Acute appendicitis in AIDS patients
Introduction
Introduction to acute appendicitis in AIDS patients In 1996, the United States reported 1 million people infected with HIV and 270,000 AIDS patients. According to the United Nations report in 1997, 30 million people worldwide carry the AIDS virus, and its incidence is still rising, so surgeons have more and more opportunities to deal with the general surgical diseases of these patients and the lesions secondary to AIDS, AIDS patients Although there are few acute appendicitis, the rate of misdiagnosis is high and the complications are many, which is urgent for the attention of the gastrointestinal surgeons. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific people Mode of infection: non-infectious complication:
Cause
Causes of acute appendicitis in AIDS patients
(1) Causes of the disease
The incidence of abdominal surgery in AIDS patients is not high (4.2%), but appendicitis is easy to occur. The reason is that it is related to the fact that the blood supply is the terminal blood vessel without anastomosis. Intravascular infection and edema cause embolism, which makes the appendix easy to smash and perforate.
(two) pathogenesis
AIDS patients are severely inhibited by immune function, and they have high complication rate and mortality. Even mild lesions often produce systemic and local significant reactions, leading to many serious cases. Once the appendix develops inflammation, its pathological development It is different from appendicitis under normal conditions, and it needs to be differentiated from gastrointestinal inflammation (such as cytomegalovirus colitis and acute appendicitis). The latter can often be cured without surgery, but the delay of appendicitis will be Give AIDS patients a much more dangerous result than normal people.
Prevention
Acute appendicitis prevention for AIDS patients
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Acute appendicitis complications in AIDS patients Complication
Nearly one-third of patients with delayed diagnosis can reach 3 to 21 days, all of which form perforated appendicitis, and the incidence of perforation is about 44%.
Symptom
Acute appendicitis symptoms in AIDS patients Common symptoms Nausea abdominal pain Abdominal tension Low fever
Symptoms are mainly abdominal pain, and later limited to the right lower abdomen. Below 50%, there are both nausea and vomiting. All of them have low fever. The signs are also tenderness in the right lower quadrant, positive abdominal muscle tension and rebound tenderness.
Abdominal pain and abdominal signs are similar to those of AIDS, which have an opportunity to cause pathogenic infections, so diagnosis is difficult.
Examine
Examination of acute appendicitis in AIDS patients
Blood routine examination revealed that the white blood cell count of 1/3 of patients was only low, and the rest were within the normal range or below normal (mean 3.9×109/L).
B-ultrasound and CT examination can often help in the accumulation of fluid around the appendix. Some people recommend laparoscopic examination as the basis for diagnosis. The diagnosis rate is very high, but this examination is a traumatic examination, unless it is used properly, otherwise it will increase unnecessary. damage.
Diagnosis
Diagnosis and diagnosis of acute appendicitis in AIDS patients
Misdiagnosis and misoperation for AIDS patients will bring great risks to patients. Therefore, treatment is often delayed for definite diagnosis. In addition to clinical symptoms and signs, blood cell tests cannot give a favorable basis. Examinations and CT scans can often help, and laparoscopic use is appropriate, with a high rate of diagnosis, but only when necessary.
The most important thing in the diagnosis is to distinguish it from the gastrointestinal infection caused by the AIDS disease itself, such as cytomegalovirus colitis and acute appendicitis.
