The Difference Between Acute and Chronic Appendicitis

Written by Ren Zheng Xin
Gastroenterology
Updated on September 05, 2024
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The differences between acute appendicitis and chronic appendicitis mainly lie in the onset of the condition, physical signs, and laboratory tests. First, regarding the onset of the condition, acute appendicitis occurs suddenly and can involve abrupt abdominal pain, whereas chronic appendicitis often manifests as fixed tenderness in the lower right abdomen and the symptoms are not particularly typical. In terms of physical signs, acute appendicitis presents with migratory pain in the lower right abdomen, while chronic appendicitis generally does not involve rebound pain. Thirdly, concerning auxiliary examinations, acute appendicitis shows a significant increase in the white blood cell count during an attack, whereas in chronic appendicitis, the white blood cell count may appear normal.

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Written by Ren Zheng Xin
Gastroenterology
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Causes of Acute Appendicitis

The main causes of acute appendicitis are obstruction of the appendiceal lumen and concurrent infection. The appendiceal lumen is a narrow tube that communicates with the cecum at one end. Obstruction, such as a fecalith, can lead to increased pressure inside the lumen, disturbances in blood flow, damage to the mucosa, and secondary infection. It can also be caused by direct bacterial infection within the appendiceal lumen, leading to acute inflammation. Additionally, repeated diarrhea or constipation and other gastrointestinal dysfunctions can also cause circulation disturbances in the appendix, leading to bacterial invasion and acute inflammation.

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Gastroenterology
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How is acute appendicitis diagnosed?

The definitive diagnosis of acute appendicitis is primarily through clinical physical examination and auxiliary tests. Based on typical symptoms of acute appendicitis, such as migratory right lower abdominal pain, vomiting, nausea, fever, and a few patients may have symptoms of constipation or diarrhea. There is obvious tenderness and rebound pain when pressing on the abdomen. Additionally, an abdominal ultrasound can indicate swelling of the appendix lumen and a significant increase in appendix size. These aspects can lead to a preliminary diagnosis, and once acute appendicitis is confirmed, surgical treatment should be carried out.

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Written by Ren Zheng Xin
Gastroenterology
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How is acute appendicitis diagnosed?

The diagnosis of acute appendicitis is primarily based on clinical symptoms, signs, and auxiliary examinations. The patient describes abdominal pain accompanied by nausea and vomiting. During the physical examination, migratory pain in the lower right abdomen and significant rebound tenderness upon palpation are noted. Additionally, ultrasound diagnostics suggest swelling of the appendix lumen, all indicative of acute appendicitis. For acute appendicitis, once confirmed, surgery is generally required to remove the appendix, which is the only way to completely cure acute appendicitis.

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Written by Ren Zheng Xin
Gastroenterology
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Symptoms of acute appendicitis

The typical symptoms of acute appendicitis include abdominal pain that starts around the upper abdomen or navel area, then localizes to the lower right abdomen. There are also manifestations of gastrointestinal spasms such as nausea and vomiting. Due to inflammation entering the bloodstream, there can be a systemic infection, often accompanied by fever, generally not exceeding 38 degrees Celsius. If there is an appendix perforation and peritonitis, the temperature can exceed 38 degrees. After the appendix becomes suppurative, symptoms can include abdominal muscle rigidity, dental pain, and rebound tenderness.

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Written by Ren Zheng Xin
Gastroenterology
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What is acute appendicitis?

Acute appendicitis refers to the acute inflammation occurring in the lumen of the appendix, which is caused by the narrowing or blockage and subsequent infection of the lumen. The primary symptom is abdominal tenderness and rebound pain, accompanied by nausea, vomiting, and fever. During the acute phase, blood tests often show an elevated white blood cell count. The main treatment is surgical removal of the appendix, with laparoscopic appendectomy being the commonly used method. This is also a minimally invasive approach to appendicitis treatment. Postoperative care is important, and it is advised to fast on the day of the surgery. Once gas passes through the rectum, a liquid diet may be resumed.