If there’s one thing that is most common in pediatric surgery, it would be inguinal hernia and syringomyelia, and of course, probably prepuce ……. However, for the general public, the most “famous” is probably “appendicitis” – the name has been ringing for decades, and there have been legends of this ” The legend of the “big man”.
So, today let’s take a look at the life of this big man.
Clinically, when we diagnose a child with appendicitis, parents often ask, “Doctor, do children get appendicitis too?” –Yes, children can get appendicitis. The reason why people think that children don’t get appendicitis is because the rate of appendicitis in children is really less than in adults: it is rare in newborns and rare in infants and children. It is not until after the age of 6 that the rate of appendicitis in children rises, reaching adult rates after the age of 12.
However, the younger the child, the lower the chance of appendicitis, and the more difficult it is to diagnose because many children are too young to describe their symptoms accurately (young babies cannot speak at all, which is why pediatrics used to be called “dumb” in medical circles). The appendicitis in children is often rapidly progressing, with necrosis, perforation, and peritonitis occurring in a short time, so don’t underestimate the impact of appendicitis on children’s health!
First, let’s talk about the causes of appendicitis.
1. Obstruction of the lumen of the appendix.
In layman’s terms, the appendix is “blocked” – the appendix is a small section of the intestinal tube protruding from the cecum, a “lonely” blind tube – unlike other intestinal tubes that are “blocked”. Unlike other intestinal tubes that are “two-way”, the appendix is a “one-way street”, with only one opening – come on, give me a thumbs up, everyone! Thumbs up, yes – imagine that your clenched fist is the appendix, and your raised finger is the appendix – I know you raised your pinky finger – the appendix is The appendix is a long, thin “worm”, so the appendix is also known as the “earthworm” – a baby’s appendix is really no thicker than an earthworm.
When the lumen of the appendix is blocked by food debris, fecal stones, roundworms and other miscellaneous things, the mucus secreted inside is not good to discharge, and slowly the pressure is held higher and higher, eventually leading to appendicitis attacks.
2. Spread of surrounding diseases.
The appendix is surrounded by a large number of intestinal tubes – what jejunum, ileum, cecum, ascending colon, sigmoid colon …… and so on, to name a few, if disease occurs – that is, enteritis (I believe “enteritis” the “big brother” is even more powerful, right, all the students here, live so big, never been his harassment raise your hand, I admire you!) –The appendicitis can spread to the appendix, resulting in inflammation of the appendix.
3. Some other cases.
For example, when diarrhea, constipation, visceral nerve reflexes, resulting in the appendix muscle, vascular spasm – the proverbial “twitch” – may also cause the appendix cavity narrowing, and Inflammation may occur.
What does “metastatic right lower abdominal pain” mean? It means that the patient starts out with pain around the belly button, and it’s not clear where the pain is – it’s in the stomach anyway. After a few hours, the pain slowly fixed to the right lower abdomen – not much pain elsewhere, but the right lower abdomen a point of pain.
You see, this stomach pain, but also with the “shifting positions” – just now in the belly button around, this time again to the right lower abdomen to go.
In fact, the place of onset has never changed, it has always been the appendix.
However, in the early stage, the appendix is still relatively shallow, only the mucosal surface is uncomfortable, this time belongs to the visceral nerve reflex pain, and the “visceral nerve” comrade, belongs to the bottom “brick dry rice people”.
And most of us a virtue, do the most work, the least pay (do not run, that is you!) A person responsible for a large area, so whether it is intestinal cramps or mild appendicitis, the news reached him here, he always to the superior (that is, the brain) (hey hey hey, brother, don’t look, don’t look, still in your head inside it, not lost!) Say: Report, stomach pain! As for where it hurts? Sorry, brother I have limited ability, can not locate, only know is the stomach this piece ……
After a few hours, the inflammation of the appendix gradually worsened and became deeper, slowly spreading to the plasma membrane layer (that is, the appendix against the outside layer), sometimes the inflammation is heavier, he “broke the circle”, the appendix outside the belly covered – that is, the peritoneum also to the involved. This is when things get serious and the processing of pain information is not left to the “visceral nerves”, the “social animals” – dang, dang, dang! The “somatic nerve” appearance – this is a tough role, social elite ah, high wages, efficiency is also a great ……
–“Report boss, right lower abdominal pain, please instruct!” -OK, as the boss of your response – oh, half a day, I’m not eating bad stomach, but the right lower abdominal pain ah, ouch ouch ouch, pain pain, do not be appendicitis it, quickly, help me to go to the registration … I’m sorry…
Of course, the symptoms mentioned above are typical, 70% or 80% of patients have typical “metastatic right lower abdominal pain”, but sometimes the symptoms are not typical, and the abdominal pain is limited to the right lower abdomen at the beginning. For us in pediatrics, it is more problematic because children are younger and many of them do not have the ability to accurately describe the symptoms of discomfort, so it puts a higher demand on the physician’s diagnosis.
In fact, the symptoms of appendicitis are not only “metastatic right lower abdominal pain”, but also malignancy, vomiting, etc. (these symptoms are called “gastrointestinal symptoms” by the doctors’ circle of wizards), fever (this should be well understood, as the appendix is inflamed and suppurated, so it is natural), and fever. fever (this should be well understood, the appendix inflammation, pus, natural fever – and tonsils pus means similar). However, these symptoms are more “popular” and always pop up from time to time in people’s daily life when they are uncomfortable, so they are easy to be ignored and not as unique as “metastatic right lower abdominal pain”. –This person has taken the route of “one trick and you can eat it all” – I have appendicitis, but whenever I appear, it means that appendicitis is coming –so it got everyone’s attention.
After patients come to the hospital and have their doctor look at them, the doctor will inevitably have to “see, touch, tap and listen”, which is a physical examination. For surgeons, the most important technique to consider appendicitis is abdominal palpation, which is probably the most frightening moment for patients
Doctor, my stomach hurts!
Oh, lie down on the examination bed, let me press it
Aigoo, I’m in so much pain, can you stop pressing, look, this is it ……
Don’t talk nonsense, lie down! Is it here? Is it here? (Physicians generally have a certain order of abdominal palpation, often the most painful areas should be the last to be palpated) …… Is it here?
Aigoo aigoo, this is the place, you do not press ……
Don’t move, I’ll press again ……
If the patient has symptoms of peritonitis (that is, the inflammation of the appendix is heavy and has spread to the peritoneum, then the abdominal pain will be more irritating, the so-called “rebound pain”) …… Well, which kind of palpation feeling I will not describe, you from I’m not going to describe what kind of sensation on palpation, just think about it from the literal meaning of “rebound pain” ……
In fact, rebound pain means that the pain will appear when the doctor presses on the abdomen, and after the doctor quickly releases his hand, the local pain in the abdomen will suddenly increase – the patient often has little reaction when the doctor presses on the stomach, and in the moment when the doctor releases his hand, the pain is instead so painful that he “ouch The patient often has no reaction when the doctor presses the stomach, but the moment the doctor releases the hand, the pain is so painful that he or she screams “ouch” and is often accompanied by a “tiger tremor”.
However, seriously speaking, when a patient is suspected of having appendicitis, palpation of the abdomen is very important, especially the examination of pressure pain and rebound pain symptoms, which is significant for the judgment of the disease, so the doctor does not have to torture the patient to see the doctor, but has to do so.
Do doctors need to do any more tests for patients who are initially considered to have appendicitis through a simple examination?
Common ancillary tests are –
1, blood routine: also known as “blood cell analysis”, is to let the nurse lady from the child’s small tender arm to draw a tube of blood sent to the laboratory, through the test results to assist judgment: if the indicators of the “white blood cell count” significantly higher, while “The higher the white blood cell count, the more serious the appendicitis infection.
2. Abdominal ultrasound: It is a non-invasive examination, especially widely used in pediatric surgery. If there are enlarged cords in the right lower abdomen (also known as the “appendix area”) or if the diameter of the appendicitis is clearly about 0.6 cm, the diagnosis of appendicitis should be considered.
3, abdominal CT, MRI, etc.: CT (i.e., electronic computed tomography) is generally used more often, especially in adult departments, and is commonly used.
Once the diagnosis of appendicitis is clear, what about treatment?
In appendicitis, whether acute, chronic or not, prompt surgery is recommended (unless the disease is more than 3 days old, an inflammatory mass has formed in the right lower abdomen, and an appendiceal abscess has formed. At this time, risky surgery may instead lead to abscess rupture and spread of infection, so the preferred treatment becomes conservative – that is, intravenous fluids to fight infection, and if conservative treatment is not effective, surgery is also necessary).
Commonly used surgical methods are.
1, traditional appendectomy.
2, laparoscopic appendectomy.
Generally timely surgery, all can achieve the desired results.