Four Body Parts You Don’t Want To Miss

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Several years ago I was urgently paged by a patient who had discovered a lump at the bottom of his chest.  He came straight over to my office, fairly certain he had cancer.  The lump turned out to be a normal part of his sternum (breastbone), a small piece of cartilage called the xiphoid.  Now that’s the kind of diagnosis I like to make.

I’m guessing most people don’t know where their xiphoid is and, fortunately, it doesn’t come up much in conversation.  But there are a few parts of the body you should be familiar with in order to recognize important symptoms and alert your doctor.  Here’s my top-four list of organs whose location patients should know but often don’t:

Appendix

The appendix is a wormlike structure in the right (from the patient’s point of view) lower quadrant of the abdomen, at the very beginning of the colon - near the junction of the large intestine (colon) and small intestine.  The word “itis” means inflammation; so appendicitis means inflammation of the appendix.  Appendicitis can cause pain and all sorts of vague gastrointestinal symptoms such as nausea, indigestion, and lack of appetite.

Where is the appendix?  Place your left index finger on your umbilicus (that’s med-speak for navel or belly button) and your right index finger on the curved bone (iliac crest) at the top of your right hip.   The appendix is usually about a third of the way from your right index finger to your left index finger.  But the location can vary considerably and the classic presentation of pain around the navel that migrates down to the right lower quadrant only occurs about half the time.  Depending on how the appendix is pointed, the pain can appear in all sorts of places - even in the right upper quadrant.

Clinical pearl:  the appendix is on the right, not the left.

Gallbladder

The gallbladder is a small sac that stores bile in the right upper quadrant of the abdomen, nestled under the right ribcage.  When the gallbladder contracts, it squirts bile down a duct and into the small intestines, where it helps digest food.  Sometimes the bile precipitates into stones or sand-like sludge inside the gallbladder, often causing no symptoms.  But if a stone blocks the thin tube (cystic duct) where the bile exits the gallbladder, the gallbladder can become inflamed and painful.  The classic symptom of an inflamed gallbladder (cholecystitis) is sharp right upper quadrant pain that may radiate to the right shoulder or right back.  There may also be nausea and vomiting.

Atypical symptoms include pain in the upper midline (epigastrium) or even chest.

Clinical pearl:  if a stone leaves the gallbladder and gets stuck in the duct (common bile duct) that leads to the small intestine, it can block the flow of bile out of the liver and cause jaundice (yellow discoloration of the skin and whites of the eyes).

Pancreas

The pancreas organ secretes digestive enzymes and hormones and is located behind the upper left and upper middle parts of the abdominal cavity - in back of the stomach and in front of the spine.  Pancreatitis can cause extreme pain that may bore through to the back.  A common cause is “gallstone pancreatitis” - occurring when tiny gallstones, sand, or sludge leave the gallbladder, travel down a duct (common bile duct) and disrupt the normal flow of digestive enzymes as they flow from the pancreas into the small intestines.  The pancreatic juices back up into the pancreas and cause inflammation.  Other causes of pancreatitis include alcohol, medication, infection, and trauma.

Clinical pearl: If you develop pancreatitis from gallstones, the gallbladder usually has to be removed in order to prevent another episode.

The Kidneys

When we were first year medical students, one of my best friends thought that the kidneys were in the pelvis.  Makes sense.  But wrong.  They’re actually fist-sized organs in the mid-upper back towards the side (the flanks).  My friend became a superb psychiatrist and can tell you exactly where the superego is located.  Kidney stones or infection can cause flank or abdominal pain and a variety of other symptoms, including nausea, pain on urination, or blood in the urine.

Clinical pearl:  With vitamin D supplementation becoming increasingly prevalent, don’t make the mistake of taking more vitamin D than your doctor recommends.  Too much can cause kidney stones.