Chronic appendicitis

　　Most chronic appendicitis comes from acute appendicitis. Chronic appendicitis is divided into primary and secondary types. Its etiology and pathogenesis are as follows:

　　First, Etiology

　　1. Primary chronic appendicitis:Its characteristics are that the onset is concealed, the symptom development is slow, the course is prolonged, ranging from a few months to several years. There is no history of acute attack at the beginning, and there is no phenomenon of repeated acute attacks during the course of the disease.

　　2. Secondary chronic appendicitis:The characteristic is that after the first acute appendicitis, it is cured or spontaneously relieved by non-surgical treatment, and then there are residual clinical symptoms, difficult to heal for a long time, and there may be repeated or multiple acute attacks during the course of the disease.

　　Second, Pathogenesis

　　Although some people believe that the pathology of chronic appendicitis is sometimes not clear, most still have relatively clear changes. The wall of the appendix is hyperplastic and thickened, showing fibrosis and short, tough and tenacious characteristics, with a surface that is grayish white. The mesentery of the appendix thickens, shortens, and hardens, with lymphocytes and eosinophils infiltrating around the blood vessels in the mucosa or submucosa. Some may also show the presence of foreign body giant cells. Sometimes, the fibrosis of the appendix wall leads to narrowing of the lumen, even becoming a string-like closure, similar to the aging and atrophy of the appendix. Narrowing and closure start from the tip of the appendix and spread towards the root. If only the root is closed, the distal lumen may fill with mucus, forming a mucous cyst. After chronic appendicitis, the appendix can curl up spontaneously, or be surrounded by a large amount of fibrous adhesions, with faecal stones or other foreign bodies present in the lumen.

　　A few patients with chronic appendicitis may develop the following complications due to untimely treatment or low body resistance:

　　1. Peritonitis The main clinical manifestations are abdominal pain, abdominal muscle tension, and symptoms such as nausea, vomiting, and fever. In severe cases, it can lead to a decrease in blood pressure and systemic toxic reactions, such as toxic shock, which can be fatal if not treated in time. Some patients may develop complications such as pelvic abscess, intestinal abscess, subdiaphragmatic abscess, iliac fossa abscess, and adhesive intestinal obstruction.

　　2. Periappendiceal abscess The time for appendectomy after appendiceal abscess is generally 3 to 6 months after the treatment of the previous infection episode, because if the time is too short, the adhesions between the appendix and the surrounding intestinal tract have not been released, and forced appendectomy may lead to intestinal fistula. If ultrasound or CT examination can clearly indicate that there is still a mass around the appendix, then you need to wait for a period of time before performing appendectomy. At present, all examinations cannot determine whether the appendix is completely free of disease, so appendectomy is still necessary after the treatment of appendiceal abscess.

　　3. Thrombophlebitis Bacteria or bacteremic thrombi can flow back into the liver via the veins to form liver abscesses.

　　4. Appendiceal mucinous cyst or complicated with purulent appendiceal abscess If the base of the appendix is blocked, the mucus secreted by the mucosal epithelium accumulates, causing the appendix to become highly distended, known as an appendiceal mucinous cyst or complicated with purulent appendiceal abscess.

　　5. Pseudomyxoma peritonei Mucus cysts penetrate the appendix wall, and the mucosal epithelium and mucus enter the peritoneal cavity and implant on the peritoneal surface, forming pseudomyxoma peritonei.

　　Chronic appendicitis refers to chronic inflammatory changes in the appendix that remain after the acute inflammatory process subsides, such as hyperplasia of the fibrous connective tissue of the wall, narrowing or occlusion of the lumen, torsion of the appendix, and adhesion to surrounding tissues. Chronic appendicitis is divided into primary and secondary types, and its specific symptoms include:

　　1. Abdominal pain

　　Pain in the lower right abdomen, characterized by intermittent dull or bloating pain, varying in intensity, and relatively fixed in location. Most patients may experience abdominal pain after a heavy meal, exercise, fatigue, catching a cold, or long-term standing. Acute appendicitis may occur during the course of the disease.

　　2. Gastrointestinal reactions

　　Patients often have varying degrees of dyspepsia and decreased appetite. In patients with a longer course of disease, weight loss and weight loss may occur. Generally, there is no nausea or vomiting, and there is no abdominal distension, but elderly patients may be accompanied by constipation.

　　3. Abdominal tenderness

　　Pain on palpation is the only sign, mainly located in the lower right abdomen, generally with a small range, fixed in position, and only apparent under heavy pressure. There is no muscle tension or rebound pain, and there are usually no abdominal masses, but sometimes the distended cecum can be felt.

　　4. Indirect signs

　　Various specific tender points such as McBurney's point, Lanz point, lumbar plexus sign, and Rovsing's sign may not necessarily appear in the diagnosis of chronic appendicitis.

　　Most chronic appendicitis mainly presents as right lower abdominal pain, which is often intermittent mild pain, persistent dull pain, or discomfort, usually localized in the right lower abdomen. Then, what are the methods to prevent chronic appendicitis? Briefly described as follows:

　　1. Develop good hygiene habits in daily life, pay attention to dietary regulation, eat less and more often, avoid overeating, do not engage in strenuous exercise immediately after meals, etc.

　　2. Maintain a cheerful mood. Negative emotions such as sorrow, depression, anger, and sadness can easily disrupt the balance of the nervous system, leading to nervous system disorders, especially autonomic nervous system disorders. The manifestations of autonomic nervous system disorders are multifaceted, and gastrointestinal dysfunction is one of the common manifestations. Under the influence of mental stimulation, the gastrointestinal tract may undergo spasm and relaxation, leading to indigestion, constipation, and diarrhea, which can induce appendicitis.

　　3. Be cautious with medication, especially antipyretic and analgesic drugs and anti-inflammatory drugs for colds. These drugs have a great impact on the gastrointestinal tract. In severe cases, they may cause gastrointestinal bleeding or perforation, so it is best not to use them or use them as little as possible.

　　4. Pay attention to the changes of the season and climate, adjust the relationship between the body and the natural world in time, take off clothes when it is hot and add clothes when it is cold, especially ensure that the abdomen is not stimulated by cold, in order to maintain the normal state of the gastrointestinal tract.

　　Chronic appendicitis drugs can only alleviate but cannot cure the disease. Since it is chronic, there is a possibility of recurrence before it is cured, and the possibility of recurrence is very high. It will recur repeatedly, otherwise it would not be called chronic appendicitis. It can also recur during pregnancy, leading to gynecological pelvic inflammation. Surgical treatment is the only method, and preoperative barium enema contrast should be used for further diagnosis.

　　Chronic appendicitis is a common disease. Clinically, it often presents with right lower abdominal pain, fever, vomiting, and other symptoms. The diagnosis of chronic appendicitis should first rule out the possibility of right urinary tract stones and gynecological diseases. The clinical examinations that need to be done include:

　　1. Blood test

　　Patients suspected of having chronic appendicitis are often required to undergo blood tests to check the level of white blood cells and the proportion of neutrophils. However, there is a 50% chance that even if chronic appendicitis is present, the blood test may be normal. Therefore, this is not the most reliable diagnostic evidence.

　　2Urine test

　　Chronic appendicitis usually requires urine tests, and some patients may have positive urinary occult blood in urine tests. Women of childbearing age should have routine urine HCG tests to exclude pregnancy.

　　3. X-ray

　　Routine X-ray examination is less commonly used for the diagnosis of chronic appendicitis and is usually performed in abdominal flat film when distinguishing from gastrointestinal perforation. Some appendicitis can be indicated by appendiceal enlargement in CT examination.

　　4. Ultrasonic

　　Ultrasonic examination is usually used first to rule out urological and gynecological diseases. When the appendix is enlarged, ultrasonic examination can indicate a strip of hypoechoic area. In children, it can also be used to rule out mesenteric lymph node enlargement. In some cases, even if chronic appendicitis has occurred, no abnormalities may be found.

　　The diet of patients with chronic appendicitis should be light, and they should eat more fiber-rich foods to keep the bowels smooth. Generally speaking, for warm natured animal meats such as lamb, beef, and dog meat, moderation should be exercised, and scallions, ginger, garlic, and chili should not be eaten in large quantities. Foods with cooling, detoxifying, and dampness-relieving effects such as mung beans, sprouts, and bitter melon can be chosen to eat.

　　1. Use ginger and taro in equal amounts, peel and chop the taro, beat it into a paste, beat the ginger into juice, mix it together, and then add an appropriate amount of flour, stir into a paste. Spread it on a cloth according to the size of the affected area and apply it to the affected area. Change twice a day, and the pain can be relieved after 3 days.

　　2. 100 grams of chicken blood vine, 50 grams of Diding, 25 grams of Chuanlianzi, once a day, decocted twice, mixed and taken in two doses.

　　3. 50 grams of Job's tears, 25 grams of winter melon seeds, 15 grams each of Danpi, Taoren, Zihua, and Diding, 300 milliliters of water, decocted to 100 milliliters. Decoct twice, mix and take in two doses, once a day.

　　4. Hongteng, Rendongteng each 100 grams, raw Dahuang 15 grams, decocted with wine and taken in two doses, once a day.

　　Chronic appendicitis refers to chronic inflammatory changes in the appendix left after the acute inflammation subsides, such as hyperplasia of the fibrous connective tissue of the wall, stenosis or occlusion of the lumen, torsion of the appendix, and adhesion with surrounding tissues. Surgical treatment is the only effective method, but it should be particularly cautious when deciding to perform an appendectomy.

　　1. After the diagnosis of chronic appendicitis, surgical treatment should be performed in principle, the pathological appendix should be removed, especially for patients with a history of acute attacks, who should receive surgery in a timely manner. For patients with suspected diagnosis or elderly patients with serious complications, non-surgical treatment should be temporarily adopted, and followed up in the outpatient department.

　　2. If the appendix appears basically normal during surgery, it should not be easily removed and the abdomen closed without careful examination of the tissues and organs around the appendix, such as the ileocecal junction, the distal end of the ileum one meter, the mesentery of the small intestine and its lymph nodes. Female patients should also be carefully examined for the pelvis and adnexa to prevent misdiagnosis and missed diagnosis.

　　3. After surgery, every patient should be followed up for a period of time to understand the actual effect after the appendix is removed.

　　Prognosis: Patients with chronic appendicitis have a good effect after early surgery and treatment.