Yesterday morning one Pakistani patient came with severe right lower abdominal pain for the last several hours. According to him, initially, the pain was around his belly button/navel (umbilicus), later shifted to his right lower abdomen (in medical terms it is called RIF or right iliac fossa). He had no history of urinary pain/discomfort, fever, nausea/vomiting. He also mentioned that he had a similar problem around one year back. He recovered from that illness with medications.
When I examined him I found the features consistent with acute appendicitis. So I asked him to see a surgeon and do some investigations such as ultrasound of the abdomen. However, due to financial reasons, he wasn’t interested in going for an operation. Any type of operation is more costly in Oman than in Pakistan, India or Bangladesh.
Anyway, I explained to him the risk of not going to a surgeon. I mentioned to him the possible complications may arise if not treated accordingly. He, however, just wanted the painkillers first. I prescribed a few for him. Then he left.
It is one of the most common surgical emergencies in the general population. It mainly is a disease of young age. However, it is seen in people of all ages.
Upon the clinical diagnosis and positive results from the investigation in favour of acute appendicitis, an urgent referral is needed for surgical removal of the appendix.
This image shows the pattern of presentation in acute appendicitis. At first pain starts at around the belly button. Later shift to right lower abdomen.
Image and information: From John Murtagh’s general practice; 6th edition; page 344
Today I was able to achieve 10k plus steps 🚶♂️ before 10pm. Alhamdulillah