Medical Case History: An Attack of Acute Appendicitis

Paul, age 24, suddenly began to suffer severe pain in the epigastrium (also called the epigastric region).
The name reflects the fact that it is the abdominopelvic region that is present (-um) immediately over
and upon (epi-) the stomach (gastr). This is one of nine different abdominopelvic regions that are
marked off upon the body surface, as a rectangular grid matrix. The nine abdominopelvic regions help
doctors localize body structures and symptoms within the trunk midsection (abdomin) and bowl (
pelvic) area between the two hip bones.

Pauls severe epigastric pain was accompanied by repeated bouts of emesis (vomiting), along with general
malaise and moderate hyperthermia. After Paul was taken to the hospital by his father, the emergency
physician carefully palpated the abdominal region. The doctor noted that the patients pain was
progressively shifting toward the right lower quadrant. This is one of four (quadr) rectangular areas
marked off upon the abdominal surface. They are created by an imaginary cross drawn through the
patients umbilicus the central pit (umbilic) or navel.

The patient grimaced in pain as the doctor deeply palpated his right lower quadrant. The doctor felt a
hard, round lump within his appendiceal or pertaining to (-eal) attachment (appendic) area. More
specifically, it was localized in the right iliac abdominopelvic region. The dramatic appendicular
stretching and dilation was attributed to a large fecalith hard stone (lith) of feces. The fecalith
(fecal stone) had become impacted or struck against the inner wall of the cecum.

A quick blood sample was drawn. A marked leukocytosis, or abnormal condition of (-osis) too many
white (leuk) blood cells (cyt), was detected. This strongly suggested the presence of an acute
inflammatory process. Therefore, a diagnosis of acute appendicitis sudden inflammation of the
appendixwas made.
The patient was scheduled for an emergency appendectomy. This is literally a removal of (-ectomy) the
appendix (append). A laparoscope an instrument used to examine (-scope) the interior of the
abdomen or trunk midsection (lapar)was inserted through a small flank incision. As suspected, the
vermiform appendix was severely inflamed and edematous (swollen) with fluid pus. A large fecalith was
blocking the lumen to the vermiform appendix and had created a severe tissue ischemia resulting in
necrosis. The etiologic agent was the bacterium Escherichia coli, a bacillus that is very common within
the GI tract. But because the fecolith put huge numbers of E. coli bacilli into constant contact with the
vermiform appendix, the immune response of the lymphatic tissue in that area was simply overwhelmed.
Tissue death (necrosis) was followed by secondary gangrene, a gnawing sore (gangren) that is
present (e).
After the appendix was removed, close examination showed there was a large abscess. An abscess is a
local collection of pus that, if ruptured, produces a going away (leaking out) of the pus and its
contained bacteria. The gangrenous appendix of Paul S., fortunately, did not suffer perforation a
process of (-tion) piercing through (perfor). Otherwise, the contents of the ruptured inflamed
appendix, including the feces, pus, and bacteria, would have been released into the normally sterile
abdominopelvic cavity. This release could have resulted in a dangerous peritonitis, an inflammation of the
membrane lining the cavity.
(adapted from Layman, D., Medical Terminology Demystified, McGraw-Hill, 2006, p. 342-345).