Disease Description (Causes and Symptoms)
- Definition·pathophysiology: An acute inflammatory disease in which obstruction of the lumen of the appendix (a small tube attached to the end of the cecum) causes increased internal pressure and bacterial proliferation, potentially progressing to mucosal ischemia, necrosis, and perforation. Lumen obstruction → retention of mucus and secretions → bacterial proliferation → appendiceal distension and ischemia → necrosis/perforation → peritonitis and abscess formation.
- Main causes: Obstruction at the opening of the appendix (lymphoid tissue hyperplasia, fecalith (appendicolith), foreign body, tumor, etc.).
- Main symptoms: Initial systemic gastrointestinal symptoms (nausea, vomiting, loss of appetite), followed typically by abdominal pain that begins in the epigastric/upper abdominal area and moves within several hours through the area around the navel to the right lower quadrant (RLQ) (migration of pain). Fever, right lower quadrant tenderness and rebound tenderness (pain when the hand is removed), and elevated white blood cell count and CRP, among others. Depending on the location of the appendix, atypical symptoms such as pelvic pain, flank pain, tenesmus, and diarrhea may occur. Atypical findings are common in children, older adults, and pregnant women.
Treatment Methods
- Emergency evaluation and initial management: Fasting (NPO), establishment of intravenous access, IV fluid replacement, pain control, and administration of intravenous antibiotics (prophylactic antibiotics before surgery).
- Surgical treatment (standard): Appendectomy. Laparoscopic surgery is generally preferred (faster recovery and fewer wound infections). Open surgery is selected when peritonitis, abscess, or anatomical limitations are present.
- Nonsurgical treatment: In cases of simple, uncomplicated appendicitis, a strategy of improvement with antibiotic treatment alone may be selectively studied and applied (with a risk of recurrence). Patient selection and follow-up are important.
- Abscess·inflammatory mass (intra-abdominal abscess): Consider delayed appendectomy after antibiotics + percutaneous drainage (guided by interventional radiology).
- Examples of antibiotics (subject to change according to local guidelines and susceptibility): Broad-spectrum gram-negative and anaerobic coverage administered IV to adults (e.g., ceftriaxone + metronidazole or piperacillin-tazobactam). In cases of penicillin allergy, alternative agents may be considered (e.g., ciprofloxacin + metronidazole or aztreonam + metronidazole). (For exact prescriptions, follow the attending physician’s and hospital’s guidelines.)
- Hospitalization·follow-up: Wound care after surgery; the duration of antibiotic treatment is determined according to clinical findings and surgical findings (whether perforation is present). Peritonitis and perforation may require long-term antibiotics and a longer hospital stay.
Precautions (Points to Note·Risk of Complications·Self-Care)
- Recommendation for immediate medical care: If symptoms such as right lower quadrant pain, progressive fever and vomiting, or abdominal rigidity occur, visit the emergency room or outpatient clinic without delay. Delays increase the risk of perforation, peritonitis, and sepsis.
- Prohibited self-care: Before diagnosis, avoid enemas, excessive use of painkillers for relief, attempting strenuous positions, or masking symptoms with painkillers (these can delay diagnosis and evaluation).
- Complications: Appendiceal perforation, peritonitis, intra-abdominal abscess, wound infection, intestinal obstruction, sepsis, and intestinal adhesion-related obstruction, among others.
- Prognosis: The prognosis is good with early diagnosis and treatment. When perforation or peritonitis occurs, morbidity, mortality, and complications increase.
Pre-Outpatient Visit Checklist (Items to Bring·Evaluation Items and Example Questions)
- Items to bring/submit
- List of medications currently being taken (including prescription drugs, OTC drugs, anticoagulants, and immunosuppressants)
- Medication allergies and records of previous surgeries and hospitalizations
- Record of recent temperature and symptoms (time pain began, location, changes, vomiting, and changes in bowel movements)
- For women, menstrual history and possibility of pregnancy/whether pregnant (a pregnancy test may be necessary)
- Recent test results, if available (blood tests, ultrasound·CT, etc.)
- Key items that medical staff will check at the outpatient visit (preparing these can speed up diagnosis and treatment)
- Time and location where the pain began, and whether the pain migrated (epigastrium→navel→right lower quadrant)
- Fever·chills·frequency and nature of vomiting
- Abdominal distension·changes in bowel movements (diarrhea·constipation)
- Whether there has been previous appendix or abdominal surgery
- Whether anticoagulants are being taken (important when considering surgery)
- Example questions (questions for the patient to prepare to ask the medical staff)
- When did the symptoms begin, and have they tended to worsen?
- What tests (blood tests·imaging) will be performed?
- How likely is surgery?
General Example Questions to Ask the Doctor
- What are the common side effects and precautions for this medication (the antibiotic/painkiller that is planned to be prescribed)?
- What is the recovery period and when can I return to daily activities after surgery (laparoscopic·open)?
- Is nonsurgical treatment (antibiotics alone) sufficient, and how high is the risk of recurrence?
- If I am pregnant, how will the diagnostic and treatment methods differ?
- What are the criteria for hospitalization and surgery?
Disease-Specific Example Questions (1–2)
- To assess the course of pain: "Where did the pain first begin, and did it move to the right lower quadrant over time? What was the severity of the pain (0–10), and how frequent was the vomiting?"
- Women·pregnancy-related: "When was your most recent menstrual period, and is pregnancy possible? If pregnant, what is the plan for diagnosis and treatment (imaging tests·surgery)?"