Because I irritate myself by not publishing this sooner BUT..

This is the mechanism as to why the pains experienced during appendicitis occurs...

Autonomic sensory neurones travel with sympathetic nerves in bowel and the visceral peritoneum. So the appendix receives its sympathetic nerve supply via the least splanchnic nerve which originates from sympathetic chain at T10 and T11. The sensation (pain) is interpreted as irritation occurring at the skin distribution of the spinal nerves of the spinal cord level (dermatome). In this case, T10 is the periumbilical region, thus pain is thought to be originating from the areas supplied by the somatic nerves entering the spinal cord at the same level as the nerves from the pain producing organ.
The pain may be described as dull in nature as it originates from the visceral peritoneum.

Continuous inflammation can cause the overlying parietal peritoneum to be irritated, thus causing a sharp pain. It is also more localised as the nerves involved are now somatic nerves.


Heh. Well, I'm not sure if I've explained this rightly/clearly haha.

Because I might as well make use of this blog to impart some knowledge to random readers...

Incidence: Most common surgical emergency (lifetime incidence = 6%)

Pathogenesis: lumen obstruction --> gut organisms invade --> oedema, ischaemic necrosis, perforation

Symptoms: Periumbilical (around the umbilicus) pain that radiates to RIF [ early inflammation --> irritates structure and walls of appendix --> colicky pain referred to mid abdomen/periumbilical --> continued inflammation --> irritation of parietal peritoneum --> somatic, lateralised pain settles @ McBurney's point (2/3 from umbilicus to right ASIS) ] anorexia, vomiting (rarely prominent), constipation, diarrhoea

O/E:

General signs: Tachycardia, Febrile, Furred tongue, Lying still (movement aggravates), Coughing hurts, shallow breaths, foetor.

Abdominal palpation: RIF - guarding, rebound tenderness, percussion tenderness

Special tests: Rovsing's sign (pain in RIF when LIF is pressed), Psoas sign (pain on extending hip if retrocaecal appendix), Cope sign (pain on flexion and internal rotation of right hip if appendix is close relation to obturator internus)

Investigations: FBC (check anaemia, WBC, CRP), USS, CT Abdo

Treatment: Appendicectomy. Start antibiotics (metronidazole 500mg/8hr + cefuroxime 1.5g/8hr, 1 to 3 doses IV starting 1 hour pre-op --> reduce wound infections)

Differential diagnoses: ectopic? UTI? mesenteric adenitis? cystitis? cholecystitis? diverticulitis? salpingitis/PID? dysmenorrhea? Crohn's? Perforated ulcer? food poisoning? meckel's diverticulum?

Complications: perforation, appendix mass --> inflamed appendix covered with omentum, appendix abscess --> appendix mass that fails to resolve

It's not that I have nothing better to do, it's just that I'm so caught up with everything else that I feel the need to do something different and definitely out of the norm.

Granted this blog is dead and CPR now would not help at all, even risk of hypoxic damage wouldn't be a problem, it's a corpse. But oh wells, consider this the blog going through reincarnation as we all have definitely gone on to a whole new chapter of Life.

So yes, I'm now in med school in Southampton, a teeny city in UK, and my co-blogger is still living life in Perth. Still being in third year, I have the perks of going through exams and boring university life. How much different is UK compared to Malaysia? For starters, the weather. Yes English people and their weather. And I now realise its for a good reason too. To have a bright sunny day is an absolute treasure to them. And me. I love the sun now. Just cause it makes the day slightly less gloomy and a little happier, giving the illusion that its going to be warmer even though its still absolutely freezing.

I never liked the whole idea of twinning, joining a bunch of people halfway through the year when bonds have been made and you just feel like an outsider because they do make you feel that way with their cliques and all. Not that I can blame them, its kinda like you've already established your clique, your friends, having a new person trying to fit into the group just doesn't work.

And speaking of work? How's the workload? It's there, having to learn their way of answering things, their syllabus is going to be one tough road. It's different yet the same in essence.

But I do still miss my loved ones, and most importantly, familiarity.

The hard cold reality of being in medical school really hits you when you reach semester 5. After being in medical school for 2 and a half years, you would think that we should be all prepared for all the stress and workload to come, turns out none of us were ever really that prepared for it.

Yes, close those gaping jaws but there really is such a thing. For me anyway. Of course I never get too much sleep if the sleep you're referring to is the night one. But let's say after that, after I've woken up, I feel tired so I take a nap. Like a pretty long nap.

Well obviously I'm 13 days late but hey, better late than never right?