Acute appendicitis is the most common disease in children's acute abdomen, due to the physiological characteristics of children, they often behave atypically, or because they can not clearly express their discomfort and easily lead to misdiagnosis or delay in diagnosis and treatment, and make the disease further aggravated. Let's take a good look at this little appendix.
The illustrations are original by chiyu Senri A bell designer
01
Where is the appendix?
Located in our right lower abdomen, from the root of the cecum, the appendix belongs to a basic degenerate organ tissue for humans. The pediatric appendix is funnel-shaped, with a broad basal base, about 4 to 8 cm long, and the appendix moves to the left posteriorly as age increases. 90% of the appendix starts from the medial wall posterior to the cecum. Its distal end is free on one side of the right lower abdominal cavity connected to the first part of the large intestine, while the other end is closed.
The Mysite point, which we often call the appendix point, is located in the first third of the distance between the navel and the anterior upper ridge of the right iliac, and is the most common projection position on the surface of the root of the appendix, and if appendicitis occurs, there will be obvious tenderness in this place.
02
The characteristics of appendicitis vary from age to age
The appendix of small infants is short and thick, the opening is relatively large, and the root is funnel-shaped, which is beneficial for drainage and has less chance of obstruction. Therefore, the younger the age of appendicitis in children, the lower the incidence.
In childhood, with the change of the immune system, the lymphatic follicle hyperplasia of the ileocular intestinal wall is significant, and the lymphatic immune response of the appendix is gradually active, which is also one of the reasons for the higher incidence of school-age children, and purulent appendicitis is the mainstay. Preschoolers eat the same food as adults, but have poor digestion, and may have indigestible slag such as rice husks, fruit husks, and sesame seeds entering the appendix and causing damage or becoming the core of fecal stones. Therefore, the perforation of fecal gravel compressive necrosis is also more common in children after school age.
03
What are the symptoms when your baby develops appendicitis?
Typical symptoms of appendicitis are metastatic right lower quadrant pain. That is, it may start with pain in the upper abdomen or around the navel, and after a while it becomes a well-defined pain in the right lower quadrant. However, due to the age characteristics of babies, they may not clearly express their discomfort, so parents need to pay more attention to their changes.
In general, school-age children present with sudden tummy pain that does not resolve, gradually worsens, and may be accompanied by fever, nausea, vomiting, diarrhea, or constipation. The baby's appetite becomes worse, refuses to eat, does not want to move, and refuses to press the abdomen. Nausea, vomiting, and diarrhea can sometimes be misdiagnosed as acute gastroenteritis. Small babies can not describe the pain themselves, manifested as paroxysmal crying, irritability, no smile, abdominal pressure refusal, when the child cries "slapping hypnosis" but crying more severely. Once the baby has the above symptoms, parents should take them to the hospital in time to clarify the cause of the discomfort.
04
What tests do I need to improve to diagnose appendicitis?
If your baby has typical symptoms and has fixed tenderness and muscle tension in the right lower quadrant, the diagnosis of appendicitis is inextricably different. However, if the symptoms are atypical and there is doubt, the doctor may ask the baby to do some of the following tests to confirm the diagnosis. The first is a number of blood tests that focus on infection and electrolytes, including blood analysis, C-reactive protein, procalcitonin, and biochemical electrolytes. In addition, imaging is mainly ultrasound at the appendix site and CT examination of the abdomen.
05
How is appendicitis treated?
Surgical resection remains the mainstay of treatment for appendicitis, especially in purulent, perforated appendicitis. During the operation, laparoscopic or open surgery is selected according to the baby's actual situation. Before the operation, it is also necessary to fast and drink according to the baby's situation, maintain the balance of water and electrolytes and use appropriate anti-infective drugs. In recent years, the concept is that if simple appendicitis is not accompanied by perforation, suppuration, etc., conservative treatment with antibiotics can be considered, but the baby's condition needs to be paid close attention.
Children's appendicitis diagnosis is more difficult, but also easy to miss or misdiagnosis, as a mother and father need to pay attention to the baby's daily spirit, diet and activity changes, timely detection of clues, take the baby to the regular hospital for treatment, clear diagnosis, to avoid further deterioration of the disease.
End of full text
Contributed by: Liang Yi
Review: Ma Xiaohan
Typography: Wolfie
bibliography:
Pediatric appendicitis. ZHANG Jinzhe. Journal of Clinical Pediatric Surgery Vol. 1, No. 5, October 2002
Analysis of misdiagnosis of appendicitis in children. LI Xiaoqing ZHOU Dekai. Chinese Journal of Pediatric Surgery Vol. 25, No. 2, April 2004
Progress and prospects of laparoscopic diagnosis and treatment of appendicitis in children. Wei Chen, Zhanlei Yang, Hongpeng Wang, Heilongjiang Medicine, No. 3, 2014, Vol. 38