Appendicitis

      Appendicitis is one of the most common causes of acute abdominal pain. On average, 7% of people will develop appendicitis in their lifetime, most commonly between the ages of ten to thirty, while it is relatively rare in children under five and people over fifty. It is easy to delay diagnosis or misdiagnose due to atypical symptoms, and the probability of complications is also relatively high. Males generally have a higher chance of developing appendicitis than females, but for females between the ages of thirty-five to forty-four, the appendix is often removed along with other abdominal surgeries. The cause of appendicitis is mostly due to obstruction of the ileocecal valve by the vermiform appendix, followed by secondary bacterial infection; however, in 30% of cases, there is no obstruction, and inflammation may be caused by viruses, parasites, or infectious coccidia, trauma, or fecal retention after surgery. During diagnosis, it is necessary to distinguish between dozens of conditions, of which cholecystitis (pain on the upper right abdomen), ulcer perforation (more pain when moving), diverticulitis (a mass can be palpated), partial obstruction of the small intestine (intestinal peristalsis accelerates), and intestinal perforation (intestinal peristalsis slows down) are important. The most important diagnostic tool is still a detailed medical history and physical examination. Abdominal pain that is difficult to define in scope but gradually increases is the first symptom of typical appendicitis, usually starting with a vague pain around the pit of the stomach or the umbilicus, gradually shifting to the lower right abdomen; followed by fear of abdominal palpation causing abdominal muscle contraction, muscle stiffness, and rebound tenderness. In addition, non-specific symptoms such as moderate leukocytosis, low-grade fever, nausea, fatigue, constipation, or occasional diarrhea are not uncommon.

　　Appendicitis is also known as acute appendicitis. Appendicitis is relatively common in daily life. If it is not treated in time, it often causes various complications, among which the more common complications include wound infection, peritonitis, intra-abdominal abscess, and appendiceal abscess, especially appendicitis perforation and peritonitis.

      The typical symptoms of appendicitis are abdominal pain, nausea, and vomiting. Abdominal pain starts from the upper abdomen, common symptoms include abdominal distension and dull pain, and then turns to the lower right abdomen. It may cause fever, but usually fever occurs after abdominal pain, with a temperature of about 38℃; after the perforation of appendicitis, the body temperature can be higher than 39℃. Young children often present with peritonitis.

　　At the beginning of appendicitis, there may be pain in an indeterminate location, but most of the time it appears around the navel or the upper abdomen. This kind of pain is dull. If it is not paid attention to, it will gradually shift to the lower right abdomen after a few hours. At this time, if you press on the right lower abdomen with your hand, the pain will be more severe. What is particularly noteworthy is that at this time, you can try to press on the right lower abdomen and quickly release it. If you feel a rebounding pain, it may be appendicitis. But how painful is this pain? Because each person's tolerance is different, it is difficult to make a comparison or describe it in words. Generally, those who have experienced it will describe it as an extremely painful pain. As to how painful it is, only those who have truly experienced it know. In addition to the obvious abdominal pain, patients may also experience poor appetite, nausea, vomiting, and some may have a slight fever (about 38 degrees). In addition, some people may have increased tongue coating, halitosis, or granular increase in white blood cells. Some people may have constipation symptoms, while some may have the opposite, with diarrhea reactions, even blood in the stool. Due to the variability of symptoms, it is relatively difficult to make a diagnosis. The course of appendicitis can range from a few hours to several months, usually distinguished by the speed of onset of the disease into acute and chronic. Acute appendicitis usually has more severe symptoms than chronic appendicitis and is more threatening. At first, it may just be due to inflammation and obstruction of the appendix, resulting in abdominal pain. However, after a long time, it may lead to abscess or even perforation due to no treatment. Generally, perforation occurs 24 to 36 hours after the onset of symptoms, but in small children or the elderly, it may be earlier. Traditionally, the treatment method is laparotomy to remove the appendix. In recent years, the medical community has begun to use laparoscopic surgery to treat appendicitis, which has the advantages of small scars and fast recovery and is gradually accepted by patients.

　　After meals, avoid vigorous exercise such as running and jumping, which can effectively reduce the occurrence of appendicitis. There are four points to note for appendicitis:

　　1. Winning time is the most urgent for this condition.

　　Do not delay it until it develops into peritonitis, not only will physical strength be depleted, but there is also a risk of life-threatening conditions.

　　It is not advisable to treat appendicitis inflammation as gastrointestinal stasis. Some people take laxatives, resulting in not only the injured organ not being able to rest, but also being stimulated, accelerating the inflammation of the appendix, and even potentially causing rupture at any time, increasing the severity of the illness. Pay more attention to this.

　　When there is stomachache, applying a hot water bottle to the painful area can usually reduce the pain, but for appendicitis patients, the heat from the hot water bottle penetrating into the abdomen will only accelerate the inflammation of the appendix, which is harmful instead.

　　Acute appendicitis is characterized by转移性right lower quadrant pain or initial right lower quadrant pain, nausea, vomiting, and other gastrointestinal symptoms. There is fixed tenderness, rebound tenderness, and muscle tension in the right lower abdomen. Palpation of the right anterior rectum is painful, or there is a sign of colonic gas, or psoas muscle sign, or obturator muscle sign, or cough and palpation test positive. Auxiliary examinations show an increase in the total white blood cell count and neutrophils to varying degrees, and ultrasound shows appendiceal swelling, effusion, or encapsulated effusion (pus).

　　The best diet for acute appendicitis is clear liquid diet, such as rice porridge, almond milk, clear soup, light tea water, lotus root starch, thin noodle soup, peeled jujube soup. It should be mainly salty food, and gradually transition to low-fiber semi-liquid food after the condition improves, trying to avoid foods that produce gas and contain a lot of fat, such as milk, soy milk, sucrose, etc.

　　When the pain is severe, food and water should be prohibited to allow the gastrointestinal tract to rest fully. When the pain subsides, eat according to circumstances. Avoid cold and stimulating foods such as vinegar, chili, scallions, garlic, Sichuan pepper, etc., and also avoid stimulating foods such as strong tea, coffee, cocoa, etc. Cooking should be light in flavor, with minimal use of oil or other seasonings.

　　In addition, attention should be paid to eating nutritious foods. Eat more high-protein and high-vitamin foods to ensure that the body has sufficient nutrients, prevent anemia and malnutrition. For those with anemia and malnutrition, increase the intake of foods rich in protein and heme iron in the diet, such as lean meat, chicken, fish, liver, kidneys, and other internal organs. High-vitamin foods include dark-colored fresh vegetables and fruits such as green vegetables, tomatoes, eggplants, jujubes, etc. It is best to eat 2-3 fresh hawthorn fruits per meal to stimulate the secretion of gastric juice.

　　When appendicitis is in the early stage of simple inflammation, once the inflammation is absorbed and subsides, the appendix can return to normal and no longer recur. Therefore, the appendix does not need to be removed, and non-surgical treatment can be adopted to promote the early disappearance of appendicitis inflammation. When the diagnosis of appendicitis is clear and there are surgical indications, but due to the patient's overall condition or objective conditions that do not allow it, non-surgical treatment can also be adopted first to delay surgery. If appendicitis has been complicated with localized peritonitis and formed inflammatory masses, non-surgical treatment should also be adopted to absorb the inflammatory masses, and then consider elective appendectomy. If the inflammatory mass turns into an abscess, it should be incised and drained first, and then elective appendectomy can be performed later. When the diagnosis of appendicitis is not yet certain and observation is needed, non-surgical treatment can also be adopted while observing the changes in the patient's condition. In addition, non-surgical treatment can also be used as preparation before appendectomy. In summary, non-surgical treatment has an important position. Non-surgical treatment includes:

　　1. General Treatment:Mainly include bed rest, fasting, intravenous infusion of water, electrolytes, and calories, etc.

　　2. Antibiotic Application:The application of antibiotics in non-surgical treatment is very important. The selection and dosage should be determined according to the specific situation. Appendicitis is mostly mixed infection, in the past, the combined use of penicillin and streptomycin has been adopted with satisfactory results. Later, it was found that there were more and more drug-resistant strains and an increasing rate of anaerobic bacterial infection, so it was changed to 'Golden Triple Combination' which is Ampicillin (Ampicillin), Gentamicin, and Metronidazole. Its antibacterial coverage is wide, and the price is not expensive, and it is highly recommended. In recent years, new high-efficiency antibiotics have emerged, and cephalosporins are constantly updated. Therefore, at present, cephalosporins or other new β-lactam antibiotics combined with Metronidazole are commonly used. The advantages are a wider spectrum of antibiotics, stronger resistance to drug-resistant bacteria, and fewer toxicity and side effects. For mild appendicitis, the application of antibiotics is approximately preventive in nature, and general antibiotics can be used for a short time. Only patients with severe inflammation are suitable for regular therapeutic application. For severe appendicitis (gangrene or perforative), it is currently recommended to use a third-generation cephalosporin combined with Metronidazole or Imipenem to achieve good results.

　　3. Pain Reliever Application:Pain relief is sometimes very necessary. Severe pain can increase mental terror, reduce the body's immune function, and thereby weaken the patient's ability to resist disease. General painkillers sometimes cannot relieve strong pain, the use of morphine类药物 can be considered but must be cautious, and can be used for patients who have decided on surgery, but is prohibited for general conditions, especially the weak.

　　4. Symptomatic Treatment:Such as sedatives, antiemetics, and placing a gastric decompression tube when necessary.