What Are the Signs of Appendicitis in Adults?

Appendicitis is an inflammatory change caused by many factors. It is a common surgical disease. It is most common in young people and more in men than women. Acute appendicitis is more common clinically, and it can occur in women of all ages and during pregnancy. Chronic appendicitis is rare.

Basic Information

English name: appendicitis
Visiting department: surgical

Multiple groups: Young men
Common causes: Mostly caused by infection
Common symptoms: Typical acute appendicitis has metastatic right lower quadrant pain, fever, and vomiting

Causes of appendicitis

Acute appendicitis

(1) The obstruction of the appendix is an elongated tube with only one end communicating with the cecum. Once the obstruction can accumulate intraluminal secretions and increase the internal pressure, it compresses the appendix wall and obstructs the distal blood flow. On this basis, bacteria in the lumen invade the damaged mucosa and easily cause infection.

(2) The main cause of infection is direct infection caused by bacteria in the appendix. If the appendix mucosa is slightly damaged, bacteria invade the wall of the tube and cause different degrees of infection.

(3) Other factors considered to be related to the onset include visceral nerve reflex caused by gastrointestinal dysfunction such as diarrhea, constipation, etc., causing spasm of appendix muscles and blood vessels, resulting in narrowing of the appendix lumen, impaired blood supply and damage to the mucosa. Acute inflammation caused by bacterial invasion.

2. chronic appendicitis

Can be roughly divided into two categories of recurrent appendicitis and chronic appendicitis clinically. The former is mostly due to the failure to completely remove the residual infection during the onset of acute appendicitis. The latter has no history of acute appendicitis, the symptoms are obscure, and the signs are uncertain.

Appendicitis clinical manifestations

Acute appendicitis

(1) Abdominal pain In the early stage of typical acute appendicitis, there is pain in the middle and upper abdomen or umbilical cord. After a few hours, the abdominal pain is transferred and fixed in the right lower abdomen. When inflammation spreads to the serosal layer and parietal peritoneum, the pain is fixed in the right lower abdomen, and the original middle and upper abdomen or umbilical pain is reduced or disappeared. Therefore, the absence of a typical history of metastatic right lower quadrant pain does not rule out acute appendicitis.

Simple appendicitis often presents as paroxysmal or persistent tenderness and dull pain, and persistent severe pain is often indicated as purulent or gangrenous appendicitis. Sustained severe pain affects the mid-lower abdomen or both sides of the lower abdomen, often with signs of perforating appendix gangrene.

(2) Gastrointestinal symptoms Gastrointestinal symptoms of simple appendicitis are not prominent. In the early stage, nausea and vomiting may be caused by reflex gastric cramps. Pelvic appendicitis or perforation of appendic gangrene may have increased bowel movements.

(3) Fever is generally low fever, no chills, and purulent appendicitis generally does not exceed 38 ° C. High fever is more common in appendic gangrene, perforation or peritonitis.

(4) Tenderness and rebound tenderness The appendix tenderness point is usually located at Mai's point, which is the junction of the middle and outer 1/3 of the line connecting the anterior superior iliac spine and the umbilicus. Bounceback pain, also known as Blumberg sign, is a manifestation of inflammation of the parietal peritoneum. Obese patients or patients with posterior cecum appendicitis may have mild tenderness, but have obvious rebound pain.

(5) Abdominal muscle tension Appendiculitis has this sign, especially when gangrene perforation is accompanied by peritonitis. However, the elderly or obese patients have weak abdominal muscles, and the contralateral abdominal muscles must be checked for comparison.

(6) In the early stage of skin hypersensitivity , especially when there is obstruction in the appendix cavity, skin hypersensitivity in the right lower abdomen may appear, the range is equivalent to the innervation area of the thoracic segment of the 10th to 12th, located at the highest point of the right condyle and the right pubic bone The triangle formed by the ridge and the umbilicus, also known as the Sherren triangle, does not change due to the location of the appendix. For example, perforation of the gangrene of the appendix, the skin sensation in this triangle disappears.

2. chronic appendicitis

(1) Abdominal pain Pain in the right lower abdomen, which is characterized by intermittent faint pain or swelling pain, which is severe and mild, and the location is relatively fixed. Most patients induce abdominal pain after eating, exercising, tired, cold and standing for a long time.

(2) Patients with gastrointestinal reactions often have dyspepsia and decreased appetite. Those with a longer course may experience weight loss and weight loss. There is generally no nausea and vomiting, and no bloating, but elderly patients may be accompanied by constipation.

(3) Tenderness in the abdomen Tenderness is the only sign, which is mainly located in the right lower abdomen. Generally, the tenderness is small and the position is constant. It can only occur under heavy pressure. No muscle tension and rebound pain, generally no abdominal mass.

(4) Signs of various specific tenderness points such as Mai's point, Lan's point, psoas muscle sign, and Roche's sign are positive.

Appendicitis examination

Blood routine

Patients with acute appendicitis have increased white blood cell counts. Generally it is (10 ~ 15) × 10 ⁹ / L. As the inflammation worsens, the number of white blood cells increases, which can even exceed 20 × 10 ⁹ / L. However, in elderly patients who are weak or whose immune function is suppressed, the number of white blood cells may not increase. At the same time as the number of white blood cells increased, the number of neutrophils also increased. The two often appear at the same time, but there is also a significant increase in only neutrophils, which is of equal significance.

2. Urine routine

Occasionally, there is inflammation of the distal appendix and adhesion to the ureter or bladder. A small amount of red and white blood cells may also appear in the urine.

3. Ultrasound

Can show retrocecal appendicitis, because the spasm of the cecum acts as a sound transmission window to make the appendix display. To rule out chronic cholecystitis, chronic mesenteric lymphadenitis, chronic appendicitis and chronic urinary tract infection that are most easily confused with chronic appendicitis.

4. Laparoscopy

This test is one of the methods that can get the most positive results in the diagnosis of acute appendicitis. Because the insertion of a laparoscope through the lower abdomen can directly observe the inflammation of the appendix, it can also distinguish other diseases that have similar symptoms with appendicitis, and can be treated at the same time.

5.X-ray barium enema

Examination of barium enema can not only determine whether the tenderness point is located at the appendix, but also exclude other diseases that can be confused with chronic appendicitis, such as ulcer, chronic colitis, cecum tuberculosis or cancer.

Appendicitis diagnosis

Metastatic right lower quadrant pain, Mai's point tenderness and rebound tenderness, and a slight increase in white blood cells are helpful for diagnosis.

Appendicitis treatment

Acute appendicitis

(1) Anti-infective treatment is available for non-surgical treatment. When the diagnosis of acute appendicitis is clear and there are indications for surgery, but because the patient's overall situation or objective conditions do not allow it, non-surgical treatment can be taken first to delay the operation. If acute appendicitis has been combined with localized peritonitis and an inflammatory mass has formed, non-surgical treatment should also be used to absorb the inflammatory mass, and then elective appendectomy is considered. Patients should rest in bed, fast, and be given intravenous water, electrolytes, and heat.

(2) Surgical treatment of acute appendicitis in principle. Appendectomy should be used for treatment except that the mucosal edema type can be cured and cured.

2. chronic appendicitis

Surgical treatment is the only effective method, but special care should be taken when deciding on an appendectomy. After the diagnosis of chronic appendicitis is confirmed, surgery should be performed in principle, especially in patients with a history of acute attacks.