Right lower abdominal pain is not only appendicitis, these 12 d
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Original Title: Right Lower Abdominal Pain Not Only Appendicitis, These 12 Diseases Must Not Be Ignored Popular Science Doctor: Dr. Zou Changlin Appendicitis is a common disease in surgery, ranking first in all kinds of acute abdomen. It can occur at any age. Abdominal pain in 70% -80% of acute appendicitis is characterized by paroxysmal pain around the umbilicus and in the upper abdomen in the early stage. After a few hours, metastatic right lower abdominal pain occurs. The pain is persistent. Abdominal pain varies in different locations and different pathological types of appendicitis. However, appendicitis is not the only disease that causes pain in the right lower abdomen, but also the following common conditions. 1. Gastroduodenal ulcer perforation Perforation discharge may flow along the paracolic groove to the right lower abdomen, which may be similar to metastatic right lower abdominal pain, much like the pain of acute appendicitis. However, the patient has a history of peptic ulcer, usually with sudden onset and severe pain. In addition to tenderness in the right lower abdomen, pain and tenderness in the upper abdomen, abdominal muscle tension and disappearance of bowel sounds and other peritoneal irritation symptoms are obvious. CT: There is no air in the downstream of the diaphragm, and no abnormality is found in the appendix. Expand the full text 2. Acute mesenteric lymphadenitis This disease is more common in children, usually preceded by upper respiratory tract infection. The location of abdominal tenderness is in the middle, the range is not fixed and wide, and it can be changed with the body position. 3. Infectious diseases of biliary system It is easily confused with high appendicitis, but there are obvious colic, high fever, and even jaundice. Physical examination may be positive for Murphy's sign, usually with a history of repeated right upper abdominal pain. 4. Colon tumor The general history is longer, with abdominal mass, hematochezia,personalised tailor tape, diarrhea or intractable constipation, as well as purulent and bloody stool and mucoid stool. CT showed an irregular soft tissue mass in the intestinal lumen, which was significantly enhanced, and there was fat space around it. 5. Crohn's disease Lesions mainly occur at the end of the ileum, which is a non-specific inflammation and is more common in young people aged 20-30. In the acute stage of the disease, the intestinal canal at the lesion site is congested, edematous and exudative, which stimulates the parietal peritoneum of the right lower abdomen,bespoken tape measure, causing abdominal pain and tenderness, similar to acute appendicitis. The location is limited to the ileum, without the characteristics of metastatic abdominal pain, and the abdominal signs are extensive, sometimes with enlarged intestines palpable. Additional, the patient can accompany have diarrhoea, defecate examination has apparent and unusual composition. 6. Ectopic pregnancy rupture After the rupture of right ectopic pregnancy, the intraperitoneal hemorrhage stimulates the parietal peritoneum of the right lower abdomen, and the clinical features of acute appendicitis may occur. However, ectopic pregnancy often has a history of menopause and early pregnancy, and vaginal bleeding may occur before the onset. The patient has a sense of swelling in the perineum and anus after abdominal pain, as well as internal bleeding and hemorrhagic shock. Gynecological examination may have positive signs such as vaginal bleeding, slightly enlarged uterus with tenderness, right adnexal enlargement and blood in posterior fornix puncture. It can be further confirmed by B-mode ultrasonography. 7. Rupture of follicular or corpus luteum cyst It often occurs in unmarried young women, often two weeks after menstruation, bespoken tape measure ,personalized tape measure, because of intra-abdominal bleeding, causing right lower abdominal pain. The local signs of the disease in the right lower abdomen were mild, and the bloody exudate could be extracted by diagnostic abdominal puncture. 8. Ovarian cyst pedicle torsion After torsion of the right ovarian cyst pedicle, the cyst circulatory disorder, necrosis and bloody exudation caused inflammation of the right abdomen, similar to appendicitis. However, the disease often has a history of pelvic mass, and the onset is sudden, paroxysmal colic, accompanied by mild shock symptoms. During gynecological examination, a cystic mass was palpable and tender, and abdominal B-mode ultrasound confirmed the presence of a cystic mass in the right lower abdomen. 9. Acute salpingitis and acute pelvic inflammatory disease Acute inflammation of the right fallopian tube can cause signs and symptoms similar to acute appendicitis. However, salpingitis often occurs in married women with a history of excessive leucorrhea, and the onset of salpingitis is often before menstruation. Although there is right lower abdominal pain, there is no typical metastasis, and the location of abdominal tenderness is low, almost near the pubic bone. Gynecological examination showed purulent vaginal secretions, obvious tenderness on both sides of the uterus, and tender masses on the right adnexa. 10. Right ureteral calculus The main symptoms were sudden severe colic in the right lower abdomen and radiation to the perineum, no obvious tenderness in the right lower abdomen, and obvious percussion pain in the kidney area. May be accompanied by hematuria, secondary infection, white blood cells may increase, bladder irritation symptoms may occur, can choose B-mode ultrasound identification. 11. Lower right pneumonia and pleurisy Inflammatory lesions of the right lower lung and pleura can reflexively cause right lower abdominal pain, and some can be misdiagnosed as acute appendicitis. However, pneumonia and pleurisy often have obvious respiratory symptoms such as cough, sputum and chest pain, and chest signs such as changes in breath sounds and moist rales. Abdominal signs are not obvious, and tenderness in the right lower abdomen does not exist. Chest X-ray and CT can make a definite diagnosis. 12. Acute gastroenteritis Most of them are caused by unclean diet, and begin to have digestive tract symptoms such as fever, spasmodic abdominal pain and multiple diarrhea. Abdominal pain often has no fixed location, sometimes around the umbilicus, without fixed tenderness in the right lower abdomen and signs of peritoneal irritation. There was no significant increase in white blood cell count, and white blood cells could be seen in routine stool examination. [See Dr. Zou Changlin]