Appendicitis: The Difference Between Men, Women and Children

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In men, appendicitis usually begins with a cramping wave-like mid-abdominal pain, that after number of hours, usually within a day, the pain is then localized in the right lower side of the abdomen.

The cramping pain is because the appendix is being blocked by a concretion, a solid mass of feces, and that cramping pain is caused by the contractions of the appendix trying to push it out.

But once the block remains, the protein mucus (germ food) in the appendix allows the bacterial germs proliferate. This causes the appendix to become inflamed from acute infection. And that infected appendix touching the inside of the abdominal cavity, its peritoneal lining’s thousands of tiny nerves, causes the localized pain.

In a woman, it is the exact same situation with appendicitis. However, making the correct diagnosis is complicated by the possibility of the infection being caused instead by pelvic inflammatory disease, usually caused by the bacterial germ gonorrhea, infecting the fallopian tubes. Here instead of a low-grade fever of approximately 100°, it’s usually between 102° to 103°. During a pelvic examination, by pushing on the mouth of the womb, the cervix, this causes severe pain. That helps distinguish between appendicitis versus infected fallopian tube‘s.

In children, the sequence of events is much faster, usually within 12 hours to one day until the rupturing of the appendix occurs. And unlike in adults, the omentum, the fat pad that hangs down from the stomach and large intestine is much less developed, and therefore infection can spread throughout the abdominal cavity, which is called peritonitis. In adults, it’s more likely that this fat pad will wall off and then localize the infection causing an abscess, rather than a widespread and potentially deadly infection, peritonitis.

 

Obstructed Labor, The Cause of Severe Brain Damage

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Once a woman goes into labor, it usually progresses in a steady fashion. The pelvic exam can determine the head of the fetus in relationship to the inside of the bones in the birth canal, the pelvis. There is a bony landmark in the pelvis which will be used as the guide in centimeters, as to whether not the fetal head it is minus or plus centimeters as a guide to gauge the progression of the labor.  If this woman is a primigravida, that is pregnant for the first time, now and having a vaginal delivery, this is called an “untried pelvis.” And if she has a narrow pelvis, the android shape, more male-like, as opposed to the gynecoid shape of the fuller pelvis, then this is a red flag that there may be a problem with the head of the fetus passing through the birth canal.

If there is no progression of labor down the birth canal, centimeter by centimeter, then this is a problem that may require a cesarean section rather quickly. The fetal heart monitor under these circumstances is really not the better way to determine if they will be a problem. If the umbilical cord is compressed, then the oxygenated blood supply from the uterus to the fetus would be impaired and the fetal heart rate would drop dramatically. That requires it immediately Cesarean section. But in this case of the failure of progression of labor, the umbilical cord is not compressed, but the head is repetitively forced against the inside of the solid bone pelvis. Unlike football players wearing a helmet, this fetal skull has no helmet, and its head is forced under great compression pressure, every few minutes, as opposed to an occasional football concussion. This repetitive concussion will cause brain damage. The failure to observe an obstructed delivery is a departure from the accepted standard of care.

Life Care Plan

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PREPARED BY: xxxx, RN, CCM, CPUR, LCP

Life Care Plan Completed:

TELEPHONE PRE-EVALUATION: 05/02/12

DATE OF EVALUATION: 05/18/12

DATE REPORT INITIATED: 06/02/12

REPORT FINALIZED: 06/11/1

SUMMARY/INTRODUCTION:

Stan XXXXX is a 69-year-old Caucasian male seen for evaluation in his residence accompanied by his wife, Suzie, on 5/18/12.  Prior to this on-site evaluation, a telephone pre-evaluation was accomplished by xxxx, on 5/2/12 for the purposes of identifying specific demographic information, establishing a list of treating professionals, equipment, supplies and past work history.

His attorney, XXXX, referred Stan for a rehabilitation evaluation.  The purpose of this evaluation is to assess the extent to which handicapping conditions impede his ability to live independently and handle all activities of daily living.

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Joint Commission (JC) Standards Report

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December 23, 2011

To Whom It May Concern:

Re: A v. Heart Hospital of Austin et al

My name is **********************. I have been a hospital chief executive officer and healthcare administrator for over 35 years and currently am a full-time educator and consultant to hospitals and health systems throughout the United States. Since 1978, I have been a Board Certified Fellow of the American College of Healthcare Executives (“FACHE”), which is the professional organization for hospital administrators, having passed the certifying examination and have been recertified as required by the College. I have lectured extensively to hospital administrators and students in hospital administration and have been a featured speaker at several national meetings. I am currently a faculty member in the graduate and undergraduate health administration programs at the University of ***** and teach at least one course every semester. I have also written a book entitled **************************. I have been continuously employed in the field of hospital and health care administration since 1973. I am familiar with the prevailing professional standards of care for acute care hospitals, such as the Heart Hospital of Austin, Texas, which is the subject of this letter for events occurring in January, 2011. More specifically, for such time period, I am familiar with standards of care and obligations applicable to such hospitals in their care of patients who present through an emergency room and are then admitted. Further information regarding my experience and qualifications is detailed on my attached CV.

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Radiology Expert Witness Report

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To Whom It May Concern

RE: A, John

Dear Sir/Madam:

At your request I have completed my review of the medical records kindly provided by your office in an organized binder and the imaging studies provided on four CDs concerning the care and treatment provided to Mr. A by the physicians and staff of the Kaiser Foundation Hospital, Santa Clara, California in regard to his traumatic cervical spine injury.

I am able to opine whether or not the standard of care was met and causation with regard to future disability. However, as is my practice in providing medical opinions with regard to the standard of care, deviations in the standard of care, or causation I do reserve the right to change or modify this medical opinion if new or undisclosed information becomes available for my review.

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Hospital Administrator Expert Witness Report

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To Whom It May Concern

RE:  S. B. v. Fayetteville, NC Veterans Administration Medical Center(VAMC)

My name is ****************** and I serve as a consultant to hospitals and attorneys regarding hospital administrative issues.  I have been a hospital chief executive officer and hospital administrator and currently am a consultant to hospitals and health systems throughout the United States. I am a Board Certified Hospital Administrator and a Fellow of the American College of Healthcare Executives, which is the professional organization for hospital administrators.  I have lectured extensively to hospital administrators and graduate students in hospital administration and have been a featured speaker at several national meetings.  I am currently a faculty member in the graduate and undergraduate health administration programs at the University of *****, **** University, and ****** University. I have also written a book entitled ************************** for the Hospital, and I recently contributed a chapter to an ACHE book entitled ***********************************************************. I have been employed in the field of hospital and healthcare administration since 1973. I am familiar with the prevailing professional standards of care for acute care hospitals. I have been actively involved in the management of acute care hospitals, including their emergency departments. Further information regarding my experience and qualifications is detailed on my CV.

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Orthopedic Foot and ankle Expert Witness Report

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To Whom it May Concern:

Re: Medical Records of Carl K. and litigation filed by wife and children.

I, ********, M. D., have been asked to review the medical records of the above-named individual, now decedent, in a malpractice action pertaining to a simple foot surgery with resulting pulmonary embolism and death. The wife has filed a wrongful death suit. I have no financial interest in the outcome of this suit.

I am a board-certified surgeon with 35 years of active full-time practice. I have performed foot and ankle surgery all these years and my current job duties at the ********** Medical center involve performing foot and ankle surgery. I have performed talo -navicular foot fusions as well as other fusions in the foot and ankle. While at the Tucson VA from 2003-2007, I served as Chief of Orthopedics but also was involved in serving as an attending on the podiatry service and performing complicated foot and ankle surgery with the podiatry residents. The risk of post-op VTE was always considered and acted upon with these cases.

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Orthopedic Expert Witness Report: Severe Thumb Injury

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To Whom It May Concern:

Re: Medical records review and treatment of severe thumb injury of Jackson G.

I, ******, MD, am a board-certified orthopedic surgeon who has been in continuous active practice for 35 years. During my t residency, the chairman of my residency program was a hand surgeon. Also during my residency, I had a mini-fellowship in hand surgery and reconstructive hand surgery. During the first 28 years of my practice experience, I was very active in having hand surgery as my subspecialty of orthopedics and treated hundreds of finger injuries. For several years I was the company hand surgeon of choice for a large steel mill which frequently had not only single but multiple traumatic finger amputations. I have also treated pediatric hand injuries, not only crush injuries but blast injuries and sharp lacerations as well. In the adult population in addition to all forms of trauma, I also performed carpal tunnel releases; Dupuytren’s excisions and joint reconstruction surgery with implants for severe arthritis. I am very familiar with and have used various means of fracture fixation in the hand, frequently with staged procedures.

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Gynecologic Oncology Expert Witness Report

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I have reviewed the medical records in this case and as requested, providing my opinion regarding the medical care given to Mrs. Annita S. I am certified by the Division of Gynecologic Oncology of the American Board of Obstetrics and Gynecology and in active clinical practice in the state of **.

Materials reviewed:

Medical records from ** medical center, including H&P and operative report of Dr. H and consultation by **, M.D. and operative report by **, M.D.

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Cardiology Expert Witness Report

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Summary of Record Review: Ray ******, DOB Records Reviewed:  J.S. *******, M.D. expert witness report 1/19/2011 Depositions: Ray ****** Debra M A.J, M.D. K. T. Mr. ****** is a 54-year-old male with a history of mild hypertension and hyperlipidemia. Mr. ****** was admitted to North Central Baptist Hospital, San Antonio, Tx., 7/11/2008 for new onset […]

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