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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Typical symptoms of acute appendicitis

The typical symptoms of acute appendicitis include abdominal pain, which starts in the upper abdomen or around the navel and, after several hours, shifts and localizes to the lower right abdomen. Additionally, reflexive gastric spasms may cause nausea and vomiting. Due to the inflammation, the body may develop a fever, generally not exceeding 38 degrees Celsius. If the inflammation affects the parietal peritoneum, it can cause tenderness, rebound pain, and abdominal muscle rigidity. These are the typical symptoms, and a preliminary diagnosis can usually be made based on them. Most cases require an appendectomy.

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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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The cause of acute appendicitis

The etiology of acute appendicitis is directly related to obstruction and infection of the appendiceal lumen. The appendix, a narrow and elongated tube connected to the cecum, can develop increased luminal pressure due to obstruction, leading to disturbances in the blood supply to the appendiceal wall. This can easily cause damage to the mucosa and subsequent infection. Infection of the appendiceal lumen can directly cause acute appendicitis. Additionally, gastrointestinal dysfunction can also cause muscle and vascular spasms in the appendix leading to blood supply disturbances and the invasion of bacteria, resulting in acute inflammation. For acute appendicitis, surgical treatment should be administered immediately upon diagnosis.

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Written by Ren Zheng Xin
Gastroenterology
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Precursors of acute appendicitis

Acute appendicitis is acute inflammation of the appendix lumen, and currently, there are no particularly typical precursors, but the causes of acute appendicitis should be noted, which are related to obstruction and infection of the appendix cavity. If the appendix lumen is compressed for a long time, the accumulation of secretions can cause blood supply disorders in the distal appendix wall, directly causing damage to the appendix mucosa, and inducing infection that leads to appendicitis. Additionally, gastrointestinal dysfunctions such as diarrhea and constipation can also cause spasms of the appendix muscles and vessels, leading to blood supply disorders and mucosal damage, thereby causing acute appendicitis.

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Written by Ren Zheng Xin
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.