What are the symptoms of appendicitis?

Appendicitis is divided into acute appendicitis and chronic appendicitis. Acute appendicitis will have symptoms such as abdominal pain, nausea, fever, abdominal muscle tension, and skin sensitivity in the early stages. Chronic appendicitis generally manifests itself in symptoms such as abdominal pain and decreased appetite. Appendicitis is caused by many factors and is one of the common diseases in surgery.

1. Acute appendicitis

(1) Abdominal pain: Typical acute appendicitis symptoms include pain in the upper 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 alleviated 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) Fever: Generally, it is only a low-grade fever without chills. In cases of purulent appendicitis, the temperature usually 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 becomes purulent, 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) Skin hyperesthesia. 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 due to the different positions 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 can be severe or mild at times and is located in a relatively fixed location. Most patients experience abdominal pain after a full meal, exercise, fatigue, cold or long-term standing.

(2) Gastrointestinal reactions: Patients 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.

(3) Abdominal tenderness Tenderness is the only physical sign, mainly located in the right lower abdomen. It is usually small in range and constant in position, and only occurs when heavy pressure is applied. There is no muscle tension or rebound tenderness, and generally no abdominal mass.

(4) Physical signs: Various specific tender points such as McBurney's point, Langerhans point, psoas sign and Roche's sign are positive.

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, hindering distal blood flow. On this basis, bacteria in the lumen invade the damaged mucosa and easily cause infection.

(2) Infection: The main factor 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 gastrointestinal dysfunction such as diarrhea and constipation that causes visceral nerve reflexes, leading 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.