appy with sob









Occam or Hickam?

Definitions Occam's razor -if there are several ways for something to happen, the fewest and simplest explanation works the best.





Hickam dictum -"patients can have as many diseases as they damn well please"





Are you an Occams or a Hickams? I think that choice changes throughout ones career. Early on when i was green, I liked Occam's razor, it was clean, easy to spell, and made me not think to much, because if i found the simplisest explanation for the presentation, I was done.

Fast forward a few years.....I'm a Hickam dictum man. I have seen way to many disease in one person and I have also seen people that say they don't have any disease, have more than the others.





Which came first the appy or the sbo?

It was a Thursday afternoon, around 6pm. The patient presented with abdominal pain and vomiting (don't they all). The difference in this case was that the patient was actually vomiting (not dry heaving, not making themselves vomit, but actually vomiting). No medical problems, no surgeries, no drugs(THC I found out is not a drug). No fevers. No Trauma

Exam : Abdomen was diffusely tender, more in the lower quadrants than upper. Negative manual assault on the rectum.

Before any consult can be obtained in my institution, labs have to be sent and imaging ordered (I think it has something to do with running a cbc and the phone line connecting). The all seeing catscan was done and showed the above, an appendicitis causing a SBO. damn you Occam!!!





SBO....Son Of a B.

Small bowel obstruction caused from acute appendicitis is rare. There have been a few case reports here and there, but nothing extensive. The above catscan easily shows the large inflamed appendix in the rlq and the dilated small bowel throughout, especially on the the left side.



















