I. Appendicitis
1. What is appendicitis?
Appendicitis is an inflammatory change of the appendix caused by a variety of factors. After acute appendicitis is treated or cured conservatively, the appendix wall can be left with fibrous tissue hyperplasia and thickening, lumen narrowing and surrounding adhesions, which is called chronic appendicitis and can easily lead to another acute attack.
The appendix is generally about 6 to 8 cm long, but there are cases up to 30 cm long, mostly located in the right lower abdomen of the body. The appendix is a slender and curved blind tube on the cecum, its root is connected to the inner posterior wall of the cecum, the proximal end is open to the cecum, and the distal end is only connected to its tract (containing the blood vessels for the appendix), so the appendix is highly mobile, and its tip is centered on its root and can be extended in any position within 360°.
2.Is the appendix a degenerative organ of the human body and does it have any function?
It is a part of the peripheral lymphoid organs in the immune system of the body, which is involved in the production and maturation of B cells in the immune system and plays a certain immune function. The lymphoid tissue of the appendix starts to appear 2 weeks after birth and reaches its peak at the age of 12 to 20 years, then gradually decreases, significantly decreases after the age of 30 years, and completely disappears after the age of 60 years, so removing the appendix in adults does not harm the immune function of the body.
3.What are the main manifestations of appendicitis when it occurs?
The typical clinical manifestations of acute appendicitis are vague pain in the upper abdomen or around the umbilicus that occurs gradually and then shifts to the right lower abdomen and is fixed after a few hours. It is often accompanied by loss of appetite, nausea and vomiting. At the beginning of the disease, there are no obvious systemic symptoms except for low fever and malaise. If acute appendicitis is not treated in time, it can develop into appendiceal suppuration, gangrene and perforation, complicated by peritonitis, with high fever and enlarged abdominal pain.
Acute appendicitis has a mortality rate of less than 1%, while perforation leading to diffuse peritonitis can result in a mortality rate of 5% to 10%.
4.Does the reduction of pain symptoms after appendicitis mean that the condition is improving?
The reduction of abdominal pain is not always a sign of improvement, but must be combined with the signs of comprehensive judgment, and treatment should not be easily abandoned. Because.
(1) In the early stage of acute appendicitis, the pressure in the lumen of the appendix is relieved when the fecal stone is discharged from the lumen of the appendix or the spasm factor of the appendix wall is released, and the abdominal pain is relieved. This is an indication of relief of the symptoms of appendicitis.
(2) In contrast, because of the progressive aggravation of appendicitis, from simple appendicitis → purulent appendicitis → appendiceal gangrene and perforation, the pressure in the appendiceal lumen suddenly decreases after appendiceal perforation, resulting in a sudden reduction of abdominal pain in patients, which is a sign of aggravation. Although the abdominal pain is relieved, it is only temporary, and soon there will be a wider range and more severe abdominal pain → acute diffuse peritonitis.
5. Do all diagnoses of appendicitis require emergency surgery?
No. Conservative treatment is only indicated for simple appendicitis and the early stages of acute appendicitis, and the patient does not accept surgical treatment or objective conditions do not allow it, or there are contraindications to surgery with other serious organic diseases, or the acute appendicitis is not perforated but has been confined to the package.
6.What are the common complications of appendicitis?
(1) Abdominal abscess: It is the consequence of untreated appendicitis. Once diagnosed, it should be drained by ultrasound-guided puncture and flushing or tube placement or, if necessary, surgical incision and drainage. Due to heavy inflammatory adhesions, the intestinal canal is easily damaged during incision and drainage. The recurrence rate of appendiceal abscess is very high after non-surgical treatment, so the appendix should be removed by elective surgery about 3 months after cure.
(2) Formation of internal and external fistula: If the periappendiceal abscess is not drained in time, in a few cases the abscess may penetrate into the small intestine or colon, and also into the bladder, vagina or abdominal wall, forming various internal or external fistulas, at which time the pus may be discharged through the fistula.
(3) Septic portal phlebitis: Infectious thrombus in the appendiceal vein in acute appendicitis may follow the superior mesenteric vein to the portal vein, resulting in septic portal phlebitis. Clinical manifestations include chills, high fever, hepatomegaly, subxiphoid pressure, and mild xanthogranuloma. If the condition worsens, it will produce infectious shock and sepsis, and delayed treatment may develop into bacterial liver abscess.
Second, gallstones.
1.Gallstones classification
Depending on the location of stones, they are classified as gallbladder stones, intrahepatic bile duct stones, and common bile duct stones.
2.Gallstones triggering factors
(1) Frequent preference for high sugar, high cholesterol, high fat diet.
(2) Those who suffer from biliary parasitic diseases, such as roundworm, liver fluke, etc.
(3) Those who have high estrogen.
(4) Those who are obese and have reduced physical activity.
(5) Those with gallbladder and biliary tract infections.
(6) Certain diseases: such as diabetes, nephritis, hypothyroidism, hemolytic diseases, etc.
(7) Emotion: long-term mental stress, depression.
(8) Heredity.
3.The consequences of untreated gallstones
(1) Gallbladder stones can easily block the cystic duct or drain into the common bile duct causing acute biliary colic, which is unbearable when the pain is severe and involves right back pain, accompanied by high fever, chills, nausea, vomiting, and even a drop in blood pressure, irritability, and even life-threatening shock.
(2) Gallbladder stones can lead to gangrene or perforation of the gallbladder, causing life-threatening acute peritonitis.
(3) Intrahepatic bile duct stones can mainly cause septic inflammation, leading to liver fibrosis and eventually cirrhosis.
(4) Elderly people with gallbladder stones can easily induce angina pectoris and cardiac arrhythmia.
(5) Gallstones are a cause of gallbladder cancer. Chronic inflammation of gallbladder and the stimulation of bile acid and choline in gallstones can easily cause cancer of gallbladder mucosa.
4.Preventive health care
(1) Diet control is the most ideal prevention method to prevent gallstone disease and gallbladder cancer. In addition, cold, greasy, high-protein, stimulating food and strong wine are easy to help generate heat and bile accumulation, so they should be eaten sparingly. Vegetables and fruits rich in vitamin A and vitamin C, fish and seafood can help clear the bile and dissolve stones, so you should eat more. Drinking a glass of milk every night or eating a fried egg for breakfast can make the gallbladder contract and empty at regular intervals, reducing the time that bile stays in the gallbladder.
(2) Life should be regular, pay attention to the combination of work and rest, often participate in sports activities, eat breakfast on time, avoid gaining weight, reduce the number of pregnancies, etc. are also very important preventive measures.
5, with gallstones diet should pay attention to the “five taboos”
One avoid eating foods containing high cholesterol, such as animal heart, liver, brain, intestines, as well as egg yolks, puffed eggs, caviar and chocolate.
Second, avoid eating foods containing high fat, such as fatty meat, lard, fried food. More oil pastries should not be eaten, because too much fat will cause gallbladder contraction, resulting in pain.
Three avoid taking advantage of the holiday or friends and relatives gathering to eat and drink. Because overeating will promote the secretion of bile, and the strong contraction of the gallbladder will cause inflammation of the gallbladder, local colic, etc..
Four avoid eating spicy and stimulating condiments, such as chili, chili oil, five spice powder, pepper noodles, etc..
Fifth, avoid smoking, alcohol, coffee, etc. These stimulating foods can cause excessive gastric acid, gallbladder contraction and lead to spasm of the sphincter of the bile duct, bile discharge difficulties and induce biliary colic.