Wednesday, July 21, 2010

Alert! Appendicitis caused by ascending colon

Clinical findings, with ascending colon carcinoma in the elderly, a considerable portion was misdiagnosed as appendicitis. One: Some anti-inflammatory conservative treatment, but good times and bad, ultimately delayed treatment; some surgery to remove the appendix, postoperative abdominal pain attributed to adhesion and delayed treatment; some to remove the appendix when the ascending colon was found in Ho prepare for the next rush without surgery, recurrence after surgery easily, and postoperative complications.

The reasons leading to appendicitis ascending colon carcinoma: the ascending colon as luminal stenosis caused cancer, intestinal stasis `content objects to the appendix lumen leading to inflammation of reflux.

Early symptoms of chronic appendicitis

Early symptoms of chronic appendicitis? Early symptoms of chronic appendicitis, you know? Early symptoms of chronic appendicitis, you know? Appendicitis is usually manifested as abdominal pain earlier, is caused by the appendix, are usually the lower right abdomen and pain with symptoms, and hand slightly lower right corner of the appendix according to the location of force will be pain!

Although appendicitis treatment methods, but the most sure of, or surgery. As a man got his head cut open septic inflammation is best to avoid osteomyelitis or sepsis. Appendicitis, the Chinese called appendicitis, that is, purulent inflammation of the appendix. Easy to necrotic appendix, perforation is very vulnerable, only to cut off early in order to avoid perforation. This is what the ancients taught us again and again, we should guard against "a means of disease, can damage several feet of footer" truth.

Conservative treatment should be thoroughly diagnosed with appendicitis later, as a result of examination, negotiation, implementation of temporary special task or work can not be separated off, will not accept surgical treatment, conservative treatment should be thorough. Principle is enough, and effective antibiotics in combination, control the development of inflammation. Conservative treatment should be closely observed during the illness and, if worse still surgery. Conservative treatment, Yi Chi digestible, nutritious diet, symptoms should be occasional fasting, do not over-exercise or over exertion, so as not to contribute to perforation.

How to care for after appendicitis operation

Although appendicitis is a small operation, but if not pay attention to postoperative care, is in for trouble. Let's have the specific brief to do something after appendectomy nursing care:

1 According to the different anesthesia, select the appropriate horizontal position, such as spinal anesthesia should be 6 to 12 hours supine pillow to prevent cerebrospinal fluid leakage caused by headache. Continuous epidural anesthesia can be a low pillow supine.

2 observed vital signs every hour measurement of blood pressure, pulse time, continuous measurement three times to smooth. Such as blood pressure and pulse speed up or down, then consider a bleeding wound should be observed in time to take the necessary measures.

3 simple appendicitis, postoperative 12 hours, or gangrenous or perforated appendicitis excision, if equipped with a drainage tube, to be stable blood pressure should be changed after the semi-supine posture Banwo or low, in order to facilitate drainage and prevent the inflammatory effusion into the abdominal cavity.

4 Diet: Fasting the day of surgery, postoperative first day of the liquid, the next day into the soft diet, in normal circumstances, 3 to 4 days into the normal diet.

5 after 3 to 5 days to disable strong laxative and irritating strong soapy water enema, so as not to increase peristalsis, Er Shi appendix stump off or suture ligature wound dehiscence, postoperative constipation can be taken orally as a laxative.

6 after 24 hours, up activities to promote recovery of bowel movement and prevent intestinal adhesion, at the same time promote blood circulation, accelerate wound healing.

7 elderly patients after surgery to keep warm, often making the back to help cough, to prevent hypostatic pneumonia.

(Postoperative complications and nursing care)

An incision infections due to contaminated surgical operation, gangrenous or perforated appendicitis in particular prone. 3 to 5 days after the body temperature continues to rise or fall after the rise again, the patient felt pain, swelling and tenderness, skin around the incision, then suggest a wound infection.

2 abdominal bleeding arterial bleeding are due to appendectomy appendectomy mesangial ligature off, patients showed pale, with abdominal pain, bloating, rapid pulse, cold sweats, there is decreased blood pressure and other symptoms of shock, immediate supine, sedation, oxygen inhalation, intravenous infusion, while blood for blood grouping and cross matching in preparation for surgery to stop bleeding.

3 patients showed postoperative abdominal abscess continued high fever, abdominal pain, bloating, with tenesmus sense, then symptoms occur. Semi-supine position should be attention to the drainage, so that secretions or pus into the pelvic cavity, to reduce toxicity while enhancing antibiotics. Not improved by the proposed drainage surgery done.

4 fecal fistula appendix stump ligature off or intestinal surgery and other accidental injury, can lead to fecal fistula. Colonic fistula fecal fistula is usually formed when the infection is generally restricted in the cecum around without the threat of diffuse peritonitis, body temperature is not high, nutrient deficiency is not serious, antibiotic treatment can largely self-healing.

(Post-operative dietary taboos)

1. Appendicitis after the operation, only food for one day, the next day to the flow of food can be, the third day of semi-liquid food, the fifth day can be given soft food, this time, the liquid should be light and nutritious, and to warm clothing, avoid rough slag into the liquid food intake. Less semi-liquid diet to use Java, the Jishi with chicken, ham and various vegetables, soups, even when these foods have been cooked sucks, have to wait until 10 days after surgery to as appropriate. Restricted diet with crude fiber foods such as celery, cabbage, parsley, garlic, leeks, Chinese toon, bamboo shoots, bamboo shoots, pineapple, etc., in order to reduce stool frequency and undigested crude fiber friction on the wound

2. Avoid oily food. Even 10 days after surgery, the body can withstand the soft food, they eat too early into the greasy food.

3. Bogey-fat thing. Two weeks after surgery, despite a good recovery, but also has stitches, but this time the body resistance is weak, the risk of inflammation still exists, it must be made taboo thing.

Note: appendicitis during pregnancy should be treated early

Pregnant stomach pain, probably because of miscarriage, premature signs, but also there may be some, the surgical emergency caused. Acute appendicitis is one of the most common surgical emergency, once the diagnosis of appendicitis during pregnancy to prevent inflammation-proliferation, while giving antibiotics to surgery as soon as possible, patients highly suspicious, but also feasible to laparotomy, to avoid the rapid development of disease.

Characteristics of appendicitis during pregnancy

1, appendix position change: location of early stages of pregnancy no significant changes in the appendix, along with the progress of pregnancy, the uterus is increasing, and the appendix will gradually upward, outward shift.

2, congestive pelvic organs during pregnancy, the appendix also congestion, inflammation of rapid development, therefore, prone to appendicitis necrosis and perforation.

3, due to the increased uterine omentum was over, difficult to package inflammation, once the perforation, likely to cause peritonitis.

4, if the spread of uterine serous inflammation, can induce uterine contractions, causing miscarriage, premature delivery or tonic contraction of the uterus, the toxin can lead to fetal hypoxia and even death threats to safe motherhood.

Three factors have led to symptoms is not easy to judge

Appendicitis occurs when the pregnant woman with symptoms similar to ordinary people, mostly manifested as abdominal pain, nausea, vomiting, a few will be accompanied by fever, blood tests showed increased inflammation index rose and the white blood cells, etc., but because of the special physiological conditions during pregnancy, may increase the difficulty of diagnosis .

Factor 1 uterus squeeze the appendix

Because the pregnant woman's uterus bigger, the appendix has been squeezed, leading to acute appendicitis during pregnancy pain point moves to the uterus often cover up the signs and symptoms of appendicitis are not typical.

Factors 2, increase the difficulty of checking

For the sake of her unborn child's health, worried that some tests (such as X-ray or CT scan) may affect fetal development; the same time as doing a blood test, the pregnant women on behalf of inflammatory white blood cell count had more than the normal, so it hard in a while to make the right judgments.

Factor 3, symptoms easily confused

Pregnant women already often nausea, vomiting, stomach discomfort symptoms, and some symptoms similar to acute appendicitis, it is not easy to diagnose from symptoms on.

Various stages of pregnancy with acute appendicitis principles

1, during early pregnancy (1 to 12 weeks) with acute appendicitis, regardless of the severity of clinical presentation, surgical treatment should be. Little interference on the uterus at this time will not affect the continued pregnancy. If the time of recurrence until late pregnancy re-surgery, can increase the difficulty of operation, the mother is also at risk.

2, second trimester (13 to 28 weeks) with acute appendicitis, in the high-dose intravenous penicillin or ampicillin to prevent the spread of inflammation at the same time, surgical treatment as soon as possible. At this point the fetus has been relatively stable, surgery on the uterus is not interference, easy to abortion, to continue pregnancy. Is generally believed that 4 to 6 months of pregnancy is surgery to remove the appendix better time.

3, late pregnancy (28 to 36 weeks) with acute appendicitis should be surgical treatment, even if the result of surgical stimulation premature birth, most babies can survive. Impact of surgery on pregnant women is not large. If the pregnancy is almost expected date of birth, cesarean section should be first, again appendectomy. To select the extraperitoneal cesarean section is appropriate. When the appendix has been perforated, complicated by diffuse peritonitis, a serious pelvic infection, or the uterus, placenta have been signs of infection should be considered when cesarean section was performed at the same time, hysterectomy, subtotal hysterectomy, and the need drainage.

Surgery to avoid the occurrence of acute peritonitis

If the pregnant woman or the side of right lower abdominal pain and persistent remission, even unbearable, accompanied by nausea, vomiting, fever, coupled with significant press the right side of abdominal pain, abdominal muscles are hard, it is a sign of acute appendicitis, should immediately go to the hospital diagnosed.

Because pregnancy increases the difficulty of diagnosis, according to statistics, acute appendicitis in pregnant women before surgery and not one hundred percent confirmed. Gynecologist suggested that if the pregnancy is highly suspected acute appendicitis, the best surgery to remove the appendix or as soon as possible. Because early acute appendicitis without surgery, once the time delay to cause acute appendicitis peritonitis complicated by sepsis can cause pregnant women, then the mother and fetus are in danger.

Surgery to avoid surprise!

Mothers who do not have to worry about the risks of surgery, because even if the traditional appendectomy, as long as the degree to oppress the uterus, however, does not result in premature delivery or fetal injury, Now that many of the major hospitals in the comprehensive removal of the appendix can use laparoscopy technology, this surgical wound is small, good vision, faster recovery, can be reduced on the mother and fetus. After surgery doctors will give pregnant women contractions inhibitors to prevent miscarriages or premature delivery.

Medical Reminder

Early detection, early treatment and leave no after-effects

After reading above, I believe you mothers for treatment of acute appendicitis during pregnancy have a preliminary understanding. Although the probability of acute appendicitis in pregnant women is not high, but if unfortunately these cases, mothers do not panic, but also no doubt that in experienced surgical and gynecologists under the guidance of an operation as soon as possible. Early detection and treatment, generally do not leave sequelae; if hesitant, missed treatment opportunities, resulting in acute peritonitis, there may be life on the risk of mothers who caution!

Children eat more cold drinks will be acute appendicitis

Yesterday morning, a 12-year-old child was admitted to hospital due to perforated appendicitis, emergency surgery. The doctor said, that children with acute appendicitis, since the beginning of summer find many of the recent two months have been admissions of more than 10 cases, most of the age of 5 years -15 years old. Eating too much cold, is that these children one of the factors of acute appendicitis.

Doctors say excessive cold can lead to gastrointestinal disorders, muscle and blood vessel happened to appendix reflex spasm, resulting in appendix obstruction and blood circulation disorder. Appendix mucosa damage after infection, misdiagnosed as gastrointestinal infections.

Eat cold drink excessive damage to the digestive tract are also quite large. Yesterday, the doctor said just one patient admissions:

Girls lobular, 7-year-old child, love to eat cold. 1 year ago, the girl ate three ice cream, the sudden hiccup, a dozen is more than an hour. Later, she was just a cold food to eat and catch cold, they begin to hiccup, increasingly longer duration, a stage beyond that day, the kind of drugs are not effective. Sent out a look, this child's illness is caused by long-term eating cold food, respiratory, gastrointestinal mucosa are not fully developed, the role of weak defensive barrier encountered cold food stimulation, it easy to keep belching.

Expert: differential diagnosis of acute appendicitis 7:00 Experience

Primary diagnosis and treatment of common diseases exchange area

Acute appendicitis is a common clinical emergency, I will be teaching the main content summarized as seven, though not necessarily strict but very practical. Summarized as follows:

The first acute abdomen Acute appendicitis is the most common acute abdomen. Rough estimate of the incidence: accounts for one-thousandth of the normal population, accounting for one percent of the hospital all the patients, accounting for one tenth of general surgery patients.

Two causes of obstruction and infection of the appendix lumen is the two main acute appendicitis risk factors, both on each other.

3 symptoms 1, systemic symptoms: fatigue, fever, body temperature, not more than 38.5 ℃; 2, gastrointestinal symptoms: upper gastrointestinal symptoms (nausea, vomiting) mainly lower gastrointestinal symptoms (diarrhea, constipation) rare; 3 abdominal pain: is the most common, most significantly, the earliest symptoms characteristic showed metastatic right lower abdominal pain, was seen only in 70% of the patients.

Four signs a special position: The patient walks over to the right of the bend, when the right hip joint was supine flexion; 2, right lower quadrant tenderness: is the most common and most important signs, mainly wheat tender point's point , Mexico's point, point 3 gram; 3, abdominal rigidity: is the inflammation of the appendix invading the serosa of the performance of the most significant parts of tenderness is the most obvious places abdominal rigidity; 4, allergic reflex: an early acute appendicitis, the phenomenon of skin hypersensitivity.

Five inspection methods 1, colon inflatable test: Tip appendicitis patients, to identify the right ureter stones; 2, psoas muscle test: Tips for the cecal appendix posterior; 3, leg raise test: Tips for the cecal appendix posterior; 4 , obturator internal muscle test: Tips appendix point to pelvic and long; 5, digital rectal examination: rectal wall tenderness on the right, indicating a lower position of the appendix, pelvic depth.

Six special type 1, chronic appendicitis: right lower abdominal tenderness, not imaging the appendix barium enema, ultrasound showed chronic inflammation; 2, ectopic appendicitis: diagnostic key is the location of cardiac auscultation; 3, Old Appendicitis: Symptoms and signs are not typical, easily misdiagnosed appendicitis is characterized by old age; 4, acute appendicitis in children: symptoms and the symptoms more obvious signs, but the baby is inaccurate and easily misdiagnosed; 5, appendicitis during pregnancy: an important feature of appendicitis with pregnancy tender point increase in the month constantly on the move; 6, appendix abscess: abscess is not real, but the inflammation caused by adhesions mass, palpable mass in right lower abdomen.

7 differential diagnosis of an acute gastroenteritis: a food dirty history of nausea, vomiting, diarrhea triad, no fixed tender points; 2, acute ulcer perforation: a history of ulcer, sudden severe abdominal pain, tenderness over The most significant abdominal, abdominal board-like rigidity, X films see subdiaphragmatic free gas; 3, acute cholecystitis: a repeated attack over the history of right upper quadrant abdominal pain and tenderness in order to clear, Murphy sign, Boas sign positive, ultrasonography had positive findings ; 4, intestinal obstruction: pain (abdominal pain), vomiting (vomiting), swelling (bloating), closed (stop defecation, exhaust) + liquid level (see intestinal fluid abdominal X film plane); 5, urinary stones: Radioactive abdominal pain, lower back pain percussion, gross or microscopic hematuria, ultrasonography had positive findings; 6, acute pancreatitis: abdominal belt bit pain, abdominal tenderness over the most significant blood and urine amylase, imaging studies have positive findings; 7, Obstetrics & E: Female patients with appendicitis to ask obstetrics and gynecology consultation, and asked menstrual history.

Note: Beware of chronic appendicitis, right lower quadrant pain

Beware of chronic appendicitis, right lower quadrant pain

Chronic appendicitis is acute inflammation of the appendix appendix left after subsiding and chronic inflammatory diseases, such as the wall of fibrous connective tissue hyperplasia, stenosis or obstruction, appendix distortion, and other surrounding tissue adhesion.

Abdominal pain is a very common symptom, some minor dull pain, after a period of time may relieve itself, and patients will be easily ignored, but this state of affairs is a long-term recurring, then there may be chronic inflammation, such as the right low abdominal pain again to indicate the possibility of chronic appendicitis.

Right lower abdominal pain - may be hidden to the symptoms of chronic appendicitis

Clinically, chronic appendicitis, there are two different types, and right lower abdominal pain is a common characteristic of its performance.

Primary chronic appendicitis: the characteristics of the onset hidden, showing chronic right lower abdominal pain, mild pain, often dull pain, symptoms develop slowly, last for a long duration, months to years. No acute episode of early disease, course of disease nor repeated acute phenomenon.

Secondary chronic appendicitis: Acute appendicitis is characterized for the first time after onset, by the more conservative treatment or on its own mitigation, then left with clinical symptoms and permanently, course can be repeated again, or acute right lower abdominal pain was more severe .

Right lower quadrant pain, chronic appendicitis is not necessarily

Can cause right lower quadrant pain and tenderness of the cause of many, some patients based on their long history of right lower abdominal pain, the self-diagnosed as chronic appendicitis, which is unscientific, but also easy to miss the diagnosis of other diseases such as chronic colitis, colon cancer , appendicitis, cecal tuberculosis, cancer and so blind.

Obscure or irregular dull pain right lower quadrant is the main clinical manifestations of chronic appendicitis, occasionally other gastrointestinal symptoms such as frequent bowel movements or constipation, abdominal fullness feeling, nausea, vomiting, fever. Right lower quadrant tenderness is the main signs. History of typical acute appendicitis, there are recurrent right lower quadrant pain and tenderness, combined with barium enema examination may rule out other diseases, before a diagnosis.

Surgery patients who are not suspected of self-care

After diagnosis of chronic appendicitis, in principle, should be surgical treatment, removal of pathological appendix, especially patients with a history of acute onset, should prompt surgery. The diagnosis of suspected patients or patients with severe mixed elderly patient should be temporary non-surgical treatment, during follow up observation, elective surgery after the diagnosis.

Daily life should note the following:

First, to maintain smooth stool eating foods rich in fiber, so that the stool to keep them open, develop good bowel habits. Because constipation can lead to fecal impaction, appendicitis cavity obstruction induces appendicitis; or fecal stimulate the appendix mucosa, causing inflammation Ershi appendicitis.

Second, avoid greasy food light in patients with chronic appendicitis, normal diet should be light and less greasy. In general, the nature of the meat for hot food such as beef, mutton, dog should be restrained, and green onion, ginger, garlic, pepper, also should not eat; with heat, detoxification, dampness role of food, such as mung bean, bean sprouts, bitter melon can be eaten in moderation.

Third, after a meal should not "take a walk" take a walk after dinner is one of the traditional health methods, but patients with chronic appendicitis immediately after a meal should not exercise, usually not suitable for rapid movement, in order to avoid incarceration caused by fecal disease.

Fourth, pay attention to rest against fatigue usually pay attention to rest, work and rest to avoid fatigue. Because fatigue makes immunity, immunity declines are likely to cause appendicitis.

5, Chinese medicine treatment of Chinese medicine treatment can ease the sub-acute and chronic appendicitis symptoms, such as Kam-red film, Daihuangmudan soup preparation or decoction, can play a role in easing the symptoms of appendicitis.