Why do I feel a little uncomfortable in my lower right abdomen?

The right lower abdomen is on the right side below the human navel, and most people in life are prone to dull pain or discomfort in the right lower abdomen. There are many reasons for the discomfort in the right lower abdomen. This may be a physical condition caused by adnexitis or appendicitis. Adnexitis is also a common uterine disease in women. It is very harmful to the body and needs to be checked and treated in time.

What is the cause of the discomfort in the right lower abdomen?

In this case, appendicitis or adnexitis should be considered. It is recommended to go to the hospital for a B-ultrasound examination. Adnexitis is a common disease caused by pathogenic microorganisms invading the reproductive organs and causing infection of the fallopian tubes and ovaries.

Causes

1. Acute appendicitis

(1) Obstruction: The appendix is ​​a long, thin tube that is connected to the cecum at only one end. Once obstructed, secretions may accumulate in the lumen, increasing the internal pressure and compressing the appendix wall, which may hinder distal blood flow. On this basis, bacteria in the lumen invade the damaged mucosa and easily cause infection.

(2) The main cause of infection is direct infection caused by bacteria in the appendix cavity. If the appendix mucosa is slightly damaged, bacteria will invade the wall of the tube and cause infection of varying degrees.

(3) Other factors believed to be related to the onset of the disease include visceral nerve reflexes caused by gastrointestinal dysfunction such as diarrhea and constipation, which lead to spasms of the appendix muscles and blood vessels, resulting in stenosis of the appendix lumen, obstruction of blood supply, damage to the mucosa, and bacterial invasion, leading to acute inflammation.

2. Chronic appendicitis

Clinically, it can be roughly divided into two categories: recurrent appendicitis and chronic appendicitis. The former is mostly caused by the failure to completely eliminate the residual infection during the acute appendicitis attack, resulting in the prolonged illness. The latter has no history of acute appendicitis, and the symptoms are vague and the signs are often unclear.

Clinical manifestations

1. Acute appendicitis

(1) Abdominal pain: Typical acute appendicitis causes pain in the upper and middle abdomen or around the umbilicus in the early stages. After a few hours, the pain moves to and becomes fixed in the right lower abdomen. When the inflammation spreads to the serosa and parietal peritoneum, the pain is fixed in the right lower abdomen, and the original pain in the upper abdomen or around the umbilicus is relieved or disappears. Therefore, the absence of a typical history of migratory right lower quadrant pain does not exclude acute appendicitis.

Simple appendicitis often presents with paroxysmal or persistent distending pain and dull pain. Persistent severe pain often indicates purulent or gangrenous appendicitis. Continuous severe pain affecting the middle or lower abdomen or both sides of the lower abdomen is often a sign of gangrenous appendix perforation.

(2) Gastrointestinal symptoms The gastrointestinal symptoms of simple appendicitis are not prominent. In the early stages, nausea and vomiting may occur due to reflex gastric spasm. Pelvic appendicitis or gangrenous appendix perforation may cause increased bowel movement frequency.

(3) The fever is usually low-grade, without chills, and the temperature of purulent appendicitis generally does not exceed 38°C. High fever is often seen in appendix gangrene, perforation or complicated by peritonitis.

(4) Tenderness and rebound tenderness Abdominal tenderness is a manifestation of inflammatory irritation of the parietal peritoneum. The tenderness point of the appendix is ​​usually located at McBurney's point, which is the junction of the middle and outer 1/3 of the line connecting the right anterior superior iliac spine and the umbilicus. Rebound tenderness is also called Blumberg's sign. In obese patients or those with retrocecal appendicitis, tenderness may be mild but there may be significant rebound tenderness.

(5) Abdominal muscle tension: This sign is present when the appendix is ​​suppurated, and is particularly evident when gangrene perforates and is complicated by peritonitis. However, the abdominal muscles of elderly or obese patients are weaker, so the contralateral abdominal muscles must be checked at the same time for comparison.

(6) In the early stage, especially when there is obstruction in the appendix cavity, skin hyperesthesia may occur in the right lower abdomen. The range is equivalent to the innervation area of ​​the 10th to 12th thoracic cord segments, located in the triangle formed by the highest point of the right iliac crest, the right pubic crest and the umbilicus, also known as Sherren's triangle. It does not change with the position of the appendix. If the appendix is ​​gangrenous and perforated, the skin hyperesthesia in this triangle will disappear.

2. Chronic appendicitis

(1) Abdominal pain: Pain in the right lower abdomen, characterized by intermittent dull pain or bloating, which is sometimes severe and sometimes mild, and the location is relatively fixed. Most patients experience abdominal pain after a full meal, exercise, fatigue, cold or long-term standing.

(2) Patients with gastrointestinal reactions often experience varying degrees of indigestion and decreased appetite. Patients with a longer course of illness may experience emaciation and weight loss. There is generally no nausea, vomiting, or abdominal distension, but elderly patients may experience constipation.