Surgery for acute appendicitis (appendectomy) account for the maximum share in the activities of the surgical departments of a General profile. To correctly diagnose, the doctor should be familiar with the symptoms of the disease, to navigate where localized pain is appendicitis.
Fix those who are interested in “how sick appendicitis”. Because appendicitis — the name of the disease, you may be sick appendicular process (also referred to as worm-like). Right need to speak “how and where it hurts the Appendix”.
Not all people have the Appendix within the right iliac fossa. The accuracy of the leading clinical signs ranges from 25 to 75%. In diagnosis should consider the entire range of manifestations. We consider the leading role of the pain syndrome.
For the disease characterized by acute onset. Man on a background of General good health suddenly feels pain in the abdomen, some Wake up at night from the sudden pain. In some patients, they are immediately localized in the iliac region on the right.
In ½ of cases, the pain of appendicitis occurs around the navel or across the abdomen, starts from the area of the epigastrium, and after several hours moved in iliac fossa. This symptom is called a symptom of Kocher, is considered typical for destructive appendicitis. Other diseases are almost not observed.
The intensity of pain is moderate, in adults, the General state little changed. No forced position. Are constant, but bearable character. This is due to inflammation in the appendicular bone. Gradually the intensity increases.
Pain decreased or temporarily withdrawn drugs with analgesic action, and then arise again. Wondering what to do in such a situation, people often apply the heating pad to the abdomen.
This irreparable harm. The inflammatory process becomes more intense and goes to the peritoneum. The patient enters the hospital with symptoms of gangrenous appendicitis and peritonitis.
In the first stage of the disease on palpation the abdomen was soft and tenderness is clearly defined in the right iliac region, destruction (wall rupture) accompanied by signs of peritonitis:
- the abdominal muscles are tense (rigid);
- the right side lags behind in breathing.
If the patient is developing phlegmonous form of appendicitis with the formation of empyema, pain localized in the right iliac region on the right, but evolve slowly in time. The disease reaches maximum symptoms in a few days.
In an average of 3-5 days the character of the pain in appendicitis is changed to pulsating (complaints that “pulls in the side”). Overall condition progressively worsens amid high temperature.
Examining a patient with complaints of abdominal pain, doctors check the symptoms of irritation of the anterior abdominal wall and parietal peritoneum. Pain in appendicitis provoked by concussion of the abdomen, cough, and walk. They long remain within the projection of the Appendix. The main reason for the involvement in inflammation of the peritoneum.
There is a recognized and proven practice, the symptoms, which are assigned names by the authors. They are especially valuable in diagnosis, since it was proposed in the era with no other opportunities examination of the patient.
Here are the most commonly used by surgeons signs:
- — made slow pressure arm in iliac region on the right, then a quick movement is interrupted at this point, the pain of appendicitis may increase.
- — held percussion (light effleurage) of the inflated stomach, stimulating pain.
- — stretched t-shirt or shirt of the patient adjacent to the stomach, the other hand, the doctor conducts in the direction from the epigastrium to iliac region right and left. Pain worsens when the arm is above the iliac area on the right. This symptom associated with the overflow vessels of the vermiform Appendix, so it is positive to the development of peritonitis.
- — local pain, if the patient takes a lying position on your left side.
- — the doctor performs a jog movement in the left iliac region. The edge of the palm compresses the sigmoid colon in the lower part. The reverse movement of content of large intestine, increases the pressure inside the cecum and the vermiform Appendix, which amplifies pain.
Features of the anatomical locations of appendicular bone determine why a significant number of patients the pain syndrome is atypical localization, manifestation.
Retrocecal location (the caecum) is the most frequent (32%) after the downward (63%). Since the bone adjacent to the liver, lumbar muscles, right kidney, the disease assumes the mask of other pathologies. Pain usually starts from the epigastrium, then moved to right side or lower back.
Difficulties identifying even destructive forms of inflammation. No symptoms of peritoneal irritation. Sometimes detect tension in the muscles of the lower back. The diagnosis helps positive symptom Obraztsova — increased pain when lifting right leg.
In pelvic localization of the Appendix in contact with the intestine (sigmoid and rectum), bladder, uterus in women. Pain symptoms are similar to kriticheskie — cramping.
If it hurts in the left iliac region, caused by inflammation and spasm of the lower divisions of the colon. Initially, the attack is localized in the epigastrium, then in the groin or in the area above the pubis. Muscle tension of the peritoneum is often missing. In such cases suspected of appendicitis is possible only by rectal examination, women examined by a gynecologist.
Extrahepatic localization is rare, but has considerable difficulties in diagnosis. It is difficult to distinguish what the pain is caused by an atypical location of the Appendix, which is inflammation of the gallbladder.
In order not to endanger the health of the patient in surgery of taken 24 hours to treat appendicitis or cholecystitis conservatively. If the pain does not disappear to operate, the diagnosis is made only during operation.
During pregnancy, appendicitis can occur at any time. Pain syndrome can be mistaken for a threatened miscarriage. In the second half of the growth of the uterus causes a shift in the dome of the cecum up. Localized pain moved higher, to the right hypochondrium. Palpation difficulty.
Hidden signs of pain need to look at the location of the Appendix behind the uterus. Then abdominal tenderness is slight.
Increases the risk of misdiagnosis. In children the pain is rarely localized, quickly spread through the abdominal wall, manifest contractions.
The disease is as infectious gastroenteritis, dysentery. Expected to lose stomach. For rapid flow is difficult to detect signs of peritoneal irritation. In old age, on the contrary, pain in the stomach little intense. Muscle tension of the abdominal wall may be absent even in destructive forms.
Differential diagnostics is conducted with diseases of organs located to the right iliac region. If this is not enough to focus only on the nature of pain, it is necessary to consider the details of the anamnesis, survey data.
Acute right-side adnexitis (inflammation of the uterus) causing pain in the right groin and lower abdomen. Such localization is possible in pelvic location of the Appendix.
- the patient with acute appendicitis can not hurt a few days, after 1-2 days, the process goes to the peritonitis;
- when adnexitis women experience pain for much longer go to the doctor after 5-7 days;
- adnexitis, a chronic disease, the pain intensifies during periods of exacerbation, is associated with menstrual dysfunction for a few months, infertility;
- palpation of the abdomen painless, not a characteristic rigidity of the muscles, not the symptoms.
In apoplexy of the ovaries, interruption of tubal pregnancy severe pain in the abdomen and on the affected side, usually associated with physical exertion, defecation. The woman has signs of internal bleeding (dizziness. fainting, drop in blood pressure).
An attack of right renal colic immediately begins with severe pain radiating to the lower back, groin, thigh, crotch. Patients unlike appendicitis is instituted. Pay attention to the dysuric symptoms, appearance of blood in the urine, pain reduction after the use of antispasmodics, self-termination attack after stone expulsion.
Inflammation of the right kidney (pyelonephritis) are accompanied by arching dull pain in the lower back, the attacks possible with the type of calculous disease. At the same time, there are growing signs of intoxication, fever, nausea, vomiting. No symptoms of peritoneal irritation. Specialist capable of the lean patients to palpate enlarged and painful kidneys.
Intestinal infections like atypical for appendicitis at the pelvic and medial position of the Appendix. Characterized by the retreat of the pain syndrome on the background. The main burden caused by vomiting, high fever, severe intoxication, diarrhea, loss of fluid.
Acute infectious disease caused by Salmonella or Shigella, have a connection with healthy food, contact with sick. Start with diarrhea, followed by abdominal pain. In appendicitis the pain occur first.
In the differential diagnosis of appendicitis has to be considered with more rare diseases: inflammation of the diverticulum of Mekele, Crohn’s disease (terminal ileitis). Their clinically detected at the time of inspection of the bowel during surgery.
In surgery, adopted the rule mandatory control ileum over a meter from the ileocecal angle, if suspected appendicitis, the Appendix was unchanged or catarrhal.
Careful assessment of symptoms allows you to choose the right tactics of treatment. If necessary, doctors use a consultation of a gynecologist, gastroenterologist, infectious diseases. To the question “can the appendicitis ache a week” we confidently reply that when such manifestations need to look for another disease. Laboratory and instrumental methods allow to confirm or exclude a suspected appendicitis.