Appendicitis or inflammation of the Appendix cecum (the Appendix) is a common pathology that is treated only with surgery.
The Appendix is an internal organ, which is usually located in the lower right abdomen.
The risk group includes both adults and children from 3 years of age. Symptoms of appendicitis vary depending on the stage of the disease and the age of the patient (young women suffer more often than men and the elderly).
Appendicitis is especially dangerous for pregnant women and for the elderly.
The main symptom of appendicitis the classic location – the constant stabbing (sometimes dull) painthat starts suddenly, without a pronounced reason in the second half of the day.
Initially characterized by pain felt in the navel area and above (epigastric area), then there is a change in character of pain, they become more pronounced, intense and localized in the right side in the inguinal region (lower abdomen on the right).
People in this state can not easily walk. As with walking, coughing and the laughter of a man concerned about the bouts of severe acute pain. The only thing that can make the patient is lying in a certain position on the right side or on the back, otherwise significantly increases the pain.
(retrocecal appendicitis occurs in 5%-12% of cases, and pelvic 8 – 19%), pain of the epigastrium (the so-called umbilical region) shifts to the lower right abdomen and groin, in the lower back or upper quadrant, depending on the nature of the location of the Appendix. Although at first, as in appendicitis, sharply there is a constant, stabbing pain in these cases often there is a slow increase of symptoms, they are expressed poorly, causing the clinical picture of the disease is not bright.
(the cecum is located in the pelvic area and often close to the bladder and to the rectum) may be sick in the area above the pubis. Painful sensations are unpleasant in nature and similar to those observed during inflammation of the genitourinary system.
If the pain dramatically subsides and disappears, it may indicate the beginning of a process of necrosis of nerve cells in the walls of the Appendix. This is a sure sign that there will be peritonitis (which is accompanied by very strong pain, weakness, fever and even loss of consciousness), which leads to complications and even death. Therefore, if suspected appendicitis should immediately call an ambulance.
The total period of development of appendicitis – 48 hours or two days. After this inflammation leads to serious complications, which is dangerous to human life.
Classification of forms of acute appendicitis according to the degree of its development is the following:
- begins with the emergence of favorable conditions for development of pathogenic microflora, resulting in an inflammatory process in the mucous layer of the cover inner walls of the Appendix. This is the catarrhal stage in which the symptoms are hidden. It goes into the surface shape, when seen inflammation. The initial phase lasts for the first 12 hours of the attack.
- – this is when you begin to appear developing destructive changes that lead to inflammatory processes in all the tissues of the walls of the Appendix. After that, the peritoneum becomes inflamed and irritation causes main symptoms or manifestations of the disease. The first symptom characterized by pain in the right iliac region. It can happen that the formation of several foci of inflammation, then talk about ulcerative phlegmonous appendicitis. This phase lasts about 36 hours and starts on the second day after the onset of the disease. During this time the appendicitis does not lead to serious consequences and is easy for a person.
- defeat when, due to necrosis (necrosis) tissues process is a loss of sensitivity and a person disappear constant pain. The next stage is perforated, the perforation (rupture) or perforation of the walls leads to purulent peritonitis (pus comes out of the Appendix enters the abdominal cavity). This is accompanied by the fact that suddenly there is a sharp pain, and if not immediately do the surgery death.
found in 1% of cases, often in young women. In this disease inflammation of the Appendix gradual, slowly evolving. The main symptom – strengthening of pain in right iliac region during exercise, the tension of the abdominal muscles during defecation or cough.
Sometimes the symptoms of chronic appendicitis are bothering a person for several years. The disease can become acute during this period. In this case, use conservative treatment reduce inflammation, swelling and restore the circulation process (antibiotics, diet and nutrition hourly)
During recurrent acute nausea and vomiting, and observed disorders of stool (constipation or diarrhea) and other symptoms of acute appendicitis. For the treatment surgery to remove the Appendix (appendectomy).
Possible causes of appendicitis:
- The presence of cancer tumors or other tumors in the lumen of the Appendix
- Circulatory disorders of the bone due to thrombosis
- Deformation of the Appendix because of individual peculiarities of its structure
- Displacement of the Appendix during pregnancy in women
- The transition of the infection on the inflamed Appendix from the bodies of female urogenital system (ovaries, appendages, etc.)
- The bacteria in the Appendix because of the goiter, diarrhea or increased gas (flatulence) and other infectious diseases
- Proper nutrition – the presence in the food of sufficient amounts of vegetables and fruits.
- Treatment of parasites,
- Treatment of constipation, dysbiosis, digestive disorders, and other disorders in the gastrointestinal tract
- Timely treatment of infectious diseases
The total time of development of the disease in children is much less than in adults and lasts for 24 – 36 hours. The table below provides information on the symptoms of the disease three main ages, when there is the likelihood of appendicitis. Appendicitis in toddlers hardly occurs, and in adolescents (11 – 18 years) the symptoms are similar to signs of illness in adults.
If the child within 6 hours of a stomach ache, a fever and other signs of appendicitis, consult a doctor.
Diagnostic measures begin with the fact that the doctor receives information about patient complaints and inspects. What methods are used to diagnose appendicitis? The following are the symptoms for authors and small information on how to test them.
In men appendicitis is also seen a slight pulling up of the testicle on the right side during the examination by palpation. Light pulling of the scrotum also causes pain in the right testicle.
In women, the diagnosis is much more complicated, if the attack began during menstruation.
For diagnosis you must see a complete clinical picture. Therefore, in suspected appendicitis, the patient requires access to a doctor and immediate hospitalization for further evaluation. At home it can be done.
In the hospital to identify the disease, it is necessary to pass a General analysis of blood and urine. Rarely, the surgeon assigns the carrying out rectal examination (lower pelvic location), or quite often, vaginal examination (in women, so rule out the presence of gynecological and urological problems). If the picture is unclear, often need additional consulting gastroenterologist and gynecologist.
If shows increased numbers of leukocytes in the blood (above the norm 9 in the absence of pregnancy in women), this indicates the presence of an inflammatory process. If detected, this indicator exceeds 20, there is a probability of rupture appendicitis (peritonitis). Leukocytosis was observed in 52% of cases. Otherwise, medical professionals believe that this may be a hidden appendicitis (medical history or symptoms in this disease is somewhat different). The amount of C-reactive protein in the blood shows the presence of inflammation (norm adult men and women – 10 mg/l, the indicators above the norm may indicate an inflammatory process, with the exception of pregnant women, for whom the rate of 20 mg/l). Indicators of reactivity increase 12 hours after the attack.
25% of the time (and retrocecal in pelvic appendicitis), shows the presence of a small amount of retrocecal and white blood cells.
If this is not enough and accurately diagnose appendicitis fails in addition to the analysis and examination of the patient by a surgeon for further diagnosis and detection is carried out . Often ultrasound of the pelvic organs, and laparoscopy. Unlike ultrasound, laparoscopic method can accurately determine the presence or absence of pathology if the diagnosis is confirmed, the Appendix immediately removed. Often a laparoscopy is performed under General anesthesia, so it has a number of contraindications.
Appendicitis is dangerous with its complications, but rather their consequences. Many of them pose a threat to life and health. Therefore, the most important in the successful treatment of disease and reduce the risk of death has timely access to a doctor .
The most common complications of appendicitis is:
- when appendicitis burst (due to perforation or rupture of the wall of the bone) and pus enters the abdominal cavity and the inflammatory process extends, causing purulent abscesses (formation of abscesses or fistulas to internal organs of the abdominal cavity), the consequences of which are General blood poisoning (sepsis) and death. Most often, the lesion affects the peritoneum and some sections of the intestine. The first signs of peritonitis – acute pain, dry mouth and fever. As the affected areas of the intestine will also require surgery to repair, surgery to remove the peritoneal appendicitis is much more serious and leads to problems such as intestinal adhesions and intestinal obstruction.
- – a serious complication that leads to chronic appendicitis. Around the process is formed of dense pathological education. Is a protective reaction of the organism to the appearance of a foreign body. To remove this education very difficult.
- – the most dangerous state, when the disease quickly affects the major vessels of the liver, they become inflamed and the blood supply to the body is disturbed, which in most cases leads to death.
The number of deaths (deaths) from appendicitis increases in emergency admission to hospital of patients requiring emergency care with advanced disease in the later stages complex peritonitis or pylephlebitis.
If you suspect appendicitis necessarily urgently contact the ambulance, regardless of your location! This measure can save lives! To a medical examination it is impossible to put a heater, to give painkillers or laxatives.
Treatment of appendicitis is surgery to remove it or appendectomy. Surgical intervention is performed either through one large incision (7-10 cm.), or through three small incisions (1 – 2cm) laparoscopically under General anesthesia.
In order to determine the location of the incision, guided to the point of Mak Burney.
The sooner diagnosed the disease, the easier the operation proceeds to the patient.
Often there are cases when the surgeon during the operation it becomes clear that appendicitis does not, then use intraoperative differential diagnosis. Special attention during laparoscopy pay gynecological pathologies.
One patient did a laparoscopy. The survey found that appendicitis is combined with the rupture of ovarian.
difficulties are cases when:
- old age
- the presence of a large number of related chronic diseases (serious diseases of the heart, kidneys, liver and other internal organs)
- advanced stage of the disease.
- Internal bleeding
- Postoperative inguinal hernia (depends on patient)
- The formation of infiltrates
- Internal abscesses
- Suppuration of the joints due to infection
- Adhesions in the intestine, leading to the formation of fistulas (after removal of appendicitis with spilled peritonitis)
- Intestinal obstruction (man is suffering from a sharp pain and other dangerous consequences)
need to lie, this is not to eat and drink. If necessary, the incision is established a special drainage tube, which is necessary for discharging the internal fluid and the introduction of antibiotics. It is removed on the third or fourth day. Some time after the surgery, the doctor prescribes painkillers.
you can drink a small amount of acidified water.
can I eat low fat yogurt or cottage cheese. Already I need to try to get out of bed and to walk slowly. Active patients recovery is faster.
after surgery sutures are removed.
Somewhere during the six weeks we need to stick to a diet, and then you can gradually introduce usual food.
During recovery, it is necessary to wear a tight bandage and reduce any physical activity (in any case, not to lift weights).
The postoperative period after appendectomy for simple appendicitis lasts from 20 days to one month. If the operation is done to an elderly person or removed appendicitis with peritonitis, then full recovery can take up to six months.
At this time, to avoid complications, it is necessary to comply with all recommendations and be sure to come on reception to the doctor.
The use of differential diagnosis allows the physician to distinguish appendicitis from other diseases.
Below shows what are the main symptoms of appendicitis are present in some other similar diseases.