Acute appendicitis

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Written by Ren Zheng Xin
Gastroenterology
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acute appendicitis symptoms

The symptoms of acute appendicitis typically include abdominal pain at the onset of the condition, which initially occurs around the navel and then localizes to the lower right abdomen, as well as early nausea and vomiting caused by gastric spasms. Patients with more severe inflammation may also exhibit fever. If the inflammation spreads to the peritoneum, there will be tenderness at McBurney's point and rebound tenderness, along with tense abdominal muscles. Based on these symptoms, making a definitive diagnosis of acute appendicitis is not particularly difficult.

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Written by Ren Zheng Xin
Gastroenterology
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How is acute appendicitis treated?

The principle of treating acute appendicitis is to rehydrate and fight infection, complete related auxiliary examinations, and then carry out an emergency appendectomy. Acute appendicitis can be controlled by medication, but the effectiveness of medications is limited; most cases still require the removal of the appendix through surgery. Currently, laparoscopic appendectomy is an available option. This method is relatively more complex, but it allows for faster recovery and less trauma post-surgery, though it tends to be more expensive.

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Written by Ren Zheng Xin
Gastroenterology
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Typical symptoms of acute appendicitis

The typical symptoms of acute appendicitis include abdominal pain, which starts in the upper abdomen or around the navel and, after several hours, shifts and localizes to the lower right abdomen. Additionally, reflexive gastric spasms may cause nausea and vomiting. Due to the inflammation, the body may develop a fever, generally not exceeding 38 degrees Celsius. If the inflammation affects the parietal peritoneum, it can cause tenderness, rebound pain, and abdominal muscle rigidity. These are the typical symptoms, and a preliminary diagnosis can usually be made based on them. Most cases require an appendectomy.

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Written by Ren Zheng Xin
Gastroenterology
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The etiology of acute appendicitis

The main cause of acute appendicitis is due to the narrowing of the appendiceal lumen, which can easily lead to the obstruction of food residues and fecal masses. Following the obstruction, mucosal damage occurs, which leads to secondary infections. Additionally, neglecting regular living habits, such as overeating, excessive fatigue, and frequent heavy drinking can exacerbate or trigger acute appendicitis. Therefore, maintaining regular living habits in daily life, such as having meals at fixed times, reasonable rest and work schedules, balancing work and leisure, and engaging in appropriate outdoor activities, can play a positive role in preventing acute appendicitis.

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Written by Li Jin Quan
General Surgery
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The difference between chronic appendicitis and acute appendicitis

The difference between chronic appendicitis and acute appendicitis is that most cases of chronic appendicitis are formed after the treatment of acute appendicitis. Chronic appendicitis and acute appendicitis display different symptoms. Acute appendicitis has typical migratory pain in the lower right abdomen, which initially appears in the upper abdomen and then moves to McBurney's point in the lower right abdomen. Chronic appendicitis, on the other hand, often lacks upper abdominal pain and initially presents with fixed discomfort or vague pain in the lower right abdomen. Only when chronic appendicitis acutely flares up does significant tenderness in the lower right abdomen occur, and rebound pain appears with peritonitis. Chronic appendicitis may also occasionally present with gastrointestinal symptoms such as nausea and vomiting.

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Written by Ren Zheng Xin
Gastroenterology
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Early symptoms of acute appendicitis

The symptoms of the early stage of acute appendicitis primarily include vague abdominal pain, initially across the abdomen, then transitioning around the belly button, and after several hours, shifting to the lower right abdomen where the pain becomes localized. The early symptoms of acute appendicitis are not typically distinctive, with the onset being quite sudden, accompanied by severe abdominal pain, vomiting, and fever. Based on these typical clinical manifestations, diagnosing acute appendicitis is not difficult. Clinically, the main treatment is the surgical removal of the appendix, with laparoscopic appendectomy being the more common practice nowadays. This method involves less bleeding during the operation and a quicker post-operative recovery.

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Written by Ren Zheng Xin
Gastroenterology
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How is acute appendicitis diagnosed?

The definitive diagnosis of acute appendicitis is primarily through clinical physical examination and auxiliary tests. Based on typical symptoms of acute appendicitis, such as migratory right lower abdominal pain, vomiting, nausea, fever, and a few patients may have symptoms of constipation or diarrhea. There is obvious tenderness and rebound pain when pressing on the abdomen. Additionally, an abdominal ultrasound can indicate swelling of the appendix lumen and a significant increase in appendix size. These aspects can lead to a preliminary diagnosis, and once acute appendicitis is confirmed, surgical treatment should be carried out.

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Written by Ren Zheng Xin
Gastroenterology
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Acute Appendicitis Etiology

The cause of acute appendicitis is primarily bacterial infection of the appendiceal lumen due to various reasons. The appendix itself is a narrow tube connected to the cecum. If a fecalith falls into the lumen, it can cause obstruction of the appendiceal lumen, leading to an increase in intra-luminal pressure and circulatory disturbances in the appendiceal wall. At this time, the mucosa is susceptible to damage, and bacterial invasion of the wall can cause infections of varying degrees. Additionally, gastrointestinal dysfunction, such as diarrhea or constipation, can also cause spasms of the appendiceal vessels, leading to blood supply disturbances and resulting in acute inflammation.

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Written by Ren Zheng Xin
Gastroenterology
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Which is more serious, acute appendicitis or chronic appendicitis?

The symptoms of acute appendicitis are relatively more severe because acute suppurative appendicititis can cause perforation of the appendiceal lumen. After the perforation, pus can flow into the abdominal cavity causing diffuse peritonitis, leading to abdominal muscle tension, tenderness, and rebound pain. If not treated promptly, it can lead to multiple organ failure. Chronic appendicitis is mostly due to incomplete treatment of acute appendicitis, or chronic latent appendicitis. The symptoms of chronic appendicitis are sometimes mild and the physical signs are not definite. Surgical removal of the appendix should be the first choice for treating acute appendicitis.

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Written by Ren Zheng Xin
Gastroenterology
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What is acute appendicitis?

Acute appendicitis refers to the acute inflammation occurring in the lumen of the appendix, which is caused by the narrowing or blockage and subsequent infection of the lumen. The primary symptom is abdominal tenderness and rebound pain, accompanied by nausea, vomiting, and fever. During the acute phase, blood tests often show an elevated white blood cell count. The main treatment is surgical removal of the appendix, with laparoscopic appendectomy being the commonly used method. This is also a minimally invasive approach to appendicitis treatment. Postoperative care is important, and it is advised to fast on the day of the surgery. Once gas passes through the rectum, a liquid diet may be resumed.