Symptoms of obstructive appendicitis?

summary

Symptoms of obstructive appendicitis? Appendicitis is the inflammation of the appendix, the most common abdominal surgical disease. The typical clinical manifestation of acute appendicitis is a gradual occult pain in the upper abdomen or around the umbilicus, which transfers to the right lower abdomen several hours later. Often accompanied by loss of appetite, nausea or vomiting, in addition to the early onset of low fever, fatigue, most no obvious systemic symptoms. If acute appendicitis is not treated early, it can develop into gangrene and perforation of appendix, complicated with local or diffuse peritonitis.

Symptoms of obstructive appendicitis?

At the beginning of acute inflammation, the appendix showed congestion and swelling, edema and polymorphonuclear leukocyte infiltration in the wall, small ulcers and bleeding points in the mucosa, and a small amount of exudation in the serosa. Because the location of visceral pain is unknown, the patient feels dull pain in the upper abdomen or around the umbilicus, often accompanied by nausea and vomiting, general discomfort, abdominal pain gradually transferred to the right lower abdomen. In clinic, McBurney's point is often used to indicate the tenderness. In the right lower abdomen, there is a limited local tenderness point in the outer 1 / 3 of the line between the umbilicus and the right anterior superior iliac spine. This tenderness point was first discovered and described by C. McBurney in 1889, so it is called McBurney's point (McBurney's point). If the disease continues to develop, a few hours after the appendix swelling and congestion is more obvious, appendix wall often have small abscess formation, mucosal ulcers and necrosis, serosal surface of a large amount of fibrous exudation, cavity full of purulent fluid, known as purulent cellulitis appendicitis. At this time, the systemic symptoms are serious, and the pain in the right lower abdomen is obvious. Finally, it can develop into tissue necrosis of the appendix wall. If there is obstruction, the necrosis of the distal end of the appendix is more serious and purple black. Perforation often occurs here, which is called gangrenous appendicitis. Generally, it is combined with limited peritonitis. At this time, in addition to tenderness, it is also accompanied by obvious muscle tension and rebound pain. The body temperature was more than 38.5 ℃ and the white blood cell count increased. Due to the swelling and closure of the proximal part of the appendix cavity, the overflow through perforation is only the pus accumulated in the cavity, without intestinal contents. In addition, it is wrapped by greater omentum, and rarely secondary diffuse peritonitis, resulting in the formation of periappendiceal abscess.

One end of the appendix is connected with the cecum, about 6-8 cm long, and the lumen is narrow, only about 0.5 cm. The appendix wall is rich in lymphoid tissue, which constitutes the anatomical basis of appendix inflammation. About 70% of the patients can find the obstruction of appendix cavity due to different reasons, such as fecal mass, fecal stone (that is, fecal mass staying for a long time mixed with appendix secretion and formed by calcium and other minerals), food debris, appendix distortion and parasites (such as Ascaris lumbricoides and pinworm), etc. After the inflammation of acute appendicitis subsides, it can form cicatricial stenosis in the appendix, which is easy to cause repeated episodes of inflammation. Due to the existence of abundant lymphoid tissue in the wall of appendix, the inflammatory reaction is serious, which promotes the occurrence of obstruction. A large number of intestinal bacteria usually exist in the appendix cavity. When there is obstruction, the pressure in the cavity at the distal end of the obstruction increases, and the blood circulation of the appendix wall is affected. The damage of the mucosa is the condition for bacterial invasion. Sometimes the feces, food debris, parasites and foreign bodies in the appendix cavity do not cause obstruction, but they can cause mechanical damage to the appendix mucosa and facilitate bacterial invasion. In addition, gastrointestinal dysfunction can also cause muscle spasm in the appendix wall, affect the evacuation of the appendix, and even affect the blood circulation of the appendix wall, which is also the cause of inflammation. Bacteria can invade the appendix through blood circulation and cause inflammation, which belongs to blood borne infection.

According to the typical clinical manifestations of epigastric and umbilical pain, a few hours later, the pain transferred to the right lower abdomen, and there was significant tenderness in the right lower abdomen, the general diagnosis is not difficult, but there is still about 20% misdiagnosis rate. In addition to the doctor's experience and technical problems, there are two main reasons for misdiagnosis: ① some of the manifestations of acute appendicitis are not typical. Due to the abnormal position of the appendix, such as high appendicitis is easy to be confused with acute cholecystitis, posterior appendicitis has mild abdominal signs, and pelvic appendicitis may have diarrhea symptoms; Or because the incidence of appendicitis is special, if the appendicitis process is blocked or twisted by foreign bodies, abdominal pain is located in the right lower abdomen at the beginning, no obvious metastasis process, and paroxysmal, abdominal signs are not obvious, very like urinary stones or enterospasm. In addition, there are also individual factors of the patients: the nerve type, pain threshold and gastrointestinal reaction of the patients are different, the elderly have poor reaction, and the symptoms and signs often can not reflect the actual severity of acute appendicitis; Appendicitis is relatively large in children, and it is difficult to inquire the history of appendicitis; Pregnant women's appendix upward, outward or backward shift, and uterine enlargement, abdominal physical examination is also different from ordinary people. ② Some other acute abdomen symptoms are similar to acute appendicitis, such as terminal ileal diverticulitis, acute mesenteric lymphadenitis, and some gynecological diseases, such as acute adnexitis, ovarian follicle rupture, ovarian cyst torsion, etc. Small ulcer perforation, perforation quickly closed, a small amount of duodenal content flow to the right lower abdomen, can also be manifested as metastatic right lower abdominal pain, and epigastric tenderness is not obvious. Some medical diseases, such as acute gastroenteritis, intestinal Ascaris, abdominal purpura, also have similar clinical manifestations of acute appendicitis.

matters needing attention

Simple acute appendicitis with non-surgical treatment, most patients can be cured, but left with chronic inflammation or narrow lumen is easy to relapse, so once the diagnosis of acute appendicitis is clear, emergency surgery should be performed to remove the lesion of the appendix. Pregnancy due to pelvic congestion, appendicitis develops faster, so it should also be timely surgery. If the diagnosis is not clear, if the patient has local peritonitis or systemic infection, open examination should be performed to avoid delay of treatment. If there is no acute inflammation in the appendix, other acute lesions should be detected. If appendicitis has formed surrounding abscess, non-surgical treatment should be carried out first. After the abscess is absorbed, appendectomy should be carried out after 3 months or half a year.