Aged acute appendicitis
Introduction
Introduction to acute appendicitis in the elderly Acute appendicitis in the elderly As the population of our country progresses, the incidence rate increases. According to the Tianjin General Hospital, patients over 60 years old are estimated to account for 3% to 4% of all acute appendicitis. Mortality also increases with age, from 5% to 20%. basic knowledge The proportion of illness: 0.005%-0.01% Susceptible people: good for the elderly Mode of infection: non-infectious Complications: peritonitis
Cause
Causes of acute appendicitis in the elderly
Medical experts believe that acute appendicitis in the elderly is related to the general health of the elderly and the anatomical and physiological characteristics of the appendix.
The appendix is a short and thin tubular organ with a lumen diameter of about 0.5 cm. As the age increases, the appendix lumen gradually narrows. In the elderly, the lumen diameter is only 0.2 cm, which is prone to obstruction, and the intestinal peristalsis in the elderly. Weakened, food residue easily enters the appendix to form fecal stone. According to statistics, one third of the elderly patients with acute appendicitis found fecal stone in the appendix cavity.
At the entrance of the appendix cavity, there is a "door" that can only be seen, which is called a blind petal. When the person reaches old age, the door will degenerate and shrink, so that the incompleteness, feces, undigested food, parasites, etc. are easy. Entering the appendix cavity, causing obstruction, causing local tissue ischemia and necrosis of the appendix, which is more conducive to bacterial invasion.
The appendix communicates with the colon. Under normal circumstances, there are many bacteria in the appendix cavity, such as Escherichia coli, Enterococcus, anaerobic bacteria, etc., when people are old, due to the immune system dysfunction, local tissue defense ability is weakened, plus the appendix cavity Blockage and other factors, the integrity of the mucosa is impaired, bacteria will directly invade the appendix, causing acute appendicitis.
Prevention
Elderly acute appendicitis prevention
Although acute appendicitis in the elderly is a serious acute abdomen, if it can be paid attention to, patients and family members can closely cooperate with medical staff, it can completely eliminate the danger. In general, the following points should be noted.
Early diagnosis and treatment is very important. If the elderly have aggravated abdominal pain, after oral atropine, belladonna and other antispasmodic drugs are still ineffective, then they should go to the hospital for examination and treatment immediately. Some patients are diagnosed and treated in time, and they are acute simple appendicitis. Can not temporarily open the knife, first with antibiotics, but need to closely observe the changes in the condition, some patients are more serious, if the doctor thinks that his original health is acceptable, surgery should be immediately, patients and their families should eliminate concerns, and actively cooperate with the doctor to perform surgery.
Once diagnosed as acute appendicitis, the patient should take a semi-recumbent position, which can prevent diffuse peritonitis caused by perforation of the appendix, and prevent post-operative local inflammation. After surgery, it should be coughed and often turned over to prevent pneumonia. It is also necessary to strengthen nutrition and cooperate with medical staff to pay attention to heart, liver and kidney function.
Complication
Elderly acute appendicitis complications Complications peritonitis
There may be increased pressure in the appendix, ischemia, necrosis, perforation of the appendix wall, causing severe suppurative peritonitis, often associated with pathological changes or underlying diseases of other important organs, which are often the cause of death.
Symptom
Acute appendicitis symptoms in the elderly Common symptoms Inflammation abdominal pain Iris necrosis of the appendix wall bloating nausea reaction retarded appendix tissue fibrotic abscess fever
Elderly acute appendicitis has the following characteristics:
1. The blood vessels of the elderly, the degenerative changes of the lymphatic vessels, the thinning of the appendix mucosa, the fat infiltration and the fibrosis of the appendix, plus the hardening of the arteries, the relative reduction of tissue blood supply, so the necrotic perforation is prone to occur after inflammation of the appendix.
2. The abdominal muscle atrophy response is low, the symptoms and signs are inconsistent, the symptoms and signs are often lighter than the pathological changes, the abdominal pain is not very severe and not typical, due to the slow response to pain, its performance can only be bloating, nausea, Differential diagnosis sometimes has difficulty and is easily misdiagnosed. Acute appendicitis in the elderly is often seen late. At the time of treatment, most of the gangrene has been perforated or has formed an abscess.
Examine
Examination of acute appendicitis in the elderly
The filling defect indicated by barium angiography depends on the anatomy of the valve and the ileum entering the entrance of the cecum. The anterior and posterior position shows a rose petal shape, and the lateral position is -shaped. The normal position of the tangential line shows a symmetric filling defect at the ileocecal junction. The prolapsed person presented as a complete circular filling defect, and air contrast X-ray angiography should not be performed until the tincture was filled with the ileocecal valve area.
Diagnosis
Diagnosis and diagnosis of acute appendicitis in the elderly
diagnosis
General diagnosis is not difficult, but patients with atypical symptoms may be misdiagnosed. Therefore, firstly, the medical history should be detailed, and the history of the disease should be grasped. Pay attention to the exact onset time, location, nature, metastatic time, abdominal pain and symptoms. Etc. Before the diagnosis of appendicitis is made, it is necessary to exclude diseases that are easily confused with it, such as ulcer disease, cholecystitis, strangulated intestinal obstruction, etc. Secondly, comprehensive physical examination should be done carefully and carefully, paying attention to the slightest response of the elderly. The abdominal wall is slack, the abdominal wall needs surgery, and the prognosis is good.
Differential diagnosis
It is distinguished from ulcer disease, cholecystitis, strangulated intestinal obstruction, and other appendicitis.
