| Posted March 13, 2014 | By Dustin Smith, M.D. | Categorized under Men's Health, Women's Health |

You have a sharp, escalating pain in your lower abdomen accompanied by a fever and maybe even vomiting. So severe, in fact, that it brings you to the Emergency Department at Williamson Medical Center. More often than not, we are able to diagnose you with one of three things we see frequently: a hernia, diverticulitis or appendicitis.

From a patient perspective, anything that brings you to the ED is scary because it hits you suddenly and before you know it, you find yourself at the hospital not knowing what in the world is happening inside your body.

It's worth taking a look at these three conditions and their symptoms, similarities and differences, which might help ease a bit of anxiety if you find yourself en route to our ED.

Appendicitis

The appendix is a small, tubular organ about the size and shape of your pinky finger. Ideally, it's hollow and contents from your GI tract move in and out freely. But when something obstructs that, the results  can be intensely painful.

When the appendix becomes blocked, bacteria has a place to grow. That causes inflammation and infection, which becomes appendicitis. What you will feel is pain in your abdomen and within 12 to 24 hours, the pain intensifies, migrates to the right lower abdomen and you might experience vomiting. It can get pretty painful pretty fast. If you think you've had this abdominal pain for a month, it's not appendicitis.

This is very common, as is the laparoscopic procedure we do to remove the appendix.

If you show up in our ED with these symptoms, we will do a CT scan to rule out other possibilities and we look for an elevated white blood cell count, which signals infection. These tests are extremely accurate, because if you can see the appendix on the CT scan, it's inflamed. If it's not inflamed, you can't see it. If these two tests support the diagnosis, you are looking at surgery relatively soon.

Surgery is ideally laparoscopic, so there's less scarring, less pain and a quicker recovery. Typically you don't even know your appendix is gone and we get you in and out in a day or so. Less than a week off from work and you are back on your feet. I tell patients they will wake up feeling a lot better than they did before the surgery.

Hernias

It's rare that we see a common denominator that sends both teenagers and people over 50 to the operating room for essentially the same reason. Both age groups, although for different reasons, are susceptible to hernias.

Hernias are basically a weakness in a muscle that allows something from inside the body to try and bulge outward. We see them commonly happening in three areas: the groin, the belly button and in an old incision. Hernias typically show up in a spot where muscle tone loses its integrity.

In the younger teen generation, we think there is a bit of innate weakness that allows guys to develop groin hernias from overdoing it in sports training. These tend to show up in sports physicals of younger male athletes.

As for everyone else, hernias stem from a lifetime of heavy lifting, straining and stress on the body that can tend to weaken the muscles. People who do repetitive lifting day in and day out are ideal candidates for hernias.

Hernias can be small and not bothersome at all. In this case, you don't have to fix them. If they are getting larger, you have discomfort or you don't like the way it looks, you can fix it with surgery. We typically do this laparoscopically, so the advantages are small incisions with less scarring, less post-op pain and a quicker return to normal activity.

These are very common procedures, so if you suspect you have a hernia, it's worth getting it checked out.

So what is the best thing to do if you think you might have one? Start with your primary care physician. They can perform a physical exam. There is really very little testing involved in diagnosing a hernia. An ultrasound or CT scan is occasionally used to rule out other alternatives, but it's a pretty easy diagnosis. If the primary doctor has questions, they send them to us and we fix it.

Diverticulitis

Diverticulitis is a bit different in that it isn't fixed as easily with surgery, but can require a more invasive procedure to remove a portion of the colon if it's serious. It can show up as the same abdominal pain, cramps and possible fever. Like appendicitis, diverticulitis occurs when inflammation sets in.

It is an acquired condition of the colon where small pockets develop. Having those pockets is something we think is related to the Western diet high in fat and low in fiber. It's a condition highly associated with obesity. You might not even know you have them unless you have a colonoscopy. But when they congested with undigested food or fecal material, bacteria can grow and cause inflammation. That's what causes the pain.

If you suspect you might have it, it's a good idea to get a colonoscopy to rule out other possibilities and then the best way to manage it is with a healthier diet high in fiber. The goal is to prevent attacks of diverticulitis, once you've been diagnosed with it. Mild cases can be managed with antibiotics at home. Moderate cases may need hospitalization for fluids, etc. Severe cases, where people show up with a rupture, need immediate surgery, because at that point you have stool and bacteria leaking into the abdominal cavity.

In these types of cases, we have to remove that part of the colon, but this happens in less than 10 percent of the cases we see. The goal is to address it before you get to that point. So watch your weight and watch what you eat. It all goes back to healthy eating and exercise.