acute appendicitis in the elderly
Introduction
Introduction to acute appendicitis in the elderly Acute appendicitis (senileacuteappendicitis) refers to acute inflammatory lesions of the appendix in the elderly over 60 years old. The physiological function of the body and organs of the elderly is declining, the submucosal lymphoid tissue is degraded, the defense function is reduced, and the pain response is slow. Often seen late, the appendix lesions are more serious, and more complications. basic knowledge Proportion of the disease: the proportion of the elderly is about 0.2% - 0.4% Susceptible people: those who are older than 60 years old Mode of infection: non-infectious Complications: abdominal pain, acute peritonitis, peritonitis, abdominal pain
Cause
The cause of acute appendicitis in the elderly
Obstruction (30%):
The appendix is a slender tube, and only one end is connected to the cecum. Once obstructed, the endocrine secretions can be accumulated, the internal pressure is increased, and the appendix wall is pressed to block the distal blood supply. On this basis, the bacteria in the lumen invade the damaged mucosa. It is easy to cause infection. Some people have found that gangrenous appendicitis has almost obstruction. The common causes of obstruction are: 1 blocked fecal stone in the appendix cavity, dried fecal mass, food debris, foreign body, aphid, etc. 2 The wall of the appendix was destroyed The stenosis or adhesion of the lumen is caused; 3 the appendix formed by the shortness of the appendix is too short, which hinders the patency of the tube; 4 the lymphatic tissue hyperplasia or edema in the wall of the appendix causes the lumen to narrow; 5 the opening of the appendix near the cecum is lesioned. Such as inflammation, polyps, tuberculosis, tumors, etc., so that the opening of the appendix is compressed, and the emptying is blocked. Among them, fecal stone obstruction is the most common, accounting for about 1/3.
Obstruction is a common basic factor in the pathogenesis of acute appendicitis. Therefore, the early stage of acute appendicitis often has xiphoid or umbilical colic, which is caused by obstruction of the appendix lumen and increased internal pressure. In addition, the specimens of the appendix are often seen. The fecal stone obstructs the lumen, and the distal end is obviously inflammatory and even gangrenous.
Infection (30%):
There are also cases of obstruction and the main cause of the direct infection caused by bacteria in the appendix cavity. The appendix cavity is connected with the cecum, so it has the same strain and quantity of Escherichia coli and anaerobic bacteria. If the appendix mucosa is slightly damaged, bacteria invade the wall, causing different degrees of infection. A small number of patients occur after the upper respiratory tract infection, so it is considered that the infection can be transmitted from the blood to the appendix, and some infections occur from the adjacent organs. Sexual infection, invading the appendix.
Low immunity (10%):
Because the elderly are weak, the function of each system is declining, or the chronic diseases are affecting the immune defense ability of the whole body, the immunity is reduced, and it is easy to be infected by the bacteria to induce appendicitis.
Other factors (10%):
Some people think that the incidence of acute appendicitis is related to eating habits and heredity. The incidence of polycellular diet is low, which may be related to the rapid emptying of the colon and the reduction of constipation. The habitual application of laxatives due to constipation may cause intestinal mucosal congestion. Affecting the appendix, some people believe that genetic factors are associated with congenital malformations of the appendix, excessive distortion, small lumen, long length, poor blood supply, etc. are all conditions that are prone to acute inflammation.
Pathogenesis
The organs of the elderly are constantly degrading, including the atrophy of the instrument and the decline of function, which affects the immune defense ability of the whole body. The wall of the appendix is also shrinking and thinning, the lymphoid follicles gradually degenerate and disappear, and the appendix cavity becomes thinner. Therefore, once the appendix is infected, it develops faster than young people, and the perforation is earlier. About 30% of the appendix has been perforated during surgery. The blood vessels of the elderly are mostly hardened. The appendix artery is easily embolized by inflammation on the basis of hardening. Acute appendicitis is easy to become gangrenous, and then the elderly omentum atrophy, once the perforation of the appendix, easy to cause diffuse peritonitis.
The symptoms of acute appendicitis in the elderly are not typical. The clinical manifestations are often milder than the lesions. Abdominal pain is often not noticed if it is not serious. It is mistaken for the common gastrointestinal dysfunction in the elderly. It is easy to be ignored in the early stage, and sometimes the lesions develop rapidly. The mortality rate of appendicitis in the elderly is several times higher than that of young people. In the patients who died of appendicitis, the elderly accounted for more than half. Of course, this is often associated with other systemic diseases, decreased physiological reserve, and poor tolerance. related.
Prevention
Acute appendicitis prevention in the elderly
Although acute appendicitis in the elderly is a serious acute abdomen, if it can be paid attention to, patients and their families can closely cooperate with medical staff, and 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 gradually increased abdominal pain, after oral atropine, belladonna and other antispasmodic drugs are still ineffective, then you should go to the hospital for treatment. Some patients are diagnosed and treated in time, and they are acute simple appendicitis. They can be treated without antibiotics, but they should be closely observed. Some patients are seriously ill. If the doctor thinks that his health condition is acceptable, he should immediately undergo surgery. Patients and their families should eliminate their concerns and actively cooperate with doctors for surgery.
Once diagnosed with 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 the operation, you should cough more often and turn over often to prevent pneumonia. It is also necessary to strengthen nutrition and cooperate with medical staff to pay attention to heart, liver and kidney functions.
Complication
Acute appendicitis complications in the elderly Complications abdominal pain acute peritonitis peritonitis abdominal pain
Perforation of appendix is the main complication of appendicitis in the elderly, not only occurs early, but also has a high perforation rate of up to 32% (6% for young people), so the mortality rate of acute appendicitis in the elderly is higher, about 6.4% (for young people 0.6) %), the serious cardiopulmonary disease that coexists is also an important cause of death.
Symptom
Acute appendicitis symptoms in the elderly Common symptoms Abdominal pain Right lower quadrant tenderness Abdominal pain Lower abdominal pain Peritonitis Appendix perforation Abdominal muscle Tension bloating Low fever
The elderly have poor reaction ability. Although the pathologically acute appendicitis develops quickly and severely, it is not serious in clinical practice. It is often mistaken to think that the lesion is in the early stage, and the treatment is delayed. The symptoms of abdominal pain in the elderly are often not sudden and not very heavy. Some elderly people have perforation of periorbital perforation and peritonitis, but also lack of typical metastatic abdominal pain. Therefore, it is not appropriate to ignore the symptoms of the elderly because of the lack of consciousness. The appendix point tenderness and abdominal muscle tension in the elderly Acute appendicitis is not as obvious as young people, but it is still an important basis for diagnosis. The clinical features of acute appendicitis in the elderly are weak, atypical, and there are characteristics such as disease development and early perforation.
Older people have lower abdominal pain, low fever, abdominal distension and other symptoms, even if there is no typical metastatic right lower abdominal pain history, if there is tenderness in the lower right abdomen, the possibility of acute appendicitis should be considered.
Examine
Examination of acute appendicitis in the elderly
Blood routine examination, white blood cells generally do not increase significantly.
1. B-ultrasound: It plays a role in assisting diagnosis.
2. Abdominal puncture: If there is a sign of diffuse peritonitis, abdominal puncture drainage may be a clear diagnosis.
3. Barium enema or fiber colonoscopy: the right lower abdomen mass should be further treated with barium enema or fiber colonoscopy to exclude colon cancer.
Diagnosis
Diagnosis and diagnosis of acute appendicitis in the elderly
Differential diagnosis
Mechanical intestinal obstruction
Elderly appendicitis can have obvious abdominal distension, which can occur when not perforated, and sometimes resembles the signs of mechanical intestinal obstruction in the small intestine.
2. Cecal cancer
In the formation of peritonitis or abscess, the body temperature of the elderly does not rise, white blood cells do not change significantly, and there is a painless mass in the right lower abdomen, and there is no history of appendicitis, which is easily confused with cecal cancer, and should be identified.
