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.