(1) Etiology and incidence
The main cause of appendicitis is appendiceal obstruction. The causes of appendiceal obstruction are: (1) catheter in the appendix cavity. Such as feces, pebbles, roundworms, etc. (2) The appendix wall is narrow. If you have suffered from acute appendicitis before, after the medicine is cured, the appendix wall will scar and make it smaller. At the same time, it will weaken the peristalsis function of the appendix. (3) Enlargement of lymphatic tissue on the appendix wall and appendix tumor can also lead to obstruction. There are many bacteria in the appendix cavity, which can easily cause inflammation after obstruction, cause thrombosis to block blood vessels, and cause necrosis and infection. Inflammation develops outward to the outer layer of appendix or penetrates into abdominal cavity, which will fester and cause peritonitis. If inflammation spreads, it may lead to more serious complications such as liver abscess, which is life-threatening.
(2) the patient's appearance
1. Abdominal pain: The typical abdominal pain of acute appendicitis is metastatic right lower abdominal pain. At first, it is often epigastric pain ("heartburn" pain), similar to stomach trouble, or pain around the navel. After a period of time, abdominal pain transferred to the right lower abdomen, and then the abdominal pain point was relatively fixed. Because everyone's appendix position is different, the pain point will be slightly different. Some people have no process of disease transfer, and pain in the right lower abdomen appears at the beginning of the disease. The time of abdominal pain metastasis varies from 2 to 3 hours, from 1 day or longer.
2. Nausea and vomiting: Because the appendix is stimulated by inflammation, the activity is enhanced, which often causes gastrointestinal reactions and nausea and vomiting. Vomiting several hours after abdominal pain 1 time, but frequent vomiting will not occur.
3. fever: there will be no fever at the beginning of abdominal pain. When inflammation is obvious, the body temperature rises, and when inflammation is aggravated, the body temperature is higher.
4. When the patient is examined, there is no abnormality in the abdomen in the early stage, and muscle tension and tenderness may occur when the inflammation is obvious.
(1) Tenderness: mostly in the right lower abdomen (depending on the position of the appendix). When you press it with your hand, you will feel pain. After pressing, the hand suddenly rises, and the patient also feels pain, which is medically called "rebound pain". When there is inflammation in the whole abdominal cavity after appendix perforation, there is tenderness and rebound pain in the whole abdomen. But the appendix is still the most obvious.
(2) Muscle tension: When appendicitis develops to the surface, inflammation stimulates the abdominal wall to make muscles tense. That is to say, the abdominal wall here feels harder than the opposite side. But if the appendix is perforated and there is inflammation in the whole abdomen, then there is muscle tension in the whole abdomen. The appendix is still the most obvious.
(3) Family maintenance
Acute appendicitis can subside, but about a quarter of patients will relapse after it subsides. At present, the surgical methods are relatively safe, and most of the operations have good results. Non-surgical treatment is mainly anti-infection (that is, anti-inflammation). However, we should be prepared to be hospitalized at any time, so as not to delay the treatment, make the disease develop to a serious degree, and lead to difficulties in treatment.
1. Family medication: Take medicine early, and it is best to control the inflammation before it develops into peritonitis. You can choose the following drugs:
(1) penicillin, 800,000 units each time, 6 hours 1 intramuscular injection. You must have an allergy test before using it.
(2) Streptomycin, 0.5g each time, 1 2h,1intramuscular injection. Should be used together with penicillin.
(3) Gentamicin, 80,000 units each time, intramuscular injection within 8 hours 1 time.
(4) Xianfeng No.4, 0.5g each time, taken orally four times a day.
(5) Spiramycin, 0.2g each time, taken orally 4-6 times a day.
2. Traditional Chinese medicine and folk prescription
50g of honeysuckle, 50g of dandelion, 20g of cortex moutan, 0g of rhubarb15g, 0g of radix paeoniae rubra12g, 9g of toosendan fruit, 9g of peach kernel and 9g of liquorice, and decocted in water for 2-4 times every day.
(2) Spatholobus suberectus 1 00g, Herba Violae 50g and Fructus Toosendan 20g, once a day1dose, decocted in water twice, and taken twice.
(3) Acupuncture Zusanli, Appendices and Ashi points. Add Neiguan point to spit.
(4) Add 50 g of Coicis Semen, 25 g of wax gourd seed, 0/5 g of Cortex Moutan/kloc-,0/5 g of peach kernel/kloc-,0/00 g of Viola yedoensis/kloc-and 300 ml (6 Liang) of water, and decoct into 100 ml. Decoct twice, mix, and take twice, daily 1 dose.
(5) Caulis Sargentodoxae, Caulis Lonicerae each 1 00g, Radix et Rhizoma Rhei 1 5g, decocted in water, and added with yellow wine1,taken twice, daily1dose.
3. Nutrition and diet
Should be given a liquid diet, such as milk, soybean milk, rice soup, broth and so on. Or semi-liquid diet, such as porridge, soft noodles and so on. If you want to be hospitalized for surgery, you should abstain from water.
4. Home care
(1) preoperative: closely observe the patient's abdominal pain, stool, temperature and pulse. The patient should have a good rest. Patients with peritonitis should take a semi-sitting position (that is, the patient sits on the bed with his back leaning against the quilt). Applying a hot towel or hot water bag to abdominal pain can promote the absorption of inflammation.
(2) Postoperative: Gastrointestinal activities were temporarily stopped after intestinal surgery. Drinking water entering the gastrointestinal tract cannot drop, and it accumulates in the stomach, causing bloating. So you can't eat or drink after the operation. You can't eat until your gastrointestinal activity is restored. The sign of the recovery of gastrointestinal activity is that you can hear bowel sounds in the abdomen (that is, purring or purring) or anal exhaust (farting). After operation, the intestine is inactive, and the surgical wound is easy to adhere. Therefore, patients should be encouraged to participate in more activities. On the one hand, it can prevent intestinal adhesion, on the other hand, it can also promote the recovery of gastrointestinal activities. Cough after abdominal surgery is a painful thing for patients. You can use some antitussive and expectorant drugs, such as compound licorice tablets 3 tablets, taken orally three times a day. Or take kebiqing 50 mg orally three times a day. The patient must cough up phlegm. In order to alleviate the pain of patients, nurses can assist patients. That is, when coughing, put your hands on both sides of the incision and apply force to the middle, which can relieve the pain of patients when coughing. Some complications may occur after appendectomy. Therefore, if the caregiver finds that the patient has abnormal changes, such as full of pain; On the third day after operation, the body temperature increased; Abdominal distension and poor anal exhaust; Incision bleeding, pus, etc. You should contact the doctor in time and get timely treatment. If the doctor instructs the patient to sit half-sitting, the chaperone should cooperate with the doctor to make the patient insist on sitting half-sitting. It is not advisable to do strenuous exercise or heavy physical labor within half a month after discharge. Such as carrying water and playing basketball.
(4) Precautions
1. Abdominal pain should not be treated with painkillers without definite diagnosis. Because the condition is covered up after analgesia, it is easy to delay the diagnosis and cause serious consequences.
2. After suffering from acute appendicitis, if the family treatment has no effect, send it to the hospital in time.
3. According to the current medical level and technical conditions, the surgical treatment of acute appendicitis is effective, and even conservative treatment is easy to relapse. Therefore, under the condition of conditional clearance, acute appendicitis is mainly treated by surgery.
4. Non-surgical treatment, medication should be thorough. After the symptoms and signs disappear, the drug should continue to be used for one week to consolidate the curative effect and reduce the recurrence.
The hospitalization should be arranged by the doctor. The accompanying staff should cooperate with the medical staff to do the patient's work well.
6. The condition and signs of appendicitis have changed greatly, and many patients are atypical. You'd better go to the hospital when you're not sure. So as not to delay diagnosis and treatment.
(5) common sense of prevention
1. Enhance physical fitness and pay attention to hygiene.
Be careful not to catch cold and eat improperly.
3. Timely treatment of constipation and intestinal parasites.