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What Is an Appendectomy? An appendectomy is the surgical removal of the appendix. It’s a common emergency surgery that’s performed to treat appendicitis, an inflammatory condition of the appendix. The appendix is a small, tube-shaped pouch attached to your large intestine. It’s located in the lower right side of your abdomen. The exact purpose of the appendix isn’t known. However, it’s believed that it may help us recover from diarrhea, inflammation, and infections of the small and large intestines. These may sound like important functions, but the body can still function properly without an appendix. When the appendix becomes inflamed and swollen, bacteria can quickly multiply inside the organ and lead to the formation of pus. This buildup of bacteria and pus can cause pain around the belly button that spreads to the lower right section of the abdomen. Walking or coughing can make the pain worse. You may also experience nausea, vomiting, and diarrhea. It’s important to seek treatment right away if you’re having symptoms of appendicitis. When the condition goes untreated, the appendix can burst (perforated appendix) and release bacteria and other harmful substances into the abdominal cavity. This can be life-threatening, and will lead to a longer hospital stay. Appendectomy is the standard treatment for appendicitis. It’s crucial to remove the appendix right away, before the appendix can rupture. Once an appendectomy is performed, most people recover quickly and without complications. Why Is an Appendectomy Performed? An appendectomy is often done to remove the appendix when an infection has made it inflamed and swollen. This condition is known as appendicitis. The infection may occur when the opening of the appendix becomes clogged with bacteria and stool. This causes your appendix to become swollen and inflamed. The easiest and quickest way to treat appendicitis is to remove the appendix. Your appendix could burst if appendicitis isn’t treated immediately and effectively. If the appendix ruptures, the bacteria and fecal particles within the organ can spread into your abdomen. This may lead to a serious infection called peritonitis. You can also develop an abscess if your appendix ruptures. Both are life-threatening situations that require immediate surgery. Symptoms of appendicitis include: stomach pain that starts suddenly near the belly button and spreads to the lower right side of the abdomen abdominal swelling rigid abdominal muscles constipation or diarrhea nausea vomiting loss of appetite low-grade fever Although pain from appendicitis typically occurs in the lower right side of the abdomen, pregnant women may have pain in the upper right side of the abdomen. This is because the appendix is higher during pregnancy. Go to the emergency room immediately if you believe you have appendicitis. An appendectomy needs to be performed right away to prevent complications. What Are the Risks of an Appendectomy? An appendectomy is a fairly simple and common procedure. However, there are some risks associated with the surgery, including: bleeding infection injury to nearby organs blocked bowels It’s important to note that the risks of an appendectomy are much less severe than the risks associated with untreated appendicitis. An appendectomy needs to be done immediately to prevent abscesses and peritonitis from developing. How Do I Prepare for an Appendectomy? You’ll need to avoid eating and drinking for at least eight hours before the appendectomy. It’s also important to tell your doctor about any prescription or over-the-counter medications you’re taking. Your doctor will tell you how they should be used before and after the procedure. You should also tell your doctor if you: are pregnant or believe you may be pregnant are allergic or sensitive to latex or certain medications, such as anesthesia have a history of bleeding disorders You should also arrange for a family member or friend to drive you home after the procedure. An appendectomy is often performed using general anesthesia, which can make you drowsy and unable to drive for several hours after surgery. Once you’re at the hospital, your doctor will ask you about your medical history and perform a physical examination. During the exam, your doctor will gently push against your abdomen to pinpoint the source of your abdominal pain. Your doctor may order blood tests and imaging tests if appendicitis is caught early. However, these tests may not be performed if your doctor believes an emergency appendectomy is necessary. Before the appendectomy, you’ll be hooked up to an IV so you can receive fluids and medication. You’ll likely be put under general anesthesia, which means you’ll be asleep during surgery. In some cases, you’ll be given local anesthesia instead. A local anesthetic numbs the area, so even though you’ll be awake during the surgery, you won’t feel any pain. How Is an Appendectomy Performed? There are two types of appendectomy: open and laparoscopic. The type of surgery your doctor chooses depends on several factors, including the severity of your appendicitis and your medical history. Open Appendectomy During an open appendectomy, a surgeon makes one incision in the lower right side of your abdomen. Your appendix is removed and the wound is closed with stiches. This procedure allows your doctor to clean the abdominal cavity if your appendix has burst. Your doctor may choose an open appendectomy if your appendix has ruptured and the infection has spread to other organs. It’s also the preferred option for people who have had abdominal surgery in the past. Laparoscopic Appendectomy During a laparoscopic appendectomy, a surgeon accesses the appendix through a few small incisions in your abdomen. A small, narrow tube called a cannula will then be inserted. The cannula is used to inflate your abdomen with carbon dioxide gas. This gas allows the surgeon to see your appendix more clearly. Once the abdomen is inflated, an instrument called a laparoscope will be inserted through the incision. The laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at the front. The camera will display the images on a screen, allowing the surgeon to see inside your abdomen and guide the instruments. When the appendix is found, it will be tied off with stiches and removed. The small incisions are then cleaned, closed, and dressed. Laparoscopic surgery is usually the best option for older adults and people who are overweight. It has fewer risks than an open appendectomy procedure, and generally has a shorter recovery time. What Happens After an Appendectomy? When the appendectomy is over, you’ll be observed for several hours before you’re released from the hospital. Your vital signs, such your breathing and heart rate, will be monitored closely. Hospital staff will also check for any adverse reactions to the anesthesia or the procedure. The timing of your release will depend on: your overall physical condition the type of appendectomy performed your body’s reaction to the surgery In some cases, you may have to remain in the hospital overnight. You may be able to go home the same day as the surgery if your appendicitis wasn’t severe. A family member or friend will need to drive you home if you received general anesthesia. The effects of general anesthesia usually take several hours to wear off, so it can be unsafe to drive after the procedure. In the days following the appendectomy, you may feel moderate pain in the areas where incisions were made. Any pain or discomfort should improve within a few days. Your doctor may prescribe medication to relieve the pain. They might also prescribe antibiotics to prevent an infection after surgery. You can further reduce your risk for infection by keeping the incisions clean. You should also watch for signs of infection, which include: redness and swelling around the incision fever above 101°F chills vomiting loss of appetite stomach cramps diarrhea or constipation that lasts for more than two days Although there’s a small risk of infection, most people recover from appendicitis and an appendectomy with little difficulty. Full recovery from an appendectomy takes about four to six weeks. During this time, your doctor will probably recommend that you limit physical activity so your body can heal. You’ll need to attend a follow-up appointment with your doctor within two to three weeks after the appendectomy.

Renal artery stenosis is a narrowing of arteries that carry blood to one or both of the kidneys. Most often seen in older people with atherosclerosis (hardening of the arteries), renal artery stenosis can worsen over time and often leads to hypertension (high blood pressure) and kidney damage.

Diagnosis To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including: Stroke consultation Stroke consultation Stroke consultation at Mayo Clinic Brain tissue damaged by stroke CT scan of brain tissue damaged by stroke Cerebral angiogram Cerebral angiogram Physical examination. Your doctor will ask you or a family member what symptoms you've been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present. Your doctor will want to know what medications you take and whether you have experienced any head injuries. You'll be asked about your personal and family history of heart disease, transient ischemic attack and stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes. Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Managing your blood's clotting time and levels of sugar and other key chemicals will be part of your stroke care. Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography). There are different types of CT scans that your doctor may use depending on your situation. Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography). Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries. Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck. Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into the tube that connects the back of your mouth to your stomach (esophagus). Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots. Treatment Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke that involves bleeding into the brain. Ischemic stroke To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given: Intravenous injection of tissue plasminogen activator (tPA). This injection of recombinant tissue plasminogen activator (tPA), also called alteplase, is considered the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm. This potent clot-busting drug ideally is given within three hours. In some instances, tPA can be given up to 4.5 hours after stroke symptoms begin. This drug restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you. Emergency endovascular procedures. Doctors sometimes treat ischemic strokes with procedures performed directly inside the blocked blood vessel. These procedures must be performed as soon as possible, depending on features of the blood clot: Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly into the area where the stroke is occurring. This is called intra-arterial thrombolysis. The time window for this treatment is somewhat longer than for intravenous tPA, but is still limited. Removing the clot with a stent retriever. Doctors may use a catheter to maneuver a device into the blocked blood vessel in your brain and trap and remove the clot. This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA, though this procedure is often performed in combination with intravenous tPA. Several large and recent studies suggest that, depending on the location of the clot and other factors, endovascular therapy might be the most effective treatment. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. Other procedures. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by plaque. Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation: Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery and removes plaque that blocks the carotid artery. Your surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions. Angioplasty and stents. In an angioplasty, a surgeon usually accesses your carotid arteries through an artery in your groin. Here, your surgeon can gently and safely navigate to the carotid arteries in your neck. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery. Hemorrhagic stroke Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. You might also need surgery to help reduce future risk. Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures. Once the bleeding in your brain stops, treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain. Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your hemorrhagic stroke: Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged. Coiling (endovascular embolization). A surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Tiny detachable coils are guided into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot. Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if its removal would cause too large a reduction in brain function, or if it's large or located deep within your brain. Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair vascular malformations. Stroke recovery and rehabilitation Brain hemisphere connections Brain hemisphere connections After emergency treatment, stroke care focuses on helping you recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders. In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and vision. Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers. Your rehabilitation program may begin before you leave the hospital. After discharge, you might continue your program in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home. Every person's stroke recovery is different. Depending on your condition, your treatment team may include: Doctor trained in brain conditions (neurologist) Rehabilitation doctor (physiatrist) Nurse Dietitian Physical therapist Occupational therapist Recreational therapist Speech pathologist Social worker Case manager Psychologist or psychiatrist Chaplain Speech therapy session Speech therapy is often a part of stroke rehabilitation. Treatment outcomes One way to evaluate the care of patients diagnosed with stroke is to look at the percentage of patients receiving the timely and effective care measures that are appropriate. The goal is 100 percent. The graphs below display the percentage of eligible Mayo Clinic patients diagnosed with stroke receiving all of the appropriate care measures.

Hepatitis C is an infection caused by the hepatitis C virus (HCV) that attacks the liver and leads to inflammation. The World Health Organization (WHO) estimates that about 3% of the world’s population has been infected with HCV and that there are more than 170 million chronic carriers who are at risk of developing liver cirrhosis and/or liver cancer. The image below depicts the HCV genome.

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Hypertensive urgency must be distinguished from hypertensive emergency. Urgency is defined as severely elevated blood pressure (ie, systolic >220 mm Hg or diastolic >120 mm Hg) with no evidence of target organ damage.

Osteoporosis is a disease in which bones become brittle and fragile due to low bone mass and bone tissue loss. It's the most common type of bone disease, according to the National Institutes of Health (NIH), and increases your risk of fractures, particularly of the hips, spine, and wrists. Prevalence In the United States, nearly 54 million people ages 50 and older were living with osteoporosis or osteopenia (low bone mass ) in 2010, according to a 2014 article in the Journal of Bone and Mineral Research. More specifically, 10.2 million adults had osteoporosis, and 43.4 million adults had osteopenia, which puts a person at high risk for osteoporosis.

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Inguinal and femoral hernias need not be confusing. In this tutorial you will be presented with colourful diagrams and animations to cover important areas, such as the anatomy of what goes on in these two conditions, the examination of groin hernias and a simple explanation of the difference between incarceration, strangulation and obstruction, in and amongst a systematic look at the clinical topic. More tutorials at www.boxmedicine.com.

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Dr Sergio Canavero, believes he can successfully perform the world's first human head transplant in 2017. Within the medical establishment there is concern and scepticism—but either way the operation is set to be one of the big talking points of the year ahead.

Thrombosis of the venous channels in the brain is an uncommon cause of cerebral infarction relative to arterial disease, but it is an important consideration because of its potential morbidity. (See Prognosis.) Knowledge of the anatomy of the venous system is essential in evaluating patients with cerebral venous thrombosis (CVT), since symptoms associated with the condition are related to the area of thrombosis. For example, cerebral infarction may occur with cortical vein or sagittal sinus thrombosis secondary to tissue congestion with obstruction. (See Presentation.) Lateral sinus thrombosis may be associated with headache and a pseudotumor cerebri–like picture. Extension into the jugular bulb may cause jugular foramen syndrome, while cranial nerve palsies may be seen in cavernous sinus thrombosis as a compressive phenomenon. Cerebral hemorrhage also may be a presenting feature in patients with venous sinus thrombosis. (See Presentation.) Imaging procedures have led to easier recognition of venous sinus thrombosis (see the images below), offering the opportunity for early therapeutic measures. (See Workup.) Left lateral sinus thrombosis demonstrated on magn Left lateral sinus thrombosis demonstrated on magnetic resonance venography (MRV). This 42-year-old woman presented with sudden onset of headache. Physical examination revealed no neurologic abnormalities. View Media Gallery Axial view of magnetic resonance (MR) venogram dem Axial view of magnetic resonance (MR) venogram demonstrating lack of flow in transverse sinus. View Media Gallery The following guidelines for CVT have been provided by the American Heart Association and the American Stroke Association [1] : In patients with suspected CVT, routine blood studies consisting of a complete blood count, chemistry panel, prothrombin time, and activated partial thromboplastin time should be performed. Screening for potential prothrombotic conditions that may predispose a person to CVT (eg, use of contraceptives, underlying inflammatory disease, infectious process) is recommended in the initial clinical assessment. Testing for prothrombotic conditions (including protein C, protein S, or antithrombin deficiency), antiphospholipid syndrome, prothrombin G20210A mutation, and factor V Leiden can be beneficial for the management of patients with CVT. Testing for protein C, protein S, and antithrombin deficiency is generally indicated 2-4 weeks after completion of anticoagulation. There is a very limited value of testing in the acute setting or in patients taking warfarin. In patients with provoked CVT (associated with a transient risk factor), vitamin K antagonists may be continued for 3-6 months, with a target international normalized ratio of 2.0-3.0. In patients with unprovoked CVT, vitamin K antagonists may be continued for 6-12 months, with a target international normalized ratio of 2.0-3.0. For patients with recurrent CVT, venous thromboembolism (VTE) after CVT, or first CVT with severe thrombophilia (ie, homozygous prothrombin G20210A; homozygous factor V Leiden; deficiencies of protein C, protein S, or antithrombin; combined thrombophilia defects; or antiphospholipid syndrome), indefinite anticoagulation may be considered, with a target international normalized ratio of 2.0-3.0. For women with CVT during pregnancy, low-molecular-weight heparin (LMWH) in full anticoagulant doses should be continued throughout pregnancy, and LMWH or vitamin K antagonist with a target international normalized ratio of 2.0-3.0 should be continued for ≥6 weeks postpartum (for a total minimum duration of therapy of 6 months). It is reasonable to advise women with a history of CVT that future pregnancy is not contraindicated. Further investigations regarding the underlying cause and a formal consultation with a hematologist or maternal fetal medicine specialist are reasonable. It is reasonable to treat acute CVT during pregnancy with full-dose LMWH rather than unfractionated heparin. For women with a history of CVT, prophylaxis with LMWH during future pregnancies and the postpartum period is reasonable. Next: Etiology What to Read Next on Medscape Related Conditions and Diseases Quiz: Do You Know the Complications, Proper Workup, and Best Treatment Practices for Ischemic Stroke? Quiz: How Much Do You Know About Hypothyroidism? Quiz: Do You Know the Risk Factors, Symptoms, and Potential Treatments for Alzheimer Disease? Quiz: How Much Do You Know About Hypertension? 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