- What is appendicitis and where is the appendix
- Why appendicitis develops
- Classification of the disease and stage
- Symptoms of acute appendicitis
- Age-related symptoms and other features of appendicitis detection
- Atypical forms
- Treatment and recovery
- Possible complications after surgery
Appendicitis is one of the most common inflammatory diseases of the abdominal cavity. Timely diagnosis of inflammation of the appendix, determination of the nature of the flow of the inflammatory process, and later, if necessary, timely surgery to remove the appendix (it is called appendectomy) minimize the likelihood of complications.
What is appendicitis and where is the appendix
Appendicitis is an inflammation of the appendix (vermiform process of the cecum). This is a small formation with a size of 10 cm and a diameter of 5-7 mm with the only exit to the caecum. In the walls of the appendix are lymphatic follicles, and the lumen of the cavity is filled with mucous contents. Under the influence of various pathogenic factors, the appendix becomes inflamed.
An operation to remove an appendix is considered to be a simple surgical procedure, and the disease itself is sometimes difficult to diagnose if appendicitis is atypical. But to determine the classic symptoms of inflammation must be able to independently.
Often the symptoms and nature of pain may depend on how the appendix of the cecum is located in a person. The classical anatomical location of the appendix – when it is located in the right iliac with the cecum.But the location of the appendix may be different:
- in front of him;
The vermiform process may also be adjacent to any organ of the abdominal cavity or small pelvis (for example, to the kidneys). Non-standard location of the appendix is a significant obstacle not only during the operation of appendectomy (appendix removal), but also significantly complicates diagnosis.
Why appendicitis develops
The etiology of the inflammation of the appendix is extremely multifaceted. The main theories of appendicitis are infectious and vascular. The infectious nature, in turn, depending on the pathogenic microflora can be specific and nonspecific.
The cause of nonspecific appendicitis can be:
- E. coli.
Specific acute appendicitis may be caused by such infectious diseases as dysentery, tuberculosis, etc. It promotes the development of inflammation and reduced immunity.
The vascular theory of appendicitis states that the cause of inflammation of the appendix can be spasms and blockage of the blood vessels that feed it. This leads to the appearance of necrotic tissue, which is a focus of inflammation. The presence of dead areas in the appendix is a direct prerequisite for the development of destructive appendicitis, that is, accompanied by destructive processes. Patients with a tendency to thrombosis with a history of atherosclerosis and other cardiovascular diseases are at risk in this case.
A provoking factor is the narrowing or complete overlap of the lumen of the appendix due to deformation of the process or ingestion of foreign bodies and fecal stones, as well as helminthic invasion and growth of lymphoid tissue.
Some scientists point out that “meat eaters” are more likely to suffer from appendicitis. And this argument can often be heard from vegetarians as another proof of the correctness of their theory (it says that a healthy diet is a diet without meat). Meanwhile, scientists are right that too much meat in the diet increases the risk of appendicitis – but this does not mean that meat should not be eaten at all. It contains animal proteins that are not in plant food, and which are necessary for the body. Vegetarians themselves, due to the use of plant foods that require “forced” fermentation for digestion, often have serious problems with the pancreas. Therefore, for health enough to choose a balanced diet. But fasting and fasting days reduce the risk of appendicitis.
Classification of the disease and stage
Appendicitis may be chronic and acute. Chronic appendicitis is divided into primary (with acute appendicitis in history) and secondary (when purulent process or inflammation of organs is present in history). The classification of acute appendicitis is more diverse, it can be:
- phlegmonous and ulcerative;
Catarrhal appendicitis – the initial stage of inflammation, which lasts no more than six hours. By the way, this is why in urgent clinics, i.e. those who take emergency patients who arrive with symptoms of acute appendicitis should have time to get to the operating table within six hours of admission.
At the phlegmonous stage, inflammation of the already purulent, phlegmonous and ulcerative appendicitis is accompanied by ulceration of the appendix walls. Gangrenous appendicitis is the death (necrosis) of tissues and their breakdown. The last two forms are accompanied by perforation of the appendix wall followed by discharge of pus into the abdominal cavity, after which we are talking about peritonitis.
In a typical acute appendicitis, the disease begins rapidly, with pronounced symptoms and, above all, pain syndrome, and the stages alternate between each other, beginning with catarrhal and ending with timely medical aid, gangrenous. The complexity of treatment (surgery) is directly dependent on the severity of the appendicitis stage at the time of going to the doctor.
Symptoms of acute appendicitis
The first and most important symptom of appendicitis is a sharp intense pain in the abdomen. As a rule, it is localized above the umbilicus, then “slips” into the right iliac region, where the inflamed appendix is located. But the pain can have a diffuse nature, as well as a different intensity. A temporary weakening of the pain syndrome can be observed after taking analgesics.
Above all, the sudden weakening or disappearance of pain should alert. This is the first sign that the vermiform process was perforated, and its contents poured into the abdominal cavity. After that, peritonitis begins (inflammation of the abdominal cavity) and the pain resumes, but has a different character. In particular, a sign of peritonitis is that the recurring pain can no longer be relieved by analgesics.
Next, acute appendicitis is accompanied by:
- digestive disorders, constipation or diarrhea.
The temperature rises, but not above 38 ° C (febrile fever). A sudden drop in temperature below normal or a rapid increase in temperature are dangerous symptoms.
The muscles of the peritoneum become tense and sharply painful, the pain increases with any action that causes tension in the abdomen (laughter, sneezing, etc.) and may radiate to the right leg.
When these symptoms appear, you should immediately call a doctor, and before he arrives, lie down, do not eat or drink anything, and in no case apply heat to the area of pain (heating pad, etc.). This greatly increases the risk of rapid development of inflammation of the abdominal cavity (peritonitis).
Age-related symptoms and other features of appendicitis detection
The average age group of those who have the greatest chances to get appendicitis is from 7 to 40 years. This pool includes the majority of those who “shoot out” for acute appendicitis. In this case, men inflammation of the appendix more often catches up to the age of 20, and women – from 20 to 40 years. But even small children and elderly people have appendicitis. And it is their symptoms that can be problematic.
The problem of determining the symptoms of appendicitis in young children is the same as the definition of the signs of any disease. Little patients are not always able to clearly describe exactly where and how they hurt, so the history has to be written according to the parents and on the basis of the clinical picture at the time of arrival of the doctor, after the examination. By the way, only 30% of children develop appendicitis according to the classical scheme, the remaining 70% show atypical symptoms.
In older people, the symptoms may be blurred, without sharp pains and an obvious rise in temperature. The difficulty in determining is that in this group, due to age-related changes, the functionality of some organs is impaired, therefore, in elderly patients, it is necessary to determine acute appendicitis, based on inspection data and, in many cases, a hardware examination. The danger is that, due to the blurring of the symptoms, it is not uncommon for such patients to seek medical help late and go to the hospital in serious condition. Mortality from peritonitis caused by perforation of the appendix, in this age group is the highest.
By the way: in the elderly, one of the most frequent causes of appendicitis is fecal stones, and in children – foreign objects of food type (husks of seeds, cherry stones, etc.) or small bright objects, such as beads.
As for the symptoms in men, an acute appendicitis may be masked by the presence of any other inflammatory diseases – for example, prostatitis or orchitis (testicular inflammation).
In some patients, the clinical picture of appendicitis is different from the textbook. Atypical appendicitis occurs in approximately two out of ten patients. The difference from the classical form is due primarily to the variability of the location of the appendix, as well as age and individual physiological features.
At the same time, more than half of atypical forms occur in cases of inflammation of the retrocecal (behind the cecum) appendix, up to 20% in a low-placed appendix (rectal, ie, an anal examination is needed to clarify the diagnosis), a median appendix – up to 10% cases, subhepatic – up to 5% (finally determined by ultrasound). The most rarely found left-sided appendix – with a mirror arrangement of all organs. As doctors wittily notice in this case, it is possible to suspect that something is wrong already when palpation on the left does not show a liver.
Atypical symptoms may occur in elderly patients, very young children, as well as people with very weak health and reduced immunity (they may not have fever and other symptoms of acute appendicitis).
The diagnosis is made by the doctor on the basis of, first of all, palpation examination of the patient, in other words, manual probing. Palpable sensations of a qualified surgeon are complemented by a blood test for leukocytes. Next comes the hardware diagnostics, where the palm belongs to the ultrasound.
The value of the ultrasound examination lies in the fact that in this case it is possible to conduct a differential diagnosis, looking at the organs of the abdominal cavity and small pelvis for the presence of inflammatory processes. The only thing that the ultrasound will not see is a retrocecal appendix, since it is hidden from its keen eye behind the cecum.
But from magnetic resonance therapy can not hide anywhere else. Another plus MRI – the absence of harmful radiation, including affecting men’s health.
The ideal diagnostic method is laparoscopy, when a special device with optical sensors is inserted through a small incision in the wall of the abdominal cavity. This allows you to inspect the entire cavity, and if necessary, an inflamed appendix can be removed, without making a lateral incision, through the same opening. The scars after this procedure are almost invisible.
The method that doctors do not recommend unanimously in the diagnosis of acute appendicitis is computed tomography. Radiation, plus is expensive, plus it takes a long time to decipher the data — and in acute appendicitis, sometimes minutes are important for a favorable prognosis after surgery.
What is a symptom of acute abdomen
Differential diagnosis is necessary in order to distinguish acute appendicitis from other diseases similar in symptoms. A complex of symptoms that indicate pathological processes in the abdominal (abdominal) cavity is called an acute abdomen. It can indicate not only appendicitis, but also:
- intestinal obstruction;
- abdominal bleeding;
- the presence of inflammatory processes in the pancreas, gall bladder, etc .;
- diseases of the stomach and intestines (peptic ulcer, etc.);
- infectious diseases (hepatitis and others);
- incision of hernia, etc.
To clarify the diagnosis, all possible methods are used, but in this case the main thing is not to fall into overdiagnosis, when in any case something that is not diagnosed. So, in the olden days, the appendix was not very ceremonious, and in case of any suspicion of acute appendicitis, the process was removed without specifying the diagnosis. In particular, such a lack of ceremony was due to the fact that the appendix was considered a rudimentary body, a primitive remnant, completely unnecessary to the modern human body. But later, scientists found that the appendix plays a large role in the formation of beneficial intestinal microflora and the formation of immunity.
Treatment and recovery
If acute appendicitis is diagnosed, no conservative treatment is expected. Only surgically, only appendectomy. If the patient shows symptoms of peritonitis upon admission to a medical institution, a laparotomy and a revision of the entire abdominal cavity with reorganization is done.
After surgery, in the absence of complications, you can get out of bed for 3-4 days (with the blessing of the attending physician). Physical activity is necessary to restore blood circulation and peristalsis. But activity should be moderate. So, already on the second day after the operation, it is necessary to gradually toss and turn from side to side. This is necessary to prevent the development of adhesive disease.
If the patient was operated on for peritonitis, activity begins later, and the abdominal cavity is washed by antibiotics.
For the patient in the postoperative period, a special diet is determined with easily digestible liquid food that does not cause flatulence (it is not recommended to drink individual fruit and vegetable juices).
Possible complications after surgery
Postoperative complications are divided into early and late. Early include:
- divergence of the wound edges;
- inflammation of the abdominal cavity.
Later complications that appear no earlier than two weeks after appendectomy are considered. This may be fistulae, adhesions, intestinal obstruction, etc.
Home prevention of appendicitis is a healthy lifestyle (rejection of habitual habitual physical activity) and a balanced diet, which necessarily includes fruits and vegetables.
Appendicitis refers to the most common human diseases that are surgically treated. No one is immune from inflammation of the appendix, so you need to know the signs of the disease and seek medical help at the first symptoms without resorting to self-treatment. This can cause complications.