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Start > Resource centre > Articles > Is it his appendix, doctor? Part 2

Next, there is a rather sudden bout of vomiting. This usually rouses the whole household and often the family doctor. By the time he is called the sufferer may begin to feel a bit hot. He looks more than just in pain; he looks ill.

This is the most usual course the illness takes. The wretched appendix (which doesn't even seem to serve any useful function) although fixed to the lower bowel at one end, can lie pointing in any direction of the compass. And this fact can change the symptoms considerably.

If it is pointing upwards it can give rise to a suspicion of pneumonia. If pointing outwards, that is towards the loin, it can cause fears that the pain may be due to a kidney. If it points directly downwards diarrhoea may be an early symptom and an infection of the bowel has to be considered.

These facts make diagnosis difficult for the doctor in a minority of cases, but for parents any abdominal pain in a child is a worry. What has gone before is often important - what the doctor calls the history of the case. Has the child been to a party and eaten too much ice-cream or too many sour apples? Has he had a sore throat the day before and got a virus infection? If the pain is slight does he refuse any offer of food?

An American surgeon, when in doubt, used to ask the child if he would like a hot, roast pork sandwich. If he said 'yes', the surgeon would wait before operating. It needs a healthy child with a good. appetite for this test to work.

Remember that in an acute appendicitis the pain does not get gradually better. If during an attack the child starts to want to play or asks for food, the diagnosis is almost certainly not that of an acute appendix. Be suspicious of the youngster whose pains begin on consecutive Monday mornings just before school!

If in doubt, if the pain persists or worsens, or if the patient begins to look or feel hot, don't delay. Remember that an operation done in good time is remarkably safe and the youngster is quickly full of beans again.

Teacher: Michael
Many articles taken from 'A word with the doctor', by Dr. John Windsor.


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