Acute appendicitis clinical features

Written by Huang Gang
Gastroenterology
Updated on December 24, 2024
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Acute appendicitis generally presents primarily as abdominal pain, specifically migratory pain to the lower right abdomen. Initially, the patient may experience stomach pain, which gradually shifts to pain in the lower right abdomen. Whether it is appendicitis needs to be diagnosed by a physical examination by a doctor, or an ultrasound of the appendix during the acute phase can be performed. If the appendix appears significantly swollen on the ultrasound, it can also confirm the diagnosis of acute appendicitis. Typically, the best treatment for acute appendicitis is surgery, especially if the condition is very severe and critical, as it may lead to perforation of the appendix and result in purulent peritonitis, which is very serious and life-threatening. Therefore, once diagnosed with acute appendicitis, it is best to be hospitalized for surgery.

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Causes of Chronic Appendicitis

The causes of chronic appendicitis mainly include three aspects. First, the narrowing of the appendiceal lumen. Most cases of chronic appendicitis have a history of acute appendicitis attacks. Long-term recurrent chronic inflammation can lead to thickening of the appendiceal wall, narrowing of the appendiceal lumen, and weakened peristalsis of the appendix. Second, obstruction within the appendiceal lumen by fecaliths is also a common cause of chronic appendicitis. Third, enlarged lymph nodes in the abdominal cavity can compress the appendiceal lumen, causing narrowing and repeated bacterial infections in the appendix. These are the common causes of chronic appendicitis.

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How to diagnose appendicitis

Appendicitis is primarily diagnosed clinically through a physical examination. The patient is asked to lie flat, exposing the abdomen, with legs bent. The doctor stands on the patient’s right side and uses the right hand with fingers together to gently rub the abdomen, pressing on the McBurney's point. If there is significant pain, this is considered positive tenderness. Then, the doctor quickly lifts the fingers; if there is significant rebound pain, it is generally confirmed as acute appendicitis. During acute appendicitis, as the appendix lumen expands and the appendix becomes congested and edematous, ultrasound imaging can also show corresponding signs that serve as an auxiliary diagnosis. Once acute appendicitis is confirmed, it is mostly treated surgically.

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Does appendicitis hurt?

Appendicitis is generally divided into chronic and acute appendicitis. Both chronic and acute appendicitis can cause pain, which is usually severe. In cases of acute appendicitis, if the pain subsides after a while, it is actually more dangerous. It may indicate complications such as intestinal perforation or intestinal necrosis, leading to gradually diminishing pain. In such cases, timely surgical removal is necessary; otherwise, if local ulceration occurs, it can potentially affect the entire intestine. Thus, appendicitis generally causes pain, especially during the chronic phase. The pain is quite noticeable and, although generally bearable, can directly impact the quality of life.

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The dangers of chronic appendicitis

Patients with chronic appendicitis primarily exhibit persistent, recurring pain in the lower right abdomen, which may be accompanied by abdominal bloating, loss of appetite, and indigestion. These prolonged gastrointestinal symptoms can lead to malnutrition and a weakened immune system. Additionally, chronic appendicitis can acutely flare up and become suppurative, which can lead to perforation of the appendix. Once the appendix perforates, it causes diffuse peritonitis, leading to sepsis, septic shock, and even multi-organ failure, endangering the patient's life. This outlines the dangers associated with chronic appendicitis.

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Causes of appendicitis

The main causes of appendicitis are the narrowing of the appendix lumen and the subsequent blockage of the appendix lumen. Bacterial infection can directly cause acute inflammation. Additionally, poor dietary habits in daily life can also trigger appendicitis. These include overeating and binge drinking, engaging in strenuous exercise right after eating, consuming strong tea, coffee, or spirits, neglecting rest, and excessive fatigue. Therefore, for the prevention of appendicitis, it is mainly important to develop regular lifestyle and eating habits, with meals at fixed times and in measured amounts, and consuming more vegetables to ensure the smooth functioning of the gastrointestinal tract.