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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The etiology of acute appendicitis

The main cause of acute appendicitis is due to the narrowing of the appendiceal lumen, which can easily lead to the obstruction of food residues and fecal masses. Following the obstruction, mucosal damage occurs, which leads to secondary infections. Additionally, neglecting regular living habits, such as overeating, excessive fatigue, and frequent heavy drinking can exacerbate or trigger acute appendicitis. Therefore, maintaining regular living habits in daily life, such as having meals at fixed times, reasonable rest and work schedules, balancing work and leisure, and engaging in appropriate outdoor activities, can play a positive role in preventing acute appendicitis.

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Gastroenterology
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Acute Appendicitis Etiology

The cause of acute appendicitis is primarily bacterial infection of the appendiceal lumen due to various reasons. The appendix itself is a narrow tube connected to the cecum. If a fecalith falls into the lumen, it can cause obstruction of the appendiceal lumen, leading to an increase in intra-luminal pressure and circulatory disturbances in the appendiceal wall. At this time, the mucosa is susceptible to damage, and bacterial invasion of the wall can cause infections of varying degrees. Additionally, gastrointestinal dysfunction, such as diarrhea or constipation, can also cause spasms of the appendiceal vessels, leading to blood supply disturbances and resulting in acute inflammation.

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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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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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Acute appendicitis complications

The main complications of acute appendicitis include: First, purulent peritonitis, due to the appendix becoming purulent and leading to perforation, pus flows into the abdominal cavity, causing diffuse peritonitis; Second, abdominal abscess, purulent appendicitis that is not treated surgically forms a capsule around the appendix, encapsulating it, and a lump can be felt on the abdominal surface; Third, internal-external fistula, if the abscess around the appendix is not drained in time, it can break through to the intestinal abdominal wall, forming a fistula.