Re: Appendicitis

[Guest guest]

Wah! Wah! Mukunda!

Tumhare Appendix da jawaab nahi!

Kishore Shah 1974

[Guest guest]

Wah! Wah! Mukunda!

Tumhare Appendix da jawaab nahi!

Kishore Shah 1974

[Guest guest]

Well, it was quite educative to receive two contrasting mails to my

reply that I do Ultra Sonographies and rule out appendicitis.

Ashok was shocked, and Neeti was impressed.

I personally think that you should neither be shocked nor impressed.

Today, USG is an integral part of a Gynaec's diagnosis. In fact, with

the USG so close at hand, I am frightened that soon I may loose my

clinical skills as I rely more and more on the machine.

I need to clarify to both of you that USG as a diagnostic tool was

discovered by Dr, Ian , a Gynaecologist. Ruling out appendicitis

is an essential part in confusing Pelvic Inflammations, Ovarian

torsions and Ectopic pregnancies.

And, yes Neeti, I do appendicectomies too. It was my routine with all

abdominal Hysterectomies. However, nowadays, most of the

Hysterectomies that I do are Vaginal, hence there is no scope of

removing the appendix. The logic was that once the abdomen is opened,

it is best not to leave that troublesome part behind, unless your are

aiming at earning some more at a repeat surgery.

I don't know about the US, but here in India, you need to know a

little about all your related branches.

Naturally, I leave the complicated USGs to the radiologist.

And Neeti, thanks for your informative write up. I agree with you. The

finger is better at diagnosing the appendicitis than the machine. Yes,

but as a Gynaec I have the advantage of using a USG machine, with

abdominal palpation, PV and PR too! Gives me an added edge, or should

I say, finger?

Kishore Shah 1974

PS: Interestingly, my computer's spell check has suggested that I

replace Sonographies with Pornographies. Hmm! Not a bad idea!

[Guest guest]

Well, it was quite educative to receive two contrasting mails to my

reply that I do Ultra Sonographies and rule out appendicitis.

Ashok was shocked, and Neeti was impressed.

I personally think that you should neither be shocked nor impressed.

Today, USG is an integral part of a Gynaec's diagnosis. In fact, with

the USG so close at hand, I am frightened that soon I may loose my

clinical skills as I rely more and more on the machine.

I need to clarify to both of you that USG as a diagnostic tool was

discovered by Dr, Ian , a Gynaecologist. Ruling out appendicitis

is an essential part in confusing Pelvic Inflammations, Ovarian

torsions and Ectopic pregnancies.

And, yes Neeti, I do appendicectomies too. It was my routine with all

abdominal Hysterectomies. However, nowadays, most of the

Hysterectomies that I do are Vaginal, hence there is no scope of

removing the appendix. The logic was that once the abdomen is opened,

it is best not to leave that troublesome part behind, unless your are

aiming at earning some more at a repeat surgery.

I don't know about the US, but here in India, you need to know a

little about all your related branches.

Naturally, I leave the complicated USGs to the radiologist.

And Neeti, thanks for your informative write up. I agree with you. The

finger is better at diagnosing the appendicitis than the machine. Yes,

but as a Gynaec I have the advantage of using a USG machine, with

abdominal palpation, PV and PR too! Gives me an added edge, or should

I say, finger?

Kishore Shah 1974

PS: Interestingly, my computer's spell check has suggested that I

replace Sonographies with Pornographies. Hmm! Not a bad idea!

[Guest guest]

Dear All,

I was happy to see that my jokes on Appendix have created a quite a

hot academic discussion. (Kucchh Halchal Ho To Hi Mazaa Hai Na......! :-))

Here are few points I will like to add-

1) As Kishore rightly pointed out USG etc are meant for ruling out

other diagnosis rather than diagnosing Appendicitis. In before USG days surgeons

here used to look appendix in an plain X- ray abdomen and if asked they will say

" It is to rule out ureteric stone we do X-ray. " ( Ofcourse after looking at the

quality of the X ray performed by them was nothing can be diagnosed on it.

Patient not prepared, Smallest Portable Xray Machine and 8th class passed

compounder operating the same. The result used to be Photooo rather than X

ray.:-) Is Ka Ek Kissa a Appendix at the end of this message)

2) Every appendicitis does not need surgery at all. With proper

conservative management you can save so many surgeries. The appendix needs

opening only if it is obstructed and leading to perforation. One of my

Gynaecologist freind from Bhusawal has a Surgeon wife. He was stating that, "

Being gynaecologist we need not do appendicectomies to feed ourselves. So when

we do only indicated appendicectomies we have hardly 3 to 5 appendix surgeries

in an year!!! "

3) The appendicectomy surgery has a very bad reputation. A son of

my gynaecologist freind from Mumbai had pain in abdomen which was not quite

fitting in Chronic appendicitis. So surgery was not performed. He was treated

medically for an year or two for the intermittent pain in abdomen. without

releif.All investigations also were in vain to point out the diagnosis. Then one

of our surgeon freind from Nandurbar had visited his place. He after putting

hand on his tummy said , " This boy needs laparatomy. I feel he is having Meckel's

Diverticulum. " And Laparatomy proved his diagnosis. Moral of the story

a)clinical judgment goes above all the investigations. Eyes can not see what

mind doesn't know!!

Now Kissa a Appendix ---

Again this is a true story told by a senior GP over here.One surgeon

had started his practice newly and he was enthusiastic for surgery. When one

patient of pain in Lt illiac fossa went to him, he took an X ray and advised

him immediate admission and an emergency appendicectomy. The patient came home

weeping for preperation of admission. His neibour was clever enough. He said "

Look man, you have pain on Left side and my relative operated for appendix had

pain on right side. Let us go to our old GP. and confirm the need for surgery. "

These two went to the GP. he after examining felt that it was just

Dyspepsia and gave him Unienzyme tablet. and asked him to get the Xray plate

from the surgeon. The patient went to surgeon to get it. The surgeon concerned

had done only screening. Considering that what a villager will know he

carelessly removed one Xray from his plates and handed over to him.

GP after loking at the Xray said very seriously, " You really need a

surgery. You have a twin pregnancy in your tummy. " The patient went back to

surgeon and got back his fees for consultation and Xray. Thanks god for the good

old days. Those days CPA was not there!!!!!

Mukund(1974)

Re: Appendicitis

Well, it was quite educative to receive two contrasting mails to my

reply that I do Ultra Sonographies and rule out appendicitis.

Ashok was shocked, and Neeti was impressed.

I personally think that you should neither be shocked nor impressed.

Today, USG is an integral part of a Gynaec's diagnosis. In fact, with

the USG so close at hand, I am frightened that soon I may loose my

clinical skills as I rely more and more on the machine.

I need to clarify to both of you that USG as a diagnostic tool was

discovered by Dr, Ian , a Gynaecologist. Ruling out appendicitis

is an essential part in confusing Pelvic Inflammations, Ovarian

torsions and Ectopic pregnancies.

And, yes Neeti, I do appendicectomies too. It was my routine with all

abdominal Hysterectomies. However, nowadays, most of the

Hysterectomies that I do are Vaginal, hence there is no scope of

removing the appendix. The logic was that once the abdomen is opened,

it is best not to leave that troublesome part behind, unless your are

aiming at earning some more at a repeat surgery.

I don't know about the US, but here in India, you need to know a

little about all your related branches.

Naturally, I leave the complicated USGs to the radiologist.

And Neeti, thanks for your informative write up. I agree with you. The

finger is better at diagnosing the appendicitis than the machine. Yes,

but as a Gynaec I have the advantage of using a USG machine, with

abdominal palpation, PV and PR too! Gives me an added edge, or should

I say, finger?

Kishore Shah 1974

PS: Interestingly, my computer's spell check has suggested that I

replace Sonographies with Pornographies. Hmm! Not a bad idea!

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