Cause of disease: Because the appendix is a blind end of the intestine, it is easy to leave things behind and bacteria are easy to reproduce.

It can be avoided by exercising more, increasing intestinal peristalsis and paying attention to food hygiene.

Appendicitis is a common disease. Clinically, there are often symptoms such as right lower abdominal pain, elevated body temperature, vomiting and neutropenia.

Etiology and pathogenesis

Bacterial infection and obstruction of appendix cavity are two main factors of appendicitis. The appendix is a slender blind tube with a narrow lumen, which is easy to retain feces and bacteria from the intestinal cavity. The wall of the appendix is rich in nerve devices (such as neuromuscular plexus, etc.), and the root of the appendix has a structure similar to sphincter, so it is easy to contract when stimulated, which makes the lumen narrower. Appendiceal artery is the terminal branch of ileocolic artery, and it is a terminal artery, so when contracture or obstruction occurs due to stimulation, it often leads to ischemia or even necrosis of the appendix.

Appendicitis is caused by bacterial infection, but there is no specific pathogen. Escherichia coli, enterococcus and streptococcus can usually be found in the appendix cavity, but these bacteria can invade and cause appendicitis only after the mucosa of the appendix is damaged. The appendix cavity can be mechanically blocked by faeces and parasites, and it can also be caused by various stimuli, causing blood circulation disorder in the appendix wall and causing mucosal damage, which is beneficial to bacterial infection and appendicitis.

pathological change

1.There are three main types of acute appendicitis.

(1) acute simple appendicitis: It is an early appendicitis, and the lesions are mostly confined to the mucosa or submucosa of the appendix. Visually, the appendix is slightly swollen, the serosal surface is congested and loses its normal luster. Microscopically, one or more defects can be seen in the mucosa epithelium, with neutrophil infiltration and cellulose exudation (Figure 10-20). Inflammatory edema was found in the submucosal layers.

Figure 10-20 Acute simple appendicitis

Mucosal epithelium in appendix recess is necrotic and exfoliated, and there is a large number of neutrophil infiltration ×94.

(2) Acute cellulitis appendicitis: or acute suppurative appendicitis, which often develops from simple appendicitis. Visually, the appendix is obviously swollen, the serosa is highly congested, and the surface is covered with cellulosic exudate. Microscopically, it can be seen that the inflammatory lesions spread from the superficial layer to the deep layer in a fan shape, reaching the muscular layer and serosa layer directly (figure 10-2 1). All layers of the appendix wall are infiltrated by a large number of neutrophils, with inflammatory edema and cellulose exudation. The serosal surface of the appendix is covered by a thin film composed of exudative cellulose and neutrophils, that is, there are periappendicitis and localized peritonitis.

Fig. 10-2 1 acute cellulitis

The dotted area in the development pattern of appendicitis shows inflammatory cell infiltration.

(3) acute gangrenous appendicitis: It is a severe appendicitis. Thrombophlebitis caused by obstruction of lumen, pus accumulation, increased pressure in lumen and infection of mesoappendix vein can all cause blood circulation disorder of appendix wall and even necrosis of appendix wall. At this point, the appendix picks up the island? Oyster advice? 5 Jia Lu ┛ Zhu? To? Would you like to shake Cang Qi? е live?

Outcome and complications

Acute appendicitis has a good prognosis after surgical treatment. Only a few cases have complications or become chronic appendicitis due to untimely treatment or low body resistance.

Complications mainly include acute diffuse peritonitis and periappendiceal abscess caused by perforation of appendix. Sometimes, due to thrombophlebitis in mesoappendix vein, bacteria or bacteria-containing thrombus can flow into the liver through portal vein blood and form metastatic liver abscess. If the proximal end of the appendix is blocked, the distal end is often highly inflated, forming a cyst. Its contents can be pus (empyema of appendix) or mucus (mucocele of appendix). Mucocele rupture, mucus into the abdominal cavity, can form pseudomyxoma on the peritoneum.

2. Chronic appendicitis is mostly transformed from acute appendicitis, or it can be chronic at the beginning. The main pathological changes are different degrees of fibrosis of the appendix wall and chronic inflammatory cell infiltration. Clinically, there is pain in the right lower abdomen.

appendicitis

Appendicitis refers to purulent disease of appendix, but it can be divided into acute and chronic diseases. If there is tenderness of lower abdomen fixation, it is of great diagnostic significance for acute appendicitis. If it is chronic appendicitis, there is a history of acute appendicitis, only discomfort or dull pain in the right lower abdomen, which can be induced by activities and improper diet. The effective remedies commonly used for this disease are mainly as follows.

[Party I]

Rhubarb10g, mirabilite 9g, forsythia suspensa and honeysuckle12g, caulis sargentodoxae15g, rhizoma corydalis10g, radix aucklandiae and peach kernel 9g each, and cortex moutan12g. Decoct with water, daily 1 dose.

This recipe is suitable for appendicitis caused by damp-heat and blood stasis. Its main symptoms are dull pain in the right lower abdomen, persistent or paroxysmal pain, or pain in the upper abdomen at first, or pain around the umbilicus first, and then transferred to the vicinity of the right Tianshu point, which may be accompanied by abdominal skin spasm, abdominal distension, anorexia, nausea, belching, slight fever, normal or secret stool. The tongue coating is thin and white or yellow and white at the same time, and the pulse is string-slippery, string-slippery or thin and astringent.

[Party II]

Flos Lonicerae12g, Herba Taraxaci and Herba Violae each15g, Herba Hedyotidis Diffusae and Radix et Rhizoma Rhei each10g, Fructus Toosendan and Cortex Moutan each 9g, Radix Paeoniae Rubra10g and Rhizoma Polygoni Cuspidati15g. Decoct with water, daily 1 dose.

This recipe can clear away heat and toxic materials, remove blood stasis and relieve pain, and is suitable for appendicitis caused by heat accumulation. Its main symptoms are abdominal pain, obvious tenderness in the right lower abdomen, rebound pain, abdominal skin contracture, or palpable mass, accompanied by fever and thirst, anorexia, nausea and vomiting, constipation or loose stool's discomfort, short and red urine, yellow and scanty fur or thick and greasy, and rapid and slippery pulse.

[Party III]

Flos Lonicerae10g, Fructus Forsythiae12g, Radix Scutellariae, Radix Rehmanniae and Radix Scrophulariae 9g each, Radix Glycyrrhizae 6g, Radix et Rhizoma Rhei10g, Herba Violae12g, Flos Chrysanthemi Indici and Herba Taraxaci 9g each, and Semen Benincasae 30g. Decoct with water, daily 1 dose.

This recipe has the functions of clearing away heat and toxic materials, dredging fu-organs and expelling pus, and is suitable for appendicitis caused by festering pus. The main symptoms are abdominal pain extending from the lower right abdomen to the whole abdomen, intense pain, abdominal skin emergency, total abdominal tenderness, rebound pain, persistent high fever or frequent cold and heat, red face and red eyes, dry lips and bad breath, nausea and vomiting, abdominal distension and constipation, or thin and foul stool, and frequent urination.

[Party 4]

60 grams of fresh wild chrysanthemum, 60 grams of Patrinia15-,and 30 grams of Viola yedoensis. Choose 1 species, and decoct in water; Take it in 3-4 times, one dose a day.

This prescription can be used for acute appendicitis.

[Fang Wu]

Radix Paeoniae Alba18-45g, Radix Glycyrrhizae and Radix Bupleuri 6-12, Fructus Aurantii, Cortex Moutan and Cortex Phellodendri 0/0-15g. Decoct in water for 3 times, daily 1 dose, and double the dose in severe cases.

This prescription is suitable for acute and chronic appendicitis.

[Party 6]

Sanguisorba officinalis, Sophora japonica each 30g, Scutellaria barbata15g, Glycyrrhiza uralensis 3g, fresh rehmannia 30g, and root onions 20.

Decoct in water, and take it in three times, one dose per day.

This prescription is suitable for acute appendicitis.

[Fang Qi]

60 grams of garlic, each gram of mirabilite and rhubarb. First, garlic and mirabilite are mashed and applied to the most painful part of the abdomen (a layer of vaseline is applied locally to prevent skin damage) for 2 hours, then the medicine is removed, and rhubarb powder vinegar is taken for external adjustment, and it is applied for 6-8 hours, * * * once, and it can be repeated after several hours if necessary.

This prescription is used for acute appendicitis.

[Party 8]

Fresh purslane120g (30g), mung bean 30-60g. Decoct the soup and take it in 2-3 times.

This prescription is effective for acute appendicitis.

[Fang Jiu]

Coix seed 50-100g. Boil clear water into porridge with moderate thickness, and take it twice a day 1-0/dose.

This prescription is used for acute appendicitis recovery period and chronic appendicitis.

[Fang Shi]

30 grams of sweet melon seeds and appropriate amount of sugar. Mash it, grind it, and take it with boiling water.

This prescription is suitable for acute appendicitis.