What is fecal stasis?

Answer 1

It is widely accepted that carcinoma of the large bowel is common in the Western world because we eat a low-residue diet which causes fecal stasis. The part of the large bowel with the most stasis is the appendix, which has similar mucosa; but the incidence of carcinoma per unit area of appendicular mucosa is four times less than carcinoma per unit area of large bowel

Answer 2

Fecal Stasis

Answer 3

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What is fecal stasis?

Answer 4

fecal stasis, also known as a fecalith, is a hardened mass of fecal matter that can obstruct the appendix and may cause appendicitis.

Answer 5

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Answer 6

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Answer 7

The appendix is a wormlike extension of the cecum and, for this reason, has been called the vermiform appendix. Its average length is 8-10 cm (ranging from 2-20 cm). This organ appears during the fifth month of gestation, and several lymphoid follicles are scattered in its mucosa. Such follicles increase in number when individuals are aged 8-20 years.

Appendicitis is inflammation of the inner lining of the vermiform appendix that spreads to its other parts. Appendicitis may occur for several reasons, such as an infection of the appendix, but the most important step is the obstruction of the appendiceal lumen.

This illness is one of the more common surgical emergencies, and it is one of the most common causes of abdominal pain. In the last few years, though, the incidence and mortality rate of this illness has markedly decreased.

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education articles Appendicitis and Abdominal Pain in Adults.

History of the Procedure: The first report of an appendectomy came from Amyan, a surgeon of the English army. Amyan performed an appendectomy in 1735 without anesthesia to remove a perforated appendix. Reginald H. Fitz, an anatomopathologist at Harvard who advocated early surgical intervention, first described appendicitis in 1886. Because he was not a surgeon, his advice was ignored for a time. Then, at the end of the 19th century, the English surgeon H. Hancock successfully performed the first appendectomy in a patient with acute appendicitis. Some years after this, the American C. McBurney published a series of reports that constituted the basis of the subsequent diagnostic and therapeutic management of acute appendicitis. Currently, appendectomy, either open or laparoscopic, remains the treatment for noncomplicated appendicitis.

Problem: Despite diagnostic and therapeutic advancement in medicine, appendicitis remains a clinical emergency. In fact, this illness is one of the more common causes of acute abdominal pain. Left untreated, appendicitis has the potential for severe complications, including perforation or sepsis, and may even cause death.

The diagnosis of appendicitis is clinical and essentially is based on history and clinical examination findings. The classic form of appendicitis may be promptly diagnosed and treated. When appendicitis appears with atypical presentations, it remains a clinical challenge. In such cases, laboratory and imaging investigation may be useful in establishing a correct diagnosis.

Statistics report that 1 of 5 cases of appendicitis is misdiagnosed; however, a normal appendix is found in 15-40% of patients who have an emergency appendectomy.

Although many antibiotics to control infections are available, appendicitis remains a surgical disease. In fact, appendectomy is the only rational therapy for acute appendicitis. It avoids clinical deterioration and may avoid chronic or recurrent appendicitis.

Although difficult, prompt recognition and immediate treatment of the disease prevent complications.

Frequency: The incidence of acute appendicitis is around 7% of the population in the United States and in European countries. In Asian and African countries, the incidence is probably lower because of the dietary habits of the inhabitants of these geographic areas.

In the last few years, a decrease in frequency of appendicitis in Western countries has been reported, which may be related to changes in dietary fiber intake. In fact, the higher incidence of appendicitis is believed to be related to poor fiber intake in such countries.

Persons of any age may be affected, with highest incidence occurring during the second and third decades of life. Rare cases of neonatal and prenatal appendicitis have been reported.

Appendicitis occurs more frequently in males than in females, with a male-to-female ratio of 1.7:1.

Etiology: Appendicitis is caused by obstruction of the appendiceal lumen. The causes of the obstruction include lymphoid hyperplasia secondary to irritable bowel disease (IBD) or infections (more common during childhood and in young adults), fecal stasis and fecaliths (more common in elderly patients), parasites (especially in Eastern countries), or, more rarely, foreign bodies and neoplasms.

Lymphoid hyperplasia of the appendix may be related to Crohn disease, mononucleosis, amebiasis, measles, and GI and respiratory infections. Fecaliths are solid bodies within the appendix that form after precipitation of calcium salts and undigested fiber in a matrix of dehydrated fecal material.

Pathophysiology: Reportedly, appendicitis is caused by obstruction of the appendiceal lumen from a variety of causes. Independent of the etiology, obstruction is believed to cause an increase in pressure within the lumen. Such an increase is related to continuous secretion of fluids and mucus from the mucosa and the stagnation of this material. At the same time, intestinal bacteria within the appendix multiply, leading to the recruitment of white cells and the formation of pus and subsequent higher intraluminal pressure.

If appendiceal obstruction persists, intraluminal pressure rises ultimately above that of the appendiceal veins, leading to venous outflow obstruction. As a consequence, appendiceal wall ischemia begins, resulting in a loss of epithelial integrity and allowing bacterial invasion of the appendiceal wall.

Various specific bacteria, viruses, fungi, and parasites can be responsible agents of infection that affect the appendix, including Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis.

Within a few hours, this localized condition may worsen because of thrombosis of the appendicular artery and veins, leading to perforation and gangrene of the appendix. As this process continues, a periappendicular abscess or peritonitis may occur.

Clinical: The most common symptom of appendicitis is abdominal pain. Typically, symptoms begin as periumbilical or epigastric pain migrating to the right lower quadrant (RLQ) of the abdomen. Later, a worsening progressive pain along with vomiting, nausea, and anorexia are described by the patient. Usually, a fever is not present at this stage.

In addition to recording the history of the abdominal pain, obtain a complete summary of the recent personal history surrounding gastroenterologic, genitourinary, and pneumologic conditions. Also consider gynecologic history in female patients.

The differential diagnosis of appendicitis is often a clinical challenge because appendicitis can mimic several abdominal conditions. The differential diagnosis must include cholecystitis and biliary colic, gastroenteritis, enterocolitis, diverticulitis, pancreatitis, perforated duodenal ulcer, renal colic, and urinary tract infection (UTI). In pediatric patients, consider mesenteric lymphadenitis and intussusception. In women of childbearing age who are not pregnant, the differential diagnosis must also include ovarian cyst torsion, mittelschmerz, ectopic pregnancy, and pelvic inflammatory disease (PID). Small bowel obstruction, Crohn disease, Meckel diverticulitis, tumors, Henoch-Schönlein purpura, and rectus sheath hematoma are more rare conditions that mimic appendicitis.

Usually, patients are lying down, flexing their hips, and drawing their knees up to reduce movements and to avoid worsening the pain.

A careful physical examination, not limited to the abdomen, must be performed in any patient with suspected appendicitis. GI, genitourinary, and pulmonary systems must be studied. Perform a rectal examination in any patient with an unclear clinical picture, and perform a pelvic examination in all women with abdominal pain.

Tenderness on palpation in the RLQ over the McBurney point is the most important sign in these patients. Additional signs such as increasing pain with cough (ie, Dunphy sign), rebound tenderness related to peritoneal irritation elicited by deep palpation with quick release (ie, Blumberg sign), and guarding may or may not be present.

Patients with appendicitis may not have the reported classic clinical picture 37-45% of the time, especially when the appendix is located in an unusual place (see Relevant Anatomy). In such cases, imaging studies may be important but not always available. Patients with this condition usually have accessory signs that may be helpful for diagnosis. For example, the obturator sign is present when the internal rotation of the thigh elicits pain (ie, pelvic appendicitis), and the psoas sign is present when the extension of the right thigh elicits pain (ie, retroperitoneal or retrocecal appendicitis).

Answer 8

poo or feces