Acute appendicitis of pregnancy
Introduction
Introduction to pregnancy-induced acute appendicitis Acute appendicitis is a common surgical disease during pregnancy. The incidence of acute appendicitis in pregnant women is 0.1%-2.9% in foreign countries and 0.1%-2.95% in domestic data. Acute appendicitis can occur in all stages of pregnancy, but it is mostly in the first 6 months of pregnancy. Pregnancy does not induce appendicitis. The enlarged uterus can change the position of the appendix and increase the difficulty of diagnosis. In addition, appendicitis is prone to perforation and peritoneum during pregnancy, and the incidence is 1.5-3.5 times of non-pregnancy. Therefore, early diagnosis and timely treatment have an important impact on prognosis. basic knowledge The proportion of sickness: 0.1--0.3% Susceptible population: pregnant women Mode of infection: non-infectious Complications: acute diffuse peritonitis abortion premature delivery
Cause
Causes of pregnancy-induced acute appendicitis
Pathogenesis
The position of the appendix changes with the development of pregnancy. From early pregnancy to late pregnancy, the appendix is gradually shifted upwards from the in situ, and after 8 months of gestation, the appendix can be located on the upper iliac crest, and the cecum and appendix are gradually Covered by the uterus, this kind of change in the position of the appendix caused by pregnancy causes atypical clinical manifestations of acute appendicitis in late pregnancy. The pelvic and adjacent organs are congested during pregnancy. Once infected by the appendix, it develops rapidly and is prone to gangrene and perforation. The uterus pushes the omentum and small intestine away from the appendix, which makes the inflammation difficult to limit. The inflammation of the appendix can also affect the uterine serosa, stimulate the contraction of the uterus. In severe cases, it can cause miscarriage or premature birth, and it can also cause fetal hypoxia and death.
Prevention
Pregnancy acute appendicitis prevention
1, after the meal should not rush to run, the summer heat should not be too cold, especially not to drink too much ice, and other cold drinks.
2, usually take care not to be too fatty, avoid eating too irritating food. Should actively participate in physical exercise, enhance physical fitness and improve immunity.
3, if there is a history of chronic appendicitis, should pay attention to avoid recurrence, usually keep the stool smooth.
Complication
Pregnancy acute appendicitis complications Complications, acute diffuse peritonitis, abortion, premature delivery
In pregnancy, the uterus is enlarged, and the omentum and small intestine are pushed away from the appendix. In addition, this period of pelvic congestion, acute appendicitis develops rapidly, and is prone to perforation and spread. It is easy to be complicated with diffuse peritonitis. When the uterine serosa is involved, it can occur. Abortion or premature birth can also lead to fetal hypoxia death.
Symptom
Pregnancy acute appendicitis symptoms Common symptoms Abdominal pain Pregnancy late abdominal pain Gastrointestinal symptoms Iris tissue Fibrosis Nausea Abdominal tension
1. Acute appendicitis in early pregnancy has fever, nausea, vomiting, lower abdominal pain, examination of tenderness, rebound tenderness and muscle tension in the right lower abdomen, and the total number of white blood cells is increased. The symptoms and signs are similar to those of non-pregnancy acute appendicitis.
2. In the middle and late stages of pregnancy, acute appendicitis causes displacement of the appendix due to the enlarged uterus. The tender point is increased during the examination, and the most painful part of the tenderness can reach the right subcostal liver area. As the uterus of the pregnancy supports the peritoneum of the abdominal wall, the appendix is deep in the abdominal cavity, and is enlarged by the uterus of the pregnancy, making the signs of localized peritonitis atypical.
Examine
Examination of pregnancy-induced acute appendicitis
Blood routine examination, white blood cell count increased, and the proportion of neutrophils increased.
Diagnosis
Diagnosis and diagnosis of pregnancy-induced acute appendicitis
diagnosis
Acute appendicitis in early pregnancy has typical clinical manifestations, and diagnosis is not difficult.
Differential diagnosis
Gastrointestinal symptoms are easily confused with pregnancy nausea and vomiting. It should be distinguished. With the development of pregnancy, the uterus is enlarged, and the clinical manifestation is gradually atypical. However, according to the change of the position of the appendix, the abdominal pain and tenderness of appendicitis can still be found. Make a positive diagnosis. In the later pregnancy, the local tenderness is moved to the right abdomen or waist. When the right lower abdomen pushes the uterus, there is occasional mild pain. When the patient is in the left lateral position, the tenderness can be found in the posterior part of the uterus. Appendicitis is of great significance, and it is necessary to strictly distinguish between clinical aura and uterine contractions caused by acute appendicitis to avoid delay in diagnosis.
The differential diagnosis of acute appendicitis is that the white blood cell and neutrophil counts are increased in most patients, while the tenderness in the right lower quadrant of the appendix (Mc's point) is an important sign of this disease.
