Early symptoms of appendicitis

Appendicitis is a common symptom. Our human appendix actually has certain functions. The appendix can absorb water and electrolytes, and the appendix has certain immune functions. However, our appendix is ​​also prone to problems. Appendicitis is a common appendix problem. Appendicitis is divided into two types, one is acute appendicitis and the other is chronic appendicitis.

We need to know some knowledge about appendicitis so that we will not be at a loss when appendicitis occurs. We need to know the early symptoms of appendicitis and we must seek treatment in time once these symptoms appear.

1. Acute appendicitis

(1) Abdominal pain

Typical acute appendicitis initially presents with pain in the upper middle abdomen or around the umbilicus. After a few hours, the pain migrates and becomes fixed in the right lower abdomen. In the early stage, it is a visceral nerve reflex pain, so the pain in the upper and middle abdomen and around the umbilicus is diffuse and often cannot be accurately located. 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. Sometimes, when the appendix is ​​gangrenous and perforated, abdominal pain can be relieved, but this pain relief is temporary, and other accompanying symptoms and signs do not improve, or may even worsen.

(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 there is only low fever without chills, and the temperature of purulent appendicitis generally does not exceed 38℃. High fever is often seen in appendix gangrene, perforation or complicated by peritonitis. Accompanied by chills and jaundice, it suggests possible complications of suppurative portal vein thrombosis.

(4) Tenderness and rebound pain

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. The tenderness point may change accordingly with the variation of the anatomical position of the appendix, but the key is that there is a fixed tenderness point in the right lower abdomen. 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 will appear when the appendix becomes purulent, and the abdominal muscle tension will be particularly obvious when gangrene perforation 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 to determine whether there is abdominal tension.

(6) Skin hypersensitivity

In the early stages, especially when there is obstruction in the appendix cavity, skin hyperesthesia in the right lower abdomen may occur. 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 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 is 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. There may be an attack of acute appendicitis during the course of the disease.

(2) Gastrointestinal reactions

Patients often suffer from indigestion and loss of appetite of varying degrees. 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, which is mainly located in the right lower abdomen. It is generally small in range, constant in position, and only occurs when heavy pressure is applied. There is no muscle tension or rebound tenderness, and generally no abdominal mass, but a distended cecum can sometimes be felt.

(4) Indirect signs

Various specific tender points such as McBurney's point, Langerhans' point, psoas sign, and Roche's sign may not necessarily appear in the diagnosis of chronic appendicitis.

Above we introduced what the appendix is. We know that the appendix has certain functions and effects on the human body. The appendix is ​​prone to appendicitis. We divide appendicitis into two types, one is acute appendicitis and the other is chronic appendicitis. The above article analyzes the early symptoms of appendicitis in detail.