The appendix (lán wěi), also known as the worm-like process, is a slender curved blind tube with its roots attached to the inside and back of the cecum. The position of the appendix varies greatly from person to person. The tip of the appendix can point in all directions. Generally, the posterior position of the cecum is the most, followed by the pelvic position. The average length of the appendix is 7 ~ 9 cm, and it can also vary between 2 ~ 20 cm. The upper end of the appendix opens to the cecum, and there are also less obvious semilunar mucosal folds at the opening. The projection of the appendix root on the body surface is generally at the lateral 1/3 of the line from the right anterior superior iliac spine to the umbilical cord, which is called the appendix point here, also called Maxwell point. When appendicitis attacks, there is often obvious tenderness here.

What is appendicitis?

Appendicitis is a common disease. Clinically, there are often symptoms such as right lower abdominal pain, elevated body temperature, vomiting and neutropenia. Appendicitis is an inflammation of the appendix and the most common abdominal surgical disease.

The typical clinical manifestation of acute appendicitis is gradually dull pain in the upper abdomen or around the umbilicus, and abdominal pain transfers to the right lower abdomen after several hours. It is often accompanied by loss of appetite, nausea or vomiting. At the initial stage of the disease, there are no obvious systemic symptoms except low fever and fatigue. If acute appendicitis is not treated early, it can develop into gangrene and perforation of the appendix, complicated with localized or diffuse peritonitis. The mortality rate of acute appendicitis is below 1%, and the mortality rate after diffuse peritonitis is 5 ~ 10%.

After non-surgical treatment or self-healing, acute appendicitis can leave fibrous tissue hyperplasia, appendix wall thickening, lumen stenosis and surrounding adhesion, which is called chronic appendicitis and easily leads to another acute attack. The more attacks, the more serious the damage of chronic inflammation, which can be repeated, acute, asymptomatic or occasionally mild right lower abdominal pain, so it is also called chronic recurrent appendicitis. If the patient has never had a history of acute appendicitis, but complains of chronic lower right abdominal pain, it is not easy to diagnose chronic appendicitis and remove the appendix. Attention should be paid to excluding other ileocecal diseases, such as tumor, tuberculosis, nonspecific appendicitis, Crohn's disease and mobile appendicitis, as well as mental and neurological factors, otherwise appendectomy is difficult, and even if there are no other diseases, the symptoms may not be eliminated.

The cause of disease

One end of the appendix communicates with the cecum, which is about 6 ~ 8 cm long, and the lumen is narrow, only about 0.5cm. There are abundant lymphoid tissues in the appendix wall, which constitutes the anatomical basis of the appendix's easy inflammation. This anatomical feature is also easy to cause obstruction of the appendix. About 70% patients can find that the appendix cavity is blocked for different reasons, such as fecal lumps, fecal stones (that is, fecal lumps that stay for a long time are mixed with appendix secretions and may be deposited by minerals such as calcium), food residues, twisted appendix itself and parasites (such as roundworms and pinworms). After the inflammation of acute appendicitis subsides, scar stenosis can be formed in the appendix, which is easy to lead to the recurrence of inflammation. Due to the abundant lymphatic tissue in the appendix wall and serious inflammatory reaction, the occurrence of obstruction is further promoted. Usually there are a lot of intestinal bacteria in the appendix cavity. When there is obstruction, the pressure in the lumen at the distal end of the obstruction increases, and the blood circulation of the appendix wall is affected, and the damage of mucosa creates conditions for the invasion of bacteria. Sometimes, although feces, food residues, parasites and foreign bodies in the appendix cavity will not cause obstruction, they can cause mechanical damage to the appendix mucosa, which is conducive to the invasion of bacteria. In addition, gastrointestinal dysfunction will also make the muscles of the appendix wall spasm, affect the emptying of the appendix and even affect the blood circulation of the appendix wall, which is also the cause of inflammation. Bacteria can invade the appendix through blood circulation and cause inflammation, which belongs to blood-borne infection.

Pathological process and clinical manifestations

At the initial stage of acute inflammation, the appendix showed congestion and swelling, edema and neutrophil infiltration in the wall, small mucosal ulcers and bleeding spots, and a small amount of serosa exudation. The accumulation of turbid exudate in the cavity is called simple appendicitis. Because the location of visceral pain is unknown, the patient feels dull pain in the upper abdomen or around the umbilicus, often accompanied by nausea and vomiting, general malaise, and abdominal pain gradually transfers to the right lower abdomen. There is obvious tenderness in the local area, and McNair's point is often used to indicate the tenderness site in clinic. In the right lower abdomen, there is a localized local tenderness point in the middle and lateral side of the line between the umbilical cord and the anterior superior spine of the right iliac bone at 1/3. This tender point was first discovered and described by American C. mcburney in 1889, so it is called mcburney point (Maxwell point). If the disease continues to develop, the swelling and congestion of the appendix will be more obvious in a few hours. There is often a small abscess on the appendix wall, mucosal ulcer necrosis, a large amount of fibrous exudation on the serosal surface, and the cavity is full of pus, which is called suppurative cellulitis appendicitis. At this time, the general symptoms are serious, and the pain in the right lower abdomen is obvious. Eventually it will develop into tissue necrosis of the appendix wall. If there is obstruction, the distal end of the appendix is more serious and purple-black. Perforation often occurs here, which is called gangrenous appendicitis. Generally accompanied by localized peritonitis. At this time, besides tenderness, there are obvious muscle tension and rebound pain. When the body temperature is above 38.5℃, the number of white blood cells in peripheral blood also increases. Because the proximal end of the appendix cavity is swollen and closed, the perforation overflows only the pus accumulated in the cavity, and there is no intestinal content. In addition, there is greater omentum wrapping, which rarely leads to diffuse peritonitis and abscess formation around the appendix.

diagnose

According to the typical clinical manifestations, there is pain around the upper abdomen and navel. After several hours, the pain moved to the right lower abdomen, and there was obvious tenderness in the right lower abdomen. General diagnosis is not difficult, but there is still a misdiagnosis rate of about 20%. Apart from doctors' experience and technical problems, there are two main reasons for misdiagnosis: ① The manifestations of some acute appendicitis are atypical. Because of the abnormal position of the appendix, such as high appendicitis is easily confused with acute cholecystitis, and the abdominal signs of posterior appendicitis are light, and pelvic appendicitis may have diarrhea symptoms; Or because of the special incidence of appendicitis, if the appendiceal process is blocked or distorted by foreign bodies, abdominal pain is located in the right lower abdomen at first, with no obvious transfer process, paroxysmal, and the abdominal signs are not obvious, much like urinary calculi or intestinal spasm. In addition, there are individual factors of patients: patients have different nerve types, pain thresholds and gastrointestinal reactions, and the elderly have poor reactions, and symptoms and signs often cannot reflect the actual severity of acute appendicitis; The child's appendix is relatively large, seeing a doctor late, and it is difficult to ask about the medical history; The appendix of pregnant women moves upward, outward or backward, the uterus is enlarged, and the abdominal physical examination is different from ordinary people. ② Other symptoms of acute abdomen are similar to acute appendicitis, such as diverticulitis at the end of ileum, acute mesenteric lymphadenitis, and some gynecological diseases such as acute adnexitis, ovarian follicular rupture, torsion of ovarian cyst, etc. Smaller ulcer perforation, perforation closed quickly, a small amount of duodenal contents flowed to the right lower abdomen, and it also showed metastatic pain in the right lower abdomen, but the tenderness in the upper abdomen was not obvious. Some medical diseases, such as acute gastroenteritis, intestinal ascariasis and abdominal purpura, also have clinical manifestations similar to acute appendicitis.

treat cordially

Simple acute appendicitis can be cured by non-surgical treatment, but chronic inflammation or lumen stenosis is easy to recur, so once the diagnosis of acute appendicitis is clear, the diseased appendix should still be removed urgently. Because of pelvic congestion during pregnancy, appendicitis develops rapidly, so it is necessary to operate in time. In the case of unknown diagnosis, if the patient has local peritonitis or obvious systemic infection, laparotomy should also be carried out to avoid delaying treatment. If there is no acute inflammation in the appendix during the operation, it is necessary to explore whether there are other acute lesions. When the patient sees a doctor, if appendicitis has formed a peripheral abscess, non-surgical treatment should be performed first. After the abscess is absorbed, the appendix should be removed after 3 months or half a year.

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. The following drugs can be selected: (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 (1): 50g of honeysuckle and dandelion, 20g of peony bark, 5g of rhubarb15g, 0g of red paeony root12g, 9g of toosendan seed, 9g of peach kernel and 9g of licorice root, which are divided into two doses 1-2 daily after decoction. (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 liquid diet, such as milk, soybean milk, rice soup, broth, etc. 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. preoperative home care (1): 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 used casually before it is diagnosed clearly. 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) Prevention knowledge 1. Enhance physical fitness and pay attention to hygiene. Be careful not to catch a cold and eat unclean things. 3. Timely treatment of constipation and intestinal parasites.