastrointestinal Endoscopy(OesophagoGastroDuodenoScopy=OGDS).

Clinical lessons;

1.It is worthwhile to repeat thorough clinical appraisals by different doctors in less straightforward clinical cases

2.It is worthwhile for Clinical Specialist performing special invasive procedures especially that require some form of anaesthesia  to have a lower threshold of clinical indications so as to save time and resources.

Lipoma - a benign fat cells tumour

Lipoma is a common skin swelling in general surgical practice.

Lipoma is a benign tumour of fat cells underneath the skin.

Lipoma can occur anywhere in the body that has fat cells.

A very large lipoma has a small risk of transformation into a malignant fat cells cancer(Liposarcoma).

A benign Lipoma on the back (above picture) can be very large.Surgery is the only way to treat this tumour. General Anaesthesia is required for the surgery.Wound closure of the flaps carries a significant risks of complications.

Appendectomy is perhaps the commonest gastrointestinal surgery in genera...