Appendicitis: symptoms and first signs, how to determine appendicitis in the article Surgeon Svechkar I. Yu.

Publication date November 20, 2017. Updated December 16, 2020.

Definition of the disease. Causes of the disease

Acute appendicitis - This is a rapidly developing inflammation of a worm-shaped outflow of a blind intestine (Appendix).

Inflamed and Normal Appendix

There is no more known disease in surgery than acute appendicitis, but this "fame" does not make it easy to identify and treat. Any surgeon, often colliding in his professional activities with this disease, will say that the diagnosis of acute appendicitis in each particular case is a necessary problem, variable and is based primarily on the experience and intuition of the doctor.

Which side is Appendix

Cell-shaped process, or appendix (lat. Appendix), is a tubular structure with a length of 4-10 cm, a diameter of 0.5-0.7 cm, which departs from the wall of the blind intestine and blindly ends. Appendix is ​​located at the bottom of the abdomen, on the right side.

Appendix is ​​located in the right lower abdomen

The wall of Appendix consists of the same four layers as other intestinal departments, and its thickness is approximately the same. But although a worm-shaped process is part of the intestine, in the digestion functions, it is practically not involved in [one] .

The role of appendix in the body

Less than a century ago, Appendix was considered a useless part of the organism, besides very dangerous and unpredictable, since the inflammation of the appendix can occur with any person at any time. The development of the disease is possible even on the background of full health, which can destroy all human plans.

There is a logical and justified question: if this process is not needed, it is not better to delete it to everyone in advance at a certain age, for example in childhood. No, no better. The experience of prophylactic planned appendectomy (Appendix's removal) to the School of Nazi Germany in the 1930s, showed that after this operation, people most often suffered from chronic intestinal diseases and infectious diseases in general.

As it turned out for further research, there is an increased content of lymphoid tissue in appendix [2] . Taking into account its location on the border of a thin and large intestine, most likely, it is an organ of the immune system - "guarding" of the sublicasy microflora. There are no unnecessary organs in the human body, and a worm-shaped process is no exception.

Epidemiology

The incidence of acute appendicitis is 4-6 people per 1000 population per year. Previously, it was considered the most frequent acute surgical disease, but in recent years he is inferior in frequency of acute pancreatitis and acute chivests. More often develops aged 18-42 years. Almost twice-often women are ill. May develop in childhood, more often in 6-12 years [one] .

Causes of the disease

There is no one apparent and unconditional cause of the development of acute appendicitis. An alimentary factor can play a certain role, that is, the nature of nutrition. It is noted that in countries with a higher meat consumption, the incidence of acute appendicitis is higher [nine] . The explanation is the fact that meat food is more important to the occurrence of putrefactive processes in the intestines and disorders of evacuation.

It is believed that frequent use of fried sunflower seeds can cause appendicitis, but there is no data that can confirm this.

In rare cases, the cause of appendicitis can be foreign bodies in appendix, for example, by chance a swallowed dental seal, fruit and vegetable seeds or non-registered vegetation residues. 95% of substances that are not digested by the gastrointestinal tract are without any problems through the digestive system. However, more difficult substances from the bottom of the blind intestine can easily get into the clearance of Appendix. The peristaltic activity of the appendix cannot remove the contents back to the blind intestine, so the accumulation of foreign bodies can lead to blockage of the lumen and, therefore, inflammation [ten] .

In childhood, the cause of the disease can be the presence of helminths in the colon with the penetration of them in appendix and disruption of evacuation from the latter. [2]

Warning

When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of appendicitis

Characteristic signs of appendicitis:

1. Pain. The most important, frequent and important symptom of acute appendicitis. Most often occurs at night or early in the morning. In the first hours of the disease, the disease is localized in the epigastric region, that is, in the upper central part of the abdomen, under the sternum. There may also be funeral pain around the abdomen.

First, painful sensations are rarely intense, can wear a spastic character for a while. After 2-3 hours, the so-called symptom of Kochker is developing - the displacement of pain and localization of them in the right iliac region (the right bottom of the abdomen, in about the middle of the distance between the groin fold and the navel).

Abdomen area

The above character of pain occurs with the typical anatomical arrangement of appendix.

Atypical forms and symptoms

Other options for the arrangement of appendix are possible: under the liver, in a small pelvis, behind the blind intestine, retroinchenously, as well as in rare cases In the left bottom of the abdominal cavity With Situs Viscerum Inversus (mirror arrangement of internal organs). In these cases, pain can be observed accordingly in the right hypochondrium, the right lumbar region, above the pubic, in the right hip, in the area of ​​the rear pass or in the left half of the abdomen. Atypical forms make up 5-8% of all cases of acute appendicitis.

Options for the location of Appendix

There are a number of symptoms that are associated with pain in appendicitis and are named after those who discovered by doctors:

  • Rovzing symptom - the appearance or strengthening of pain in the right iliac region, when the doctor performs push movements in the descending bowel area in the left ileum region;
  • symptom Sitkovsky - the appearance or enhancement of pain in the right lower abdomen, if the patient lies on the left side;
  • Syptom Voskresensky (Symptom "Shirts" or "Slip")  - the doctor through the shirt with the tips of the fingers makes a fast and light moving movement from top to bottom towards the right iliac region, while the pain is enhanced at the end point of the movement;
  • Symptom of exemplary - the appearance of pain in the right iliac region, when the patient raises the straightened right leg;
  • Symptom KoPa - The appearance of pain in the depth of the pelvis on the right and above Lona, when the patient in the position lying on his back bends the right leg in the knee joint and turns the dust.

When the patient falls into the hospital, the receiving rest surgeon must necessarily perform some of these manipulations to check for the presence of pain symptoms characteristic of appendicitis.

2. Nausea and vomiting. It does not always occur, about 2/3 cases. Usually shortly after the appearance of the original pain appears nausea, and then one-time or two-time vomiting, which is rarely abundant. Vomiting is reflexive, it is the result of irritation of the nervous endings of the peritoneum in the field of developing inflammation. If you do not apply for help, in two days from the moment of the beginning of the disease, vomiting may resume, but already against the background of developing peritonitis and general intoxication of the body.

3. Increased body temperature. In the first 12 hours at the initial stage of the inflammatory process, the body temperature is usually 37.2-37.5 ° C. . In 3-7% of cases in the first hours, the temperature can reach 38 ° C. and more. In the future, after 12 hours and to two days, the temperature usually reaches febrile numbers - 38 ° C. And above, the feeling of heat or chills appears.

4. Violation of the chair. Infrequently, but a liquid chair can be observed, 1-3 times. It occurs at the pelvic arrangement of appendix and adjacent it to the rectum or irritation of the nerve endings of the pelvic peritoneum.

5. Frequent urination. This symptom of appendicitis is more often observed in women, which is associated or with the above-described irritation of the pelvic peritoneum, or with the impact of the inflamed appendix on the bladder or the right ureter at their close position.

6. GENERAL WEABLITY AND AREATING. Associated with developing intoxication of the body [2] .

Why can sick on the other side

With acute appendicitis, pain often occurs in other parts of the abdomen, which is associated with the spread of inflammation on the peritoneum. In the initial phases of the development of acute appendicitis, pain can "give" to the area above the pubic and in the crotch, sometimes in the right thigh. With an atypical retroperitoneal arrangement of Appendix, pain can be localized in the right lumbar region. With the development of an acute inflammatory process, pain will be distributed in an increasing number of areas.

Signs of appendicitis in women

Appendicitis in men and women proceeds almost equally.

Acute appendicitis in pregnant women

During pregnancy, the location of the abdominal organs changes - they are pushed out by an increasing uterus on the parties and up. The blind intestine with appendix is ​​also pushed up. The frequency of acute appendicitis in pregnant and non-empty women of the same age is the same.

But in the event of an acute appendicitis during pregnancy, the clinical picture may be uncharacteristic - pain is localized, the higher the longer the term of pregnancy. In addition, many pregnant women often face pulling unpleasant sensations at the bottom of the abdomen, in the lumbar region, with nausea and vomiting. All this may lead to the fact that acute appendicitis they will be detected in the later phase of the disease.

Operational treatment in the first and second trimesters for uncomplicated forms - laparoscopic. In the third trimester, open interventions are more often used, since a large uterus prevents the safe carrying out of laparoscopy. It is very important to prevent the development of peritonitis, since in this case the likelihood of adverse effects for mother and fetus increases.

A sharp appendicitis of the child

Acute appendicitis is more common in children aged 6-12 years. Perhaps this is due to the peculiarities of rapid growth and physiological restructuring of the children's body in this period. Anatomical feature of children is that their large gland is less developed and fulfills its protective function worse than adults. Therefore, the spread of the inflammatory process on the abdominal cavity occurs faster.

In children, the symptoms of acute appendicitis are usually pronounced and the diagnosis is set at the first appeal to a specialist.

Pathogenesis of appendicitis

As appendicitis develops

Inflammation in Appendix almost always begins from the inside - with mucous membranes. Subsequently, it applies to the outer layers. The order may be violated in the case of blockage (thrombosis) of the appendicular supply of the blood vessel, in this case there comes a gangrene (death) of all layers of the organ.

The main way of developing acute inflammation is enterogenic, which implies infection with certain types of bacteria from the lumen of the blind intestine. In 90% of cases, an anaerobic flora is the source of acute inflammation, for the development of which oxygen is not required, in the rest - aerobic microorganisms that need oxygen, including the intestinal wand well known to all.

There is also a theory of hematogenic (through the bloodstream) and lymphogenic (through lymphatic ducts and nodes) of the path of infection of the wall of appendix from other foci of inflammation. But the likelihood of these events is low, this is possible only in weakened patients and individuals with immunodeficiency. An important factor in the pathogenesis and development of acute appendicitis is the violation of evacuation from it: when blocking the mouth of the scene, helminths or ethnic phenomena with inflammatory bowel diseases.

Classification and stage of development of appendicitis

In our country, the classification of Professor V. S. Savelyev was adopted. It reflects the stages of the course of acute appendicitis, which follow one after another in the course of the progression of the inflammatory process [3] .

Forms of acute typical appendicitis:

  • Catarial appendicit (Simple, surface) affects only the mucous membrane of appendix;
  • Flegmonous appendicit affects all layers, fibrin protein appears on the serous shell;
  • Gangrenoz appendicitis Donation of all the layers of Appendix;
  • Perforative appendicitis breakthrough of the walls of appendix;
  • Empiam of a worm-shaped process - R The nitrogenousness of phlegmonous inflammation, in which, as a result of a scarsing process or blockages, a closed cavity filled with pus is formed in the enlightenment of the process.

К atypical forms of acute appendicitis Below options for its location:

  • Retrocecal Appendix - Located along the back surface of the intestinal wall ;
  • Sanguchny - Located under the biscuits ;
  • pelvic - Located in a small pelvis ;
  • left-sided - Located on the left.

Complications of appendicitis

In case of late treatment for medical care or incorrectly providing it in 2-3 days after the start of the disease, life-threatening complications may develop [2] [four] :

  • Peritonitis - acute inflammation of the peritoneum. Local peritonitis in the zone of the primary inflammatory hearth (appendix) begins to develop from a phlegmosic form. In the future, if there is no separation of the process, it progresses, it applies to the rest of the abdominal cavity departments and in 3-4 days it acquires purulent. In the absence of treatment, the fatal outcome occurs.
Peritonitis
  • Periappendicular infiltrate. The biological meaning of the formation of infiltrate is the separation of an acute inflammatory focus from the remaining organs of the abdominal cavity and an attempt of the body to protect themselves from peritonitis. Infiltrate is a paved intestine loop of the small intestine and a thick intestine with their mesenter, the fatty tissue of the abdominal cavity and the adjacent abdominal wall.
  • Apandicular abscess - intra-painted delighted ulcet, arising from the gap of appendix. It is often the next phase of the process after the formation of infiltrate.
  • Abdominal abscesses - Refranted intra-paintings against the background of peritonitis.
  • Phlegmon abdominal wall - Spilled purulent inflammation of tissues that r Pomed in the case of the close location of the appendix or abscess to the abdominal wall. Retroitoneal phlegmon is the spread of the inflammatory process on the retroperitoneal tissue with the corresponding arrangement of the draft-like process.
  • Pilefelbit. A rare, but extremely heavy complication, which is a septic thrombophlebitis of a large visceral veins of the abdominal cavity - upper-holeculent and portal veins. The path of spreading purulent inflammation - vascular, from appendicular vessels [four] .
  • Sepsis Blood infection with infectious agents and their toxins.

Diagnosis of appendicitis

Attempting self-diagnosis and further self-treatment in acute appendicitis can be dangerous. With persistent more than 1.5-2 hours in the stomach and the availability of other listed appendicitis symptoms, the best solution will be the appeal to the receiving clinic that has a license to provide relevant assistance. As a rule, these are large state municipal clinics, as part of which there are surgical departments (central district, urban and regional hospitals). Most of the private clinics assistance in appendicitis does not and redirect patients to relevant institutions.

The diagnosis in acute appendicitis is based on the results of the inspection, the overall analysis of blood, the ultrasound of the abdominal bodies and the CT abdominal cavity.

Inspection and collection of anamnesis

Inspection of the duty officer, collection of anamnesis in a patient It is implied to find out the characteristic features and symptoms of appendicitis, the thermometry, palpation of the abdomen with the detection of the disease zone, identifying the symptoms of the peritoneal irritation, check the so-called "appendicular symptoms". There are clinical scales, which, by the totality of symptoms, show the likelihood of the presence of acute appendicitis. For example, in Western countries, the Alvarado scale is distributed.

Alvarado scale

Interpretation:

  • 0-4 points Low probability of appendicitis;
  • 5-6 points indefinite probability of appendicitis;
  • 7-8 points The average probability of appendicitis;
  • 9-10 points High probability of appendicitis.

What can a doctor ask:

  • where does it hurt;
  • how hurts;
  • how long ago hurts and from what place the pain began;
  • The circumstances of the appearance of pain (connection with the welcome, physical activity, stress);
  • there was no nausea, vomiting, temperature increase;
  • whether the chair and urination is not disturbed;
  • whether surgical operations were performed (including appendectomy);
  • In women - the phase of the menstrual cycle and the probability of pregnancy;
  • The presence of concomitant diseases.

Lab tests

General blood analysis It can identify: an increase in leukocyte levels (in the first day to 11-15 thousand \ μl, in the future it may be even higher); leukocytic formula shift to the left - the phenomenon of the appearance of immature forms of leukocytes; Eosinophilia may also be observed ( Increasing the number of eosinophils ).

Instrumental diagnostics

Ultrasound of the abdominal organs. It does not have 100% sensitivity and specificity in the diagnosis of acute appendicitis, but should always be performed under abdominal pain syndrome of unclear origin in order to distinguish appendicitis from other diseases. If ultrasound performs an experienced specialist on high-resolution equipment, the informativeness of ultrasonic diagnosis of acute appendicitis can reach 90%.

CT abdominal cavity. It is used in cases complex for diagnosis, including during atypical forms of the disease. Informativeness reaches 95%.

Is it possible to immediately make a diagnosis

Even when conducting all surveys in doubt, an experienced physician may remain in the correct diagnosis. In this case, hospitalization is shown in the surgical hospital and the implementation of diagnostic laparoscopy under general anesthesia.

How to distinguish appendicitis from other diseases  

A number of diseases have a picture of a sharp appendicitis, for example, a kidney colic, acute pyelonephritis, acute cholecystitis, acute pancreatitis, ulcerative disease, Crohn's disease, acute gastroenteritis, an apochy of the ovary, salpintingitis and others. To distinguish appendicitis from other diseases, conduct differential diagnosis, during which characteristic features are compared. For this, additional surveys may be required: biochemical blood test, EGDS, ultrasound of small pelvis and kidney organs, survey and excretory urography, examination of the gynecologist and urologist, etc. [four] [five]

Treatment of appendicitis

First aid in the development of appendicitis

Specific first assistance in appendicitis is not required. If suspicion of appendicitis should be counted for the doctor.

To which doctor to contact

The treatment of appendicitis is engaged in the surgeon.

Indications for the operation

Acute appendicitis without treatment is fraught with severe consequences, so the diagnosed inflammation of the appendix is ​​a sufficient reading for the operation.

When installing the diagnosis of "acute appendicitis", emergency surgery is shown: the removal of appendix, or appendectomy. The first 24-48 hours of the onset of the disease proceed, as a rule, without the development of complications, therefore the operation is limited only by the volume of the removal of appendix. The operation can be performed by cutting the abdominal wall in the right iliac region with a length of 5-7 cm (McBurnum access Volkovich Dyaconov).

Scar after the removal of appendix

Laparoscopy in appendicitis

More modern and preferably laparoscopic operation. Laparoscopy is a more universal technique that allows you to hold the diagnostic stage at first - an inspection of the abdominal organs, a worm-like process. When confirming the diagnosis of acute appendicitis, the laparoscopic appendectomy is possible. If the diagnosis is not confirmed, laparoscopy avoids an unnecessary cut of the abdominal wall. In any case, this method is more sparing and cosmetically beneficial than incision. [five] .

Appentectomy laparoscopic path

In case of detection common purulent peritonitis which develops with 3-4 days of the disease, the operation is already produced in the volume of the large cut of the abdominal wall - the median laparotomy. This is necessary not only for the removal of appendix, but also for the full rehabilitation of the abdominal cavity.

With the catarrhal form of appendicitis, the assignment of antibiotics is not necessary. With phlegmonous and gangrene form and peritonitis - it is necessary to assign antibacterial drugs, starting from the moment of the operation. Also, bacteriological sowing is produced from the intervention zone for possible further correction of therapy.

When identifying Appendicular infiltrate Immediate appendectomy is not shown, as it is associated with increased trauma due to the risk of damage to the organs involved in infiltrate. As a rule, antibacterial therapy is prescribed to a decrease in inflammatory phenomena.

When identifying Appendicular abscess A minimally invasive drainage is produced - installation of a tube into an absurpenix of a peppy in order to empty and eliminate the focus of inflammation. Drainage can be left in an abscess cavity for up to 2-3 months.

With appendicular abscess , As with appendicular infiltrate, a delayed operation is shown (1-3 months after primary treatment) in the volume of appendectomy. This time is required to reduce inflammatory phenomena and interference in a relatively favorable "cold" period.

The diagnosis of "Chronic appendicitis" causes doubts with his eligibility from many researchers. It is usually a state after a previously transferred acute appendicitis, treated not by the operational way, but through antibacterial therapy. Chronic appendicitis requires operational treatment in a planned manner.

Contraindications to surgery in acute appendicitis

  • Appendicular infiltrate (detected during the palpation of the abdomen, as well as according to the ultrasound and CT of the abdominal cavity) - with this form of an acute appendicitis, the process is deliberate and requires the use of antibacterial drugs;
  • Heavy concomitant diseases that significantly increase the risk of postoperative complications and mortality - in such cases it is also permissible to begin treatment with acceptance of antibiotics.

Postoperative period

The first 5-7 days after the operation should adhere to a gentle diet. Physical activity both after laparoscopy and after "cut" is recommended to limit for one month. Heavy exercise and sports workouts should be canceled for 2-3 months.

No special items of rehabilitation (for example, treatment with mineral waters of Kislovodsk or mud baths) is not required. When restoring after an extensive strip operation, an individual approach is needed with peritonitis.

Is it possible to cure appendicitis by folk remedies

At appendicitis, an emergency operation is shown, the treatment of folk remedies can lead to the patient's death.

Forecast. Prevention

With the uncomplicated course of acute appendicitis and performing the operation during the first day forecast Favorable, patient usually spends 2-3 days in the clinic. When carrying out the operation for two days of the disease, the forecast is generally also favorable, but the probability of complications is slightly higher and the duration of stay in the hospital increases due to the course of antibacterial therapy - up to 5-7 days. With peritonitis and other complicated forms of acute appendicitis, the success and duration of treatment will depend on many factors: the volume of operations, the presence and degree of prevalence of peritonitis, the age of the patient and the presence of concomitant diseases. Therefore, when symptoms appear, it is necessary to immediately consult a doctor.

Proven way to prevent appendicitis does not exist. As Primary prophylaxis can be recommended nutrition with High fiber content: Fruits, vegetables, legumes, oatmeal, brown rice, solid wheat and other whole grain products. ОDnako does not have reliable data that such a nutrition warns the development of inflammation of the appendix.

According to studies, in rare cases, the cause of appendicitis can become The accumulation of foreign bodies in appendix. In this regard, it is recommended, not to use the seeds of fruits and vegetables, as well as thoroughly chew out vegetable food [ten] .

Treatment of appendicitis

Treatment of appendicitis

The only most efficient and acceptable method of treating appendicitis occurring in acute form is the removal of the inflamed process of the blind intestine. Surgical intervention in a comprehensive comprehensive treatment allows you to avoid complications, keep health and life to the patient.

Medicia treatment

Eliminate inflammation in the tissues of the Cell-shaped outflow of a blind intestine with drugs unrealistic. Moreover, before arrival in the hospital, when attaching appendicitis is categorically contraindicated by the reception of any painful medicines, which can "lubricate" the clinical picture of the course of the disease and complicate the diagnosis.

The use of drug therapy is relevant only with surgery for the prevention of postoperative complications and faster recovery of the body after an attack of appendicitis.

Surgery

After arriving in the hospital and carrying out all necessary studies, in confirming the diagnosis of "acute appendicitis", the patient is sent to the operation. If the diagnosis is questioned, the patient is left for time in the hospital and are observed for its condition.

The operation to remove the inflamed transformation of the blind intestine was called Appendectomy. There are two types of operational intervention, practiced today. The most common is open operational intervention, performed through a cut under general or local anesthesia. To date, laparoscopic appendectomy in acute appendicitis is carried out in most cases.

Open surgical intervention

Open surgical intervention

Standard appendectomy is performed through a small incision in the front abdominal wall. If the body has already managed to develop complications, surgical intervention through incision is the most optimal. When perforation, the abdominal reproduction of the abdominal cavity can be carried out through the bottom-median laparotomy. As a rule, in such cases, patients are carried out intra- and postoperative antibiotic therapy, and at the final stage of operational intervention, drainage is installed in the abdominal cavity.

Laparoscopy

Laparoscopy is a unique technique that allows not only to diagnose with maximum accuracy, but also to immediately perform surgical operations. Laparoscopy as a diagnostic procedure is performed through a puncture in the patient's abdomen wall, where the special device is introduced, at the end of which the miniature video camera is located. Through laparoscopy, the doctor may inspect the organ affected by the inflammatory process, and with maximum accuracy to diagnose. When surgical pathology, requiring urgent surgery, additionally in the abdominal wall, is still performed, as a rule, three punctures intended for the introduction of tools. In appendicitis, diagnostic laparoscopy is assigned in the following cases, for example:

  • If, in the formulation of the diagnosis, certain difficulties arise and the patient's monitoring has not produced the necessary result for a certain time;
  • If, in the diagnosis of acute appendicitis, standard instrumental studies are difficult, for example, due to excess weight in the patient;
  • Women with signs of acute appendicitis, since this technique allows you to clarify the diagnosis and differentiate it with many gynecological diseases whose symptoms are quite similar.

Laparoscopic appendectomy (removal of the inflamed appendix through punctures in the abdomen) is performed if there are special equipment and doctors in the clinic and doctors with experiences of such operational interventions. Such an option is the removal of appendix least trauma. In addition, with the help of laparoscopy, the treatment of appendicitis will be safer for patients with diagnosis of diabetes mellitus.

Complications of appendicitis before and after removal

Complications of appendicitis before and after removal

The lack of timely medical care in the attack of acute appendicitis can lead to a number of complications dangerous to the health and life of the patient. Thus, against the background of an acute inflammatory process in the tissues of a black-shaped outflow, an appendicular infiltrate and peritonitis can develop, an affectionant in the tissues of the abdominal cavity may develop. The most dangerous and rare complication of appendicitis is pylephlegitis, in which purulent content falls into a glow vein, causing an inflammatory process in their walls and provoking the formation of thromboms.

Complications after surgery and excision of the inflamed process can be expressed in:

  • complications associated with the joint after appendicitis (hematomas, infiltrate formation, the discrepancy between the edges of the wound, etc.);
  • development of acute inflammatory processes localized in the tissues of the abdominal cavity;
  • postoperative disorders in the operation of the gastrointestinal tract (the formation of intestinal fistula, the occurrence of gastrointestinal bleeding, acute mechanical intestinal obstruction, etc.);
  • Complications in the work of cardiovascular, respiratory or excretory systems.

How to handle seam after appendicitis?

Seam after appendicitis, or rather after an operation conducted according to the classic scheme, in length, an average of 3-8 cm. The quality and speed of its healing depends on the professionalism of the doctor performing the operation and the superlacing seam after appendicitis, as well as from the accuracy of the patient with the patient of all destinations .

Seams after appendicitis take off, as a rule, on 5-7 days after surgery. The minimum period required for the patient's complete recovery is one and a half. At the same time, the person who suffered an operation must comply with the gentle regime and attend a doctor in advance with a specialist deadlines.

Diet after appendicitis

Diet after appendicitis

After surgery, food intake is allowed from about third days. But at the same time, all products used by the patient must be crushed to a casual form. An ideal diet after appendicitis for the first time after the operation is the use of dairy tubers, liquid pounds, cooked on water, chicken and vegetable broth, vegetable puree. Assign a special gentle diet after appendicitis patients individually. Its compliance recommended during the first two or three months after surgery. Among the main recommendations for maintaining a diet after appendicitis should be noted:

  • the need to break the daily diet into many food techniques with small portions;
  • Recommended eating, only slightly warmed;
  • drafting a diet, taking into account the content of vitamins and nutrients in it, the necessary organism for full recovery after the operation;
  • Exception from the daily ration of products causing fermentation and increased gas formation in the organs of the gastrointestinal tract.

Since after surgery, the patients are contraindicated with excessive physical activity in the first few months, the diet after appendicitis should be not only nutritious, but not too calorie. In an individual, the doctor may prescribe an additional reception of vitamine-containing drugs. After the expiration of a certain period, which is revealed to comply with a gentle diet, it is necessary to introduce new products to the diet gradually.

How to determine appendicitis at home?

The article is prepared by a specialist for informational purposes. We urge you not to engage in self-medication. When the first symptoms appear - contact your doctor. We recommend reading: "Why can not be engaged in self-medication?".

Often, the first signs of inflammation of appendicitis are confused with the most diverse attacks of approximately in the same area: food poisoning, renal colic, stomach disorder, etc. Remove the appendix doctor can very quickly and carefully, however, with timely handling, but for this it is necessary to confirm the diagnosis. In order to recognize all signs of the inflammation of the appendix in time and in time to contact the medical institution for the necessary surveys, it is necessary to know certain features of appendicitis.

It is very important not to confuse pain associated with appendicitis, with the same monthly, poisoning, colic or other diseases that have similar symptoms.

Content:

Basic symptoms

  • First of all, think about appendicitis you can make pain in the abdomen. Most often, if this is the inflammation of the appendix, the pain is localized mainly on the right side or in the navel area. The pain can over time to move from the center of the abdomen to the right and go down down, but not reach the bone of the pelvis. Remember that pregnant women have appendicitis can change its location depending on the period of pregnancy, so the pain may be slightly higher.

  • Try to go smoothly on a rigid surface and click on the stomach in the area of ​​painting pain. If, even with a sufficiently easy press, you are experiencing acute pain in the right side - immediately call an ambulance.

  • Usually, when you click on the stomach you should feel that it is soft, the fingers are slightly pushing the fabrics and plunge into them. One of the symptoms of appendicitis will be a solid stomach, to some extent even tough. In addition, pay attention whether the bloating is present. Contact physicians immediately.

  • Try to get up and go straightened. At the first signs of inflammation of appendicitis, this does not feel a strong pain. And if you try to "curl up", pursing the legs to the chest, the pain can become much smaller.

Basic signs

Basic signs

It should also be paid to the other signs of appendicitis, it is not at all that they will manifest themselves at the same time, just some are enough to know exactly what time has come to ask for help from doctors:

  • You should not postpone the visit of the doctor if you have a very high temperature (38 ° - 39 °). In the event that it is much higher - call ambulance;

  • Chills and strong sweating indicates the presence of inflammation in the body;

  • Constipation, especially if vomiting is added to it, clearly gives you to understand the inflammation of the appendix;

  • Diarrhea, especially if there are blood particles in it, says about the same;

  • Nausea or vomiting;

  • Back pain, similar to renal colic;

  • False urges for defker.

What exactly should not be done if the question is about the possible inflammation of the appendix:

  • If, in addition to abdominal pain, you have a high temperature, you should not wait, it is better to call a doctor or ambulance.

  • In no case do not take any painkillers or laxatives, it will only aggravate the situation in the diagnosis of specialists.

  • Do not take any preparations for the stomach or intestines, they can only cause a strong chemical reaction that will provoke the gap of the appendix.

  • Try to abandon meals before providing medical care, you may need an operation. It should also be done in order not to cause irritation of the intestinal mucosa, which can at times amplify the pain.

Useful: The first signs and symptoms of appendicitis

When should I call an ambulance?

When you need to call an ambulance

If you observe in myself several signs of appendicitis, especially if they are accompanied by vomiting and strong pains - immediately call ambulance!

After the doctors arrive to you, it is very important to describe all their symptoms and signs. Do not disregard any violation that happened in the last 2-3 days (no matter, vomiting is or diarrhea). Be sure to notify the doctor about the first pain, who could not pay attention.

Consider that for the accuracy of the doctor's diagnosis, you must fully explore you, including palpate your stomach, to exclude from the list of possible peritonitis. If necessary, the doctor can make a rectal survey to confirm or refute appendicitis. With peritonitis, the abdominal muscles will be very tense.

With an implicit or blurred diagnosis, additional surveys are prescribed: an analysis of urine and blood, ultrasound of the small pelvis organs, probe (tool in the form of a thin rod intended for conducting diagnostic or therapeutic procedures in various cavities and human body channels) and so on.

Some delight advice

The most dangerous complication of appendicitis is its gap. During the tissue bundle, all its contents turns out to be in the abdominal cavity, which is sterile, infection penetrates there. This can cause the development of peritonitis.

It should be remembered that in children the first signs of appendicitis can manifest themselves otherwise, in view of the immaturity of some organism systems. In addition, not all children can clearly and clearly explain where, how and that they hurt. Most often, the child suffers pain consider that it just hurts the intestines, while it can abandon meals and want to sleep much. Therefore, if the baby refused his beloved dish, you should be alerted and find out the reason that it bothers. Not all people have the symptoms and signs described above.

Classic symptoms are not manifested in people who relate to the following categories:

  • diabetics;

  • pregnant women in 3 trimester;

  • people who suffer from obesity;

  • cancer patients;

  • HIV-infected;

  • people who have undergone organ transplantation;

  • elderly age;

  • Small children.

Diseases with similar symptoms

Inflammation of ovarian

It is not always possible to recognize appendicitis at the first inspection without additional analyzes and surveys. This happens only because the primary symptoms of appendix are very similar and on signs of other diseases that are painful "give" to the same area.

So, here is a small list of such diseases:

  • inflammation of ovarian, uterine pipes or uterus;

  • pyelonephritis;

  • renal colic;

  • Crohn's disease (also referred to as Terminal Ileit);

  • ulcer and her perforation;

  • enterocolitis and colitis of varying degrees;

  • inflammation of the nodes of the small intestine;

  • inflammation of eggs;

  • Rip, sometimes stretching, front abdominal muscles and more.

It is not always possible to put an accurate diagnosis of ultrasound organs of a small pelvis and abdominal cavity. This is due to the fact that on the ultrasound apparatus you can view something or just not to see due to the imperfection of the technique or skills of the specialist. 100% result when diagnosis can only be given laparoscopy.

Causes of inflammation of Appendix

Despite the rapid development of medicine in all its regions, until the end, all the causes of the inflammation of the appendix still failed. Appendicitis belongs to inflammatory diseases, which often flows imperceptibly and manifests itself. It is impossible to predict his manifestation.

Inflammation caused by various microorganisms (anaerobes, staphylococci, intestinal sticks, streptococci and so on) occurs in a dark-shaped outflow of a blind intestine.

Often, the result of inflammation of the appendix is ​​the excessive overload of the body of protein food: frequent overeating and obesity on the soil of essay. Modern people spend a lot of time sitting at work, and then at home near the computer, such a sedentary lifestyle can also provoke inflammation of appendicitis.

How to avoid appendicitis?

In order to minimize the risk of appendicitis inflammation, it is very important to comply with the proper nutrition. At the same time try to use in their diet only easily disabled proteins. They are mainly contained in a variety of dairy products.

Also daily use fresh fruits and vegetables. The most useful will be grown on their garden or purchased from dacrooms. Try not to overeat, always follow the calories consumed.

Periodically make unloading days and follow the health status of the gastrointestinal health, do not allow constipation.

Article on the topic: Diet after appendicitis

The gap of appendicitis is a risk to die, so do not try to cure it on your own, and pass the tests from your attending physician or call ambulance.

  • Remember, feeding pain or vice versa, excessively sharp strengthening, may indicate the start of serious complications.

  • It is very important to know the first signs and symptoms of appendicitis in order to ask for help from experts.

  • With the slightest suspicions of appendicitis, especially in young children, immediately call an ambulance, better once again make sure that this is not inflammation of the appendix.

Some interesting cases from medical practice

doctor

1 case from medical practice

A young 28-year-old guy with pain in the right side came to the doctor at the reception. To the question of how long the pain began, the answer was that somewhere 8 hours ago. Side began to hurt completely unexpectedly, without any reason to the reasons, while he slightly rose temperatures up to 37.8 °.

During inspection, the doctor determined that the pain spreading from the left side in the region just below the navel. At first glance, the symptoms talked about peritonitis.

The patient was diagnosed with acute appendicitis. The young man was immediately taken to the surgical department to the operating room for laparotomy. During the operation, it turns out that the outflow of the blind intestine is not changed despite the presence of serous traffic in the peritoneum. It was decided to inspect a more thoroughly thin and colon. As a result, an inflamed diverticulus (embryonic biliary duct) was found at their compound. It was removed, because It was he who caused symptoms similar to appendicitis. Most often, the inflammation of the diverticulus occurs without any symptoms and only 5% of people is detected during laparoscopy or any other operation.

2 case from medical practice

An ambulance car was delivered a 65-year-old man with a suspicion of acute appendicitis in the reception room. Required analyzes were taken and additional surveys were carried out. It was decided to operate, since in other ways to eliminate pain failed. The patient agreed to carry out surgery.

When conducting surgery, the surgeon was discovered by the inflamed appendix process, having a dense consistency. Its length was 3.5-4 cm, fibrin raid and explicit signs of the inflammatory process. Appendix deleted. After surgery, the wound began a little foggy, despite this patient was discharged home.

After 21 days, a conclusion was received after the examination of the process. Outcome: cancer appendicitis. The necessary data were transferred to the clinic at the patient's observation site. He was called on the reception to consult with an oncologist. From further treatment, a man preferred to refuse. After 6 months he died.

3 case from medical practice

The hospital at ambulance delivered an 82-year-old woman with complaints of pain at thenore of the abdomen. According to the results of inspection, the history of the disease and the patient's survey, the conclusion was made about the need for an urgent operation to remove acute appendicitis.

The patient was prepared for operation and delivered to the operating surgical department. As a result of laparoscopy, the surgeon did not notice any deviations of Appendix. However, when inspection of the connection site of the fine and colon, a small hole was detected through which the content of the intestine fell into the abdominal cavity. The reason for such a hole was the foreign body (fish bone), which was safely removed. Intestinal perforation was walked. The necessary postoperative treatment and observation was carried out. The patient was discharged home in satisfactory condition.

This is only a few real cases from the practice of surgeon doctors. The cases described only confirm the statement that it is not necessary to hope for the case and wait until everything goes. It is better to immediately call an ambulance and be calm while helping qualified doctors.

Not always signs of appendicitis speak certainly about the inflammation of the film of the blind intestine, often with similar symptoms, completely unexpected pathology for the patient differ from which its health depends on.

Volkov Dmitry Sergeevich

Article author: Volkov Dmitry Sergeevich | k. m. n. Surgeon, Flabog

Education:

Moscow State Medical and Dental University (1996). In 2003, he received a diploma of the Educational and Scientific Medical Center for the Office of the President of the Russian Federation.

Our authors
How to define appendicitis

The disease relates to frequently observed pathologies, requires immediate surgery. Operation to remove appendix is ​​considered a safe that does not affect the subsequent state of health. Surgeons warn that ignoring primary symptoms and long-term refusal of hospitalization becomes the cause of the development of complications, including peritonitis. In the latter case, the risk of death is increasing.

Content:

Definition of the beginning of the inflammation process

How to determine the appendicitis of the house without doctors: for assumption you do not need to be a medical worker. The pathological process proceeds with different clinical signs, the main of which is painful sensations in the abdomen. Discomfort accompanies not only the inflammation of the draft-like process, but also other diseases, because of this particular, patients are prohibited from the reception of painkillers.

Anesthetics facilitate state, but cause problems with diagnostics. Standard symptoms of appendicitis should know each - for timely appeal to those skilled in the art. The list of standard clinical signs includes:

  • permanent pain syndrome - in the abdomen;

  • Symptom of Kohler - pain from the epigastric region gradually passes into the iliac right-hand;

  • Sittivsky's symptoms - when lying, on the left side, the unpleasant sensations are enhanced by the intestinal pressure on the inflamed area.

In addition, patients noted the absence of appetite, raising the temperature to the subfebrile marks of 38 degrees. Approaches for nausea and vomiting, diarrhea, rapid urination may occur.

Appendicitis in women, elderly and children

Clinical manifestations of female resemble individual gynecological pathologies. Anomaly is associated with the close location of the appendages, and the pain syndrome is present:

To form an accurate diagnosis, you must pay attention to the presence of gynecological diseases and menstrual cycle.

Separate specific manifestations of appendicitis are present in the elderly, childhood, in pregnant women and with an abnormal arrangement of Appendix.

For kids are characterized by the following clinical signs:

  • diarrhea with frequent vomit;

  • Febral temperature indicators;

  • Reduced activity - the child loses interest in toys;

  • lethargy, whims;

  • Anxiety - when increasing unpleasant sensations.

In old age, the symptomatic picture is different:

  • no temperature increases;

  • The pulse remains in standard boundaries - without an increase in heart rate;

  • There are weak signs of abdominal irritation.

At the older age, clinical manifestations of appendicitis resemble a neoplasm located in the area of ​​the blind intestine. During pregnancy, pain syndrome is localized over the iliac region - due to raising the bowel at the background increased in the volume of the uterus.

Apandicitis in men

The primary signs of developing pathology include:

  • pain syndrome;

  • Increased temperature;

  • one-time vomiting;

  • white flare in the language;

  • state of general weakness;

  • dry mucosa in oral cavity;

  • accelerated heartbeat, diarrhea;

  • Failure to eat.

The intensity and nature of the manifestations of each patient is different. The age and individual characteristics of the body are of great importance. Sharp and spilled abdominal pain become the reason for an urgent visit to the precinct clinic.

Forms of appendicitis

The pathological process is divided:

  1. Ostly shape - occurs everywhere, the clinical picture increases and is characterized by severity. The inflammatory process creates favorable conditions for the formation of purulent complications, so surgical intervention should be like during the first day from the appearance of symptoms.

  2. On chronic - is a rare type of pathology, arises against the background of previously suffered acute inflammation. In some cases, it develops primary. A characteristic feature of pathology is considered to grow in the wall of appendix of the connecting tissues with subsequent atrophy of the mucous cover. The disease is conditionally allocated in a separate form - disputes about it are still underway.

In chronic appendicitis, it is noted:

  • stupid, buttering pain on the right side, increasing after exercise;

  • digestive disorders - with constipation and diarrhea;

  • The feeling of discomfort and gravity in the epigastria area.

The temperature does not change, remains in standard boundaries, the clinical study of urine and blood tests does not show serious deviations. Deep palpation causes soreness on the right side of the abdomen. Accurate diagnosis is an ultrasound examination of the problem area.

The main cause of inflammation of the doctors consider the blockage of the enlightenment of the process. The provoking factors include:

The treatment of appendicitis is to surgically removing a worm-like process. The development of the consequences and complications depends on the rate of medical treatment. The gap of the appendix threatens peritonitis, purulent inflammation of tissues, thrombosis of a portal vein and sepsis with unpredictable results.

The listed pathologies are accompanied by unbearable pains, confused, constant vomiting, high temperatures. The absence of timely assistance leads to a fatal outcome.

Apandicitis is an acute pathology that requires immediate surgery. If you do not take measures to eliminate appendix from the human body, there may be dangerous complications for living, for example, peritonitis.

Inflammation may occur at any age, but more often occurs in people from 10-19 years. A black gut is inflamed. The authority affects the work of the immune system and helps the body to deal with infection.

The reasons for the development of appendicitis

The exact reasons for the development of the inflammatory process are still unclear. But there are several common options:

  • Balance of microflora - bacteria, which in a normal medium are safe, become poisonous and cause inflammation.

  • Spasm of vessels - causes deterioration of fabric nutrition. Some sites die and become a focus of infection.

  • Stagnation in the intestines - hiding masses, foreign bodies, neoplasms or parasites can close the clearance of the process. At the closure site accumulates the mucus, where he begins to multiply by the microbi. The narrowing and squeezing of the process disrupts the processes of blood circulation, the influx of lymphs, which leads to the rapid progression of inflammation and necrosis of the appendix tissues.

The predisposing factor will be frequent constipation that form fertile stones.

Symptoms of appendicitis

Signs of inflammation of appendicitisAppendix is ​​located at the bottom of the abdomen. The first symptom is unbearable pain, which appears in the navel area and applies to the lower right side of the abdomen. The pain is enhanced for a short time, when driving, deep breath, cough or sneezing.

Other typical symptoms:

  • nausea, right up to vomiting

  • Reduction or complete absence of appetite

  • constipation or, on the contrary, diarrhea

  • Meteorism, painful bloating

  • Raising temperature, chills, symptoms of intoxication

  • Causes to the act of defecation

Signs of the inflammatory process of Appendix in men and women may differ. For example, women appear nausea, vomiting and temperature increase. At the beginning of the development of the disease, the grinding pain, pulling and even not necessarily on the right side, which is erroneously recognized as gynecological problems.

Then the pain can become grapple-shaped, such symptoms most often occur in the evening or night.

In men, with acute inflammation there are severe pain in the abdomen, spontaneous pulling up of the right egg. When pulling the scrotum, discomfort and pain in the field of anus and a pronounced urge to the intestinal emptying.

In the elderly, appendicitis symptoms can manifest themselves less distinctly: minor pains, unlock nausea. At the same time, appendicitis in the elderly often has a severe course and development of complications.

In children under 5 years, the symptoms of appendicitis are not so bright as in adults. Pains often do not have a clear localization. Recognize appendicitis in a small child can be at an increase in body temperature, diarrhea and the presence in the tongue of the plaque.

Types of pathology

Acute appendicitis - develops rapidly, manifests pronounced symptoms. With the inaction of pain, inflammation can lead to serious complications.

By its nature, acute appendicitis can be complicated and uncomplicated. Uncomplicated pathology, in turn, has 2 forms: catarrhal (only the mucous membrane is inflated), destructive (deeper layers are affected).

Chronic - enough rare form. In most cases, it is developing due to a changed acute appendicitis in the absence of treatment. It has the same symptoms, but they manifest themselves very sluggish. Infected periods of exacerbation and remission, as well as a chronic disease.

Chronic appendicitis is also divided into subspecies:

  • Residual - the consequence of transferred acute appendicitis, who ended with self-esteem. It is manifested by stupid mining pains in the right iliac region.

  • The recurrent - wears an approaches: from time to time exacerbations occur, and removing remission.

  • Primary-chronic - develops independently, without the preceding of acute appendicitis.

Diagnosis of appendicitis

The first thing that the patient's examination begins is to inspect and collect anamnesis. The doctor asks to talk about when symptoms appeared and how long the discomfort lasts. It is important to understand in order to distinguish the disease from something else.

It is important to take into account other factors that could cause for the development of appendicitis:

  • Surgical surgery in the abdomen, transferred in the recent past.

  • Reception of drugs or additives.

  • Harmful habits, alcohol, drug abuse, etc.

Touching the abdomen will help determine the localization and intensity of pain, its characteristics. You may need pelvic and rectal examination. The final diagnosis is made only after passing laboratory tests. Blood and urine test will help detect signs of inflammation or other health problems.

Visual examination methods may also be required - ultrasound of the abdominal organs, CT or MRI. They will allow:

  • determine the state of appendix and evaluate its integrity

  • Detect signs of inflammation

  • Rate blockage inside appendix

  • reveal abscess or other complications

How to treat appendicitis?

Pathology requires immediate treatment, since the process can burst and its contents will fall into the abdominal cavity and the peritonitis will begin. Therefore, the only solution is the removal of appendix surgically.

Appendectomy is a surgical operation to remove appendix. It can be carried out in two ways:

  1. Classic - Lucky Operation

  2. laparoscopic when there are no major cuts

The extension operation is carried out in the event of the appendix break and, if its contents broke into the abdominal cavity, and also if the gap caused abscess.

Laparoscopy is considered the most modern method of removing appendix due to different reasons: smaller invasiveness, rapid recovery, and the number of complications less.

The operation is carried out as follows:

  • Surgeon makes small cuts through which access to appendix appears

  • An illumination camera is entered

  • Other tools are removed from the removal

  • Plots are processed to disinfect infectious material

  • The operated area is examined, the seams are superimposed

Prevention of appendicitis

Special prevention does not exist, appendicitis can happen with each. It is best to abandon bad habits, keep the right nutrition. A sufficient content of fiber, fresh vegetables and fruits, fermented milk products supports normal intestinal operation, prevents constipation.

Also, preventive measures include timely treatment of any infectious and inflammatory diseases, tractologies of the gastrointestinal tract and melted invasions.

Treatment of appendicitis in Krasnoyarsk

Treatment of appendicitis in "Medunion"To undergo diagnosis and treatment of appendicitis, contact Medunication Medical Center. We have experienced doctors who will conduct a full inspection and examination, friendly medical personnel.

Sign up You can one of the ways convenient for you:

  • Online on our website Medyunion.ru. Fill out an electronic form by specifying your contact details, a specialization of a doctor, convenient date and time for reception.

  • Order a callback by specifying your name and phone number. Our managers will call you back within 15 minutes and answer your questions.

  • Call the registration of a medical clinic by phone number +7 391 203-01-01.

What it is?

Appendicitis is an acute inflammation of the appenda of the blind intestine, also known as Appendix (Fig. 1).

Figure 1. Appendix (a), a bag-shaped with a blind intestine with a length of about 7-9 cm, located in the lower right of the abdominal quadrant. At the inflammation of appendix (b) appendicitis develops. Source: CCH0 Public Domain

Appendicitis always declares itself unexpectedly. This is not the case when the so-called prudent period is preceded by acute manifestations of the disease. If the appendix hurts, the patient may need emergency help.

Among the acute surgical diseases of the abdominal cavity appendicitis occupies an honorable place - 89% of the total number. Most often, he meets in young people aged 15-30 years, and women are more susceptible to this pathology. However, this does not mean that adults and older people do not suffer from this disease - it may arise at 50, and even 70 years. Let such cases are rare, still they are found, and the danger to health is much higher, because the person is older, the more related diseases inhibit the process of recovery.

The reasons

To date, experts cannot say with complete confidence that it is precisely the starting mechanism of inflammation of the appendix.

It is believed that the main reason for the inflammation of the appendix is ​​the blockage of its lumen, as a result of which the mucus accumulation occurs and its subsequent infection occurs.

The role of hereditary predisposition to appendicitis is still not well understood. However, already some domestic and foreign experts, based on their clinical observations, put forward the assumption that genetic factors can still contribute to the development of appendicitis. In addition, there are such congenital features like bends or narrowing of a worm-like process - they can cause stagnant phenomena and inflammatory processes.

There are less popular, but still adopted for consideration in broad scientific circles of theory affecting the possible causes of appendicitis:

  1. Vascular. There is an assumption that systemic vasculitis and other diseases of the vessels leading to a violation of blood supply to the blind intestine may cause inflammation of a worm-like process.
  2. Endocrine. The mucous membrane of the fat intestine contains the so-called. Enterochromaffine cells that distinguish substances contributing to inflammatory processes. It is in the appendix of such cells a lot, therefore the theory is considered viable.
  3. Infectious. Many scientists believe that infectious diseases (for example, amoebiasis or abdominal title) are able to cause inflammation of the appendix. True, no one can clearly explain exactly which bacteria can be attributed to specific causative agents of appendicitis.

Types of illness

Most often, appendicitis has an acute course. Some scientists insist on the possibility of developing chronic appendicitis in patients who have not previously translated the acute form of the disease, but this statement still remains the subject of disputes in scientific circles.

Thus, the clinical classification includes the following types of appendicitis:

  1. Spicy uncomplicated.
  2. Acute complicated (read about complications in the next section of the article).
  3. Chronic.

Acute appendicitis, in turn, is customary to be classified by the nature of pathological changes in the tissues determined in histological examination.

Such a classification is called clinical and morphological and shares the acute form of appendicitis into the following types:

  1. Catarial. The most common and at the same time the least dangerous appendicitis appendicitis, in which only the mucous membrane of a worm-like process is inflamed. The attack begins with a spilled pain in the top of the abdomen, which after a few hours shifts into the right iliac area. The stomach is not tense and takes part in the respiratory movements. The temperature may be normal, but more often there is a raising of approximately 37.5 s. о.
  2. Purulent (phlegmonous). The foci of purulent inflammation covers the entire appendix, while it is significantly increasing in size, the swelling of the intestinal walls is noted. Puritini inflammation may occur (peritonitis). The main feature is pain in the right iliac area with constantly increasing intensity. The language is covered, vomiting is noted (sometimes - multiple). Abdominal muscles are moderately tense.
  3. Gangrenous. There is an extensive necrosis of the appendix walls, and its color becomes black and green. The clinical picture resembles a phlegmonous appendicitis, but the intensity of pain is usually smaller, since many nerve endings in Appendix will die by this time. The pulse of weak filling, often observed chills.
  4. Perforated. In the wall of the heart-shaped process, the soda hole is formed, which is fraught with the penetration of purulent contents in the abdominal cavity. Intense pains a few hours later weaken, but soon renewed, and already throughout the abdomen. There is a heat, nausea, but the patient himself almost does not impose complaints. This is explained by Euphoria against the background of severe general intoxication. Abdominal muscles are tense and do not take part in the respiratory movements.

What is dangerous appendicitis: complications

The absence of timely medical care can lead to perforation (wall rupture) of appendix and the development of hazardous complications:

  • peritonitis (inflammation of the peritoneum),
  • purulent inflammation of tissues - abscesses (subiaphragmal, interchess, retroperitoneal, periapendicular, liver),
  • PILEFLEBIT (inflammation and thrombosis of the carrier vein),
  • Sepsis (distribution of infection throughout the body).

All listed states are accompanied by a severe clinical picture: unbearable abdominal pain, high temperature, vomiting, confused. In the absence of emergency medical care, death comes.

Symptoms of appendicitis

For acute appendicitis, a sharp start is characterized. Usually symptoms appear at night or early in the morning, while the clinical picture unfolds rapidly. The first sign is the appearance of spilled pulling pain in the top of the abdomen (epigastric area). As pain gaining, pain becomes sharp and pulsating, moving at the same time into the lower right side of the abdomen. The general symptoms of the "acute abdomen" are related (Fig. 2):

  • Increase temperature (usually up to 37.5 s оbut with complicated forms there is a rise to 40 s о),
  • nausea and vomiting,
  • dry mouth
  • lack of appetite,
  • stool disorders (both constipation and diarrhea are possible),
  • cardiopalmus,
  • Singly fallow
  • Swimming belly and meteorism.
Figure 2. Classic symptoms of "acute abdomen", often accompanying acute appendicitis. Source: Adobe Stock

At appendicitis, there are several specific symptoms that allow it to distinguish it from other diseases:

  • The symptom of Bartier-Michelson - pain during palpation of the blind intestine is enhanced if the patient lies on the left side,
  • The symptom of the Resurrection is the doctor with fingertips makes a fast and easy moving movement from top to bottom towards the right iliac region, while the pain is enhanced at the end point of the movement,
  • Symptom of valve - the strengthening of pain in the right lower abdomen when it is retracting,
  • Symptom of Volkovich-Kochra - first pain occurs in the upper part of the abdomen, and a few hours later moved to the right iliac region,
  • The symptom of Crimean Dumbadze is the strengthening of pain when palpation of the umbilical ring,
  • The Symptom of Razdolsky (Mendel-Razdolsky) - Percussion of the abdominal wall is accompanied by a strengthening of pain in the right iliac region,
  • Sitkovsky's symptom - the occurrence or enhancement of pain in the right bottom of the abdomen, if the patient lies on the left side,
  • The symptom of roving is the occurrence or enhancement of the intensity of pain in the right side of the abdomen when sigmoid squeezing and a bell-shaped pressure on the descending separation department.
Rare cause of Pain in Appendix - Tumor

Appendix cancer usually does not cause any symptoms until the disease goes into the running step. A large tumor can provoke bloating. Pain may appear if the cancer goes on the tissue of the abdominal cavity.

A malignant tumor can develop and simultaneously with an acute appendicitis. Usually it is found after the removal of appendix. Cancer can also find accidentally with a planned inspection or diagnostic procedures aimed at identifying other pathologies. Diagnosis of cancer includes biopsy, ultrasound and MRI.

Among the risk factors for the development of Cancer Appendix:

  • smoking,
  • the presence of gastritis and some other gastrointestinal diseases,
  • Cases of Apandix Cancer in relatives,
  • age (the risk of cancer is increased over the years).

Which side hurts?

As a rule, pain in appendicitis is localized in the lower right side of the abdomen, since it is there is Appendix - between the navel and the right iliac bone (Fig. 3).

Figure 3. Pain in appendicitis is usually the strongest in the place of inflammation - at the bottom of the abdomen on the right side. Source: CCH0 Public Domain

However, in rare cases, pain is noted on the left side. There are several reasons for this phenomenon:

  1. Excessive mobility of the colon.
  2. Irradiation. Appendicitis is known in the fact that when pressed on the stomach, pain can give to any part of the abdomen (including left).
  3. The mirror arrangement of the internal organs (that is, organs that normally should be on the right are located on the left side, and vice versa).

Character of pain

At the beginning, the pain during appendicitis can be spilled, pulling. Later, as the disease develops, it becomes sharp and pulsating. In rare cases, pain appears suddenly, simultaneously with the attacks of non-believing vomiting and leaps of temperature.

How to distinguish from other diseases?

The pain that arose due to the inflammation of the appendix usually becomes stronger during coughing and sneezing, when moving and breathing. There is also a phenomenon characteristic of appendicitis, which received the name "Symptom of Expansion" - an amplification of pain, when the patient in the standing position lifts his right leg.

The characteristic feature of the appendicitis, allowing it to distinguish it from other diseases of the abdominal cavity - the pain pokes, if we take a pose lying on the side with the knees tumaled to the belly.

Diagnostics

Diagnostic events begin with palpation. When pressed on the stomach to the right and a sharp cleaning of the hand, the pain is enhanced - this is called the symptom of the brush-blubberg.

Lab diagnostics:

  1. Blood test (about the presence of appendicitis is indicated by the increased content of leukocytes and immature neutrophils).
  2. Urine analysis (spend to make sure the cause of pain is not a disease of the urinary system).

Tool diagnostics:

  1. Ultrasonic examination of the abdominal cavity.
  2. CT scan.
  3. Radiography.

In doubtful cases, the doctor may assign diagnostic laparoscopy: an endoscope is introduced through an incision in the abdominal wall, with which there is a direct inspection of appendix. This procedure relates to diagnostic operations, but the accuracy of the study is committed to 100%.

Treatment

As a rule, appendicitis is treated surgically - when confirming the diagnosis of appendix is ​​removed.

Urgent care

If all the symptoms point to appendicitis, it is not necessary to take independent attempts to facilitate the state, the only right solution is to call emergency medical care. Thermal procedures are strictly contraindicated (that is, it is impossible to apply the heating pad).

Important! In suspected of acute appendicitis, it is necessary to urgently call in ambulance at the number 103. If the attack began to be away from the city, you can call the united salvation service at 112.

Before the arrival of the ambulance brigade cannot be taken painkillers. The patient will have to be patient because the anesthesia can change the clinical picture and makes it difficult to diagnose. It is forbidden to eat food (in rare cases in appendicitis, the appetite may increase), do not even recommend drinking. If a strong thirst is tormented, you can make a couple of small sips of water, but no more.

Important! The patient should not move independently - any physical activity can provoke the gap of the appendix.

How is the operation going

The standard Operation to remove appendix passes under general anesthesia and lasts an average of 40-50 minutes. With classical appendectomy, an incision is made 6-8 cm in the right iliac region, the tissue is moved using special tools. The surgeon extracts the outward part of the blind intestine and removes appendix, after which the vessels and fabric eats.

With laparoscopic removal of appendix, the abdominal wall punctures. In one hole, the doctor introduces an endoscope that helps him control the course of operation. Surgical instruments are introduced into two other holes (Fig. 4).

Figure 4. Laparoscopic removal of appendix injures fabrics to the smallest. Source: CCH0 Public Domain

In the case of the gap of appendix and the development of peritonitis, a more complex operation is necessary - median laparotomy (the length of the cut is approximately 10 cm) with the abdominal cavity sanitation carried out using drainage devices. In the postoperative period, the patient needs to undergo a course of antibiotics of a wide range of action.

Medical therapy

Domestic specialists consider the medication of appendicitis ineffective. In Europe, the approach is somewhat different: when exacerbating appendicitis, the doctor first assigns the course of antibiotics, and only if it does not help, the patient is sent to the operation. Russian surgeons consider such an approach unreasonably risky, since delay with operational removal of appendix can lead to the development of complications and even a fatal outcome.

Prevention

To reduce the likelihood of acute appendicitis, follow the following rules:

  • Include a sufficient amount of fiber to the prevention of constipation and putrid processes in the intestine,
  • avoid the uncontrolled use of antibiotics to prevent the development of dysbiosis,
  • Imprigize immunity: to lead an active lifestyle, avoid bad habits, regularly take vitamin complexes,

Previously, abroad was practiced preventive appendectomy - American doctors removed the children of appendixes with the same zeal, as Soviet doctors cut out Glad to children with the slightest signs of the cold. However, now from this practice they refused, because after preventive appendectomy, children suffered from regular disorders of digestion and were exposed to frequent colds due to the weakening of immunity.

Conclusion

Thus, it is important for the prevention of appendicitis to use a sufficient amount of fiber, raise the body's protective forces and avoid bad habits. As a rule, the inflammation of a worm-like process is developing rapidly, therefore, if you suspect the appendicitis, you should call an ambulance brigade without a delay. Upon timely appeal to the doctor, the forecast is favorable.

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