How is acute appendicitis diagnosed?

Written by Ren Zheng Xin
Gastroenterology
Updated on September 19, 2024
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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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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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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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Which is more serious, acute appendicitis or chronic appendicitis?

Acute appendicitis is relatively common in clinical practice with severe symptoms. Compared to chronic appendicitis, acute appendicitis can cause the appendix tube to become purulent and perforate, leading to a widespread peritonitis. Severe peritonitis can cause multi-organ failure and even shock. Chronic appendicitis, on the other hand, mainly manifests as chronic abdominal pain and seldom shows signs of appendix perforation. It primarily leads to an abscess around the appendix, encapsulating the appendix and causing repetitive chronic pain, which is difficult to heal. Both acute and chronic appendicitis should be treated surgically by removing the appendix to achieve a complete cure.

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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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Precursors of acute appendicitis

Acute appendicitis is acute inflammation of the appendix lumen, and currently, there are no particularly typical precursors, but the causes of acute appendicitis should be noted, which are related to obstruction and infection of the appendix cavity. If the appendix lumen is compressed for a long time, the accumulation of secretions can cause blood supply disorders in the distal appendix wall, directly causing damage to the appendix mucosa, and inducing infection that leads to appendicitis. Additionally, gastrointestinal dysfunctions such as diarrhea and constipation can also cause spasms of the appendix muscles and vessels, leading to blood supply disorders and mucosal damage, thereby causing acute appendicitis.