Elderly acute appendicitis

　　The appendix, also known as the vermiform appendix in colloquial language, is a tubular organ at the beginning of the large intestine. Due to its growth position, it is prone to inflammation due to infection, cavity blockage, and other factors. The commonly referred to appendicitis is actually a reference to appendicitis (Appendicitis), although the cecum and appendix are actually two different organs, they are almost not distinguished in general colloquial usage. There are records of appendicitis in literature around 1886, which can generally be divided into acute and chronic according to the speed of the development of the disease process.

　　Appendicitis, as the name implies, is inflammation of the appendix. The appendix is usually located in the lower right part of the abdomen, resembling a small tube, about 5-10 centimeters long, with one end attached to the cecum and the other end closed. The lumen of the appendix may be partially or completely blocked, leading to the accumulation of bacteria and causing infection. In severe cases, it can lead to appendiceal cavity formation, gangrene, and even perforation. Most cases of appendicitis require surgical removal of the appendix, while some early or simple cases can be cured with anti-infection treatment.

　　Appendicitis, as the name implies, is inflammation of the appendix. The appendix is usually located in the lower right part of the abdomen, resembling a small tube, about 5-10 centimeters long, with one end attached to the cecum and the other end closed. The lumen of the appendix may be partially or completely blocked, leading to the accumulation of bacteria and causing infection. In severe cases, it can lead to appendiceal cavity formation, gangrene, and even perforation. Most cases of appendicitis require surgical removal of the appendix, while some early or simple cases can be cured with anti-infection treatment.

　　The main cause of appendicitis is usually the swelling of the appendiceal lymph nodes, leading to appendiceal obstruction. Other things that are most commonly responsible for cecal obstruction, including fecal stones, parasites, etc., may also cause appendicitis if microorganisms are infected at this time. Appendicitis that occurs within 3 months is considered acute, while that lasting longer than 3 months is chronic.

　　It is currently believed that acute appendicitis in the elderly is related to the overall health status of the elderly and the anatomical and physiological characteristics of the appendix.

　　If acute appendicitis in the elderly is not treated promptly, it can easily lead to the following diseases.

　　1. Peritonitis

　　Peritonitis, either localized or diffuse, is a common complication of acute appendicitis, closely related to the occurrence and development of appendiceal perforation. Perforation occurs in gangrenous appendicitis, but it can also occur in the late stage of purulent appendicitis.

　　2. Formation of abscesses

　　It is the consequence of appendicitis not being treated in a timely manner, with the most common site being an abscess around the appendix. Abscesses can also form in other parts of the abdominal cavity, such as the pelvis, subdiaphragmatic area, or intestinal spaces.

　　3. Formation of internal and external fistulas

　　If the pericecal abscess is not drained in time, it can break through to the intestine, bladder, or abdominal wall, forming various internal or external fistulas.

　　4. Empyema of the portal vein

　　Infectious thrombi in the appendiceal veins can extend along the superior mesenteric vein to the portal vein, causing portal vein inflammation, which can further lead to liver abscess.

　　The main clinical symptoms of appendicitis are abdominal pain, which can occur in the upper abdomen, lower abdomen, or around the navel in the early stage. It is followed by loss of appetite, nausea, and vomiting. After several hours, the pain may gradually shift to the lower right abdomen, and the pain will increase when pressed and released with the hand. In addition, fever, vomiting, constipation, or diarrhea may also occur. However, not all patients will experience these symptoms.

　　In addition to the above clinical manifestations of acute appendicitis in the elderly, there are usually the following characteristics:

　　1. Elderly blood vessels and lymphatic vessels have degenerative changes, the appendix mucosa becomes thin, there is fat infiltration and fibrosis of the appendix tissue, and with vascular sclerosis, the relative blood supply to the tissue is reduced, so the appendix is prone to necrosis and perforation after inflammation.

　　2. Elderly abdominal muscles atrophy, the body's resistance is low, the symptoms and signs and pathological changes are not consistent, the symptoms and signs are often less severe than the pathological changes, the pain is not very severe and is not typical. Due to the delayed response to pain, the manifestation may only include bloating and nausea, and differential diagnosis can sometimes be difficult, leading to misdiagnosis. Elderly acute appendicitis often presents late, and most patients have gangrene perforation or abscess formation when they seek medical attention.

　　Although acute appendicitis in the elderly is a serious acute abdominal condition, if it is given attention and patients and their families can closely cooperate with medical staff, it is completely possible to turn a dangerous situation into a safe one. Generally speaking, the following points should be noted.

　　1. Early diagnosis and treatment is crucial. If elderly patients experience gradually worsening abdominal pain and oral atropine or belladonna-type antispasmodics have no effect, they should go to the hospital for examination and treatment immediately. Some patients are diagnosed and treated in a timely manner, and they have acute simple appendicitis, which can be treated with antibiotics first without surgery, but the condition should be closely monitored. Some patients have more severe conditions, and if the doctor believes that their original health condition is good, surgery should be performed immediately. Patients and their families should eliminate concerns and actively cooperate with the doctor for surgery.

　　1. Once diagnosed with acute appendicitis, patients should assume a semi-recumbent position, which can prevent diffuse peritonitis caused by appendiceal perforation and also prevent local postoperative inflammation from spreading. After surgery, patients should cough more often and frequently turn over to prevent pneumonia. They should also strengthen nutrition and pay attention to the heart, liver, and kidney functions in coordination with medical staff.

　　"Retroperitoneal pain in the right lower quadrant" or "Fixed right lower quadrant pain" is the main clinical manifestation and diagnostic basis of appendicitis. The diagnosis of appendicitis should first rule out the possibility of right urinary tract stones, gynecological diseases (if the patient is female). In clinical examination, appendicitis has four major signs: cough sign, obturator muscle sign, psoas muscle sign, and Rovsing sign. Routine examination methods:
　　1. Blood test
　　Patients suspected of appendicitis are often required to undergo blood tests to check the level of white blood cells and the proportion of neutrophils. However, there is a 50% chance that even if appendicitis is present, the blood test may be normal. Therefore, this is not the most reliable diagnostic evidence.
　　2. Urinalysis
　　Appendicitis usually requires a urine test, and some patients may have a positive urine occult blood test.
　　3. X-ray
　　Routine X-ray examination is rarely used for the diagnosis of appendicitis and is usually performed when distinguishing from gastrointestinal perforation. Some cases of appendicitis can be indicated by appendiceal enlargement in CT scans.
　　4. Ultrasound
　　Ultrasonic examination is usually used first to rule out urological and gynecological diseases. When the appendix is enlarged, ultrasonic examination can indicate a strip of hypoechoic area. In children, it can also be used to rule out mesenteric lymphadenopathy. In some cases, even if appendicitis is present, no abnormalities may be found.

　　The diet of elderly patients with appendicitis should be light, and they should eat more fibrous foods to keep the bowels regular. Generally speaking, it is advisable to moderate the intake of warm性质的 animal meats such as lamb, beef, and dog meat, and avoid eating too much scallion, ginger, garlic, and chili. Foods with a cooling and detoxifying effect, such as mung beans, sprouts, and bitter melon, can be eaten more. The following are four recommended食疗recipes.

　　1, Peach seed and Coix seed porridge

　　10 grams of peach seeds (peeled and with the tip removed), 30 grams of Coix seed, 50 grams of glutinous rice, cooked into porridge until very soft for consumption.

　　2, Celery and Benincasa hispida seeds decoction

　　30 grams of celery, 20 grams of Benincasa hispida seeds, 20 grams of lotus root nodes, 30 grams of Chrysanthemum indicum, decocted, taken twice a day.

　　3, Benincasa hispida seeds and Sophora flavescens decoction

　　15 grams of Benincasa hispida seeds, 30 grams of Sophora flavescens, 10 grams of Liquorice root, decocted in water, mixed with appropriate honey for drinking.

　　4, Hedyotis diffusa and Patrinia scabiosaefolia decoction

　　30 grams of Hedyotis diffusa, 20 grams of Patrinia scabiosaefolia, decocted in water, mixed with appropriate honey for drinking.

　　The most effective method of treating appendicitis is surgical resection. If acute appendicitis is considered, it is advisable to undergo surgical resection as soon as possible, otherwise, the appendix may even become suppurative and rupture, leading to peritonitis. If there is already a surrounding abscess or encapsulation, surgery is not advisable. Usually, anti-inflammatory treatment is first given, and then appendectomy is scheduled after 3 months. Chronic patients can be scheduled for admission for surgery 3 months after the inflammation is controlled, or emergency surgical treatment can be given when there is a recurrence of acute attacks.

　　In recent years, there has been a method of removing the appendix using minimally invasive surgery, which usually requires opening three small holes in the lower abdomen to perform the operation. Each wound is about five millimeters long, and most operations take 30 to 90 minutes. If it can be removed early, the success rate of the operation can reach 90%. The improved traditional surgery usually only requires a cut of 2 to 5 centimeters, and the operation time for cases with clear anatomy is generally about 15 to 30 minutes. There is no absolute advantage between the two surgical methods. Compared to traditional surgery, minimally invasive surgery has lower infection rate at the incision site, lighter abdominal adhesion, fewer complications, and less pain at the incision, and has more obvious advantages in obese patients.