Appendicitis in children

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Appendicitis is an inflammation of the appendix or appendicitis. In most cases, the worm-shaped tumor is located at the junction of the small intestine with the large intestine. However, in some people, the worm-like tumor may be located under the liver, in the small pelvis, and along the ascending portion of the colon. In addition, the blind area is not only on the right side of the abdomen, but also on the left side. Appendicitis is more common in adults, but in this article we will discuss in detail the causes of blindness in children, their symptoms and treatment options.
REASONS
Risk factors for appendicitis include constipation, dysbacteriosis and vomiting, as well as excessive sweets.
The function of the appendix has not been fully studied, and it is not clear what causes its inflammation. Inflammation of the appendix is ​​thought to be caused by the accumulation of foreign bodies in the area and the influence of intestinal microflora. Obstruction (accumulation of body) is caused by the accumulation of fecal stones, helminths, and foreign bodies in the intestinal cavity.
Closure of the appendix and rupture of the bowel may also be due to enlargement of the lymph nodes in the area. In congenital anomalies, twisting or bending of the appendix and the presence of intestinal microflora also increase the risk of inflammation.
Microbes can enter the worm-shaped tumor through the blood or lymph flow, and inflammation of the appendix has been reported in children with angina, otitis, OVI, and other diseases. Some groups of infections, such as yersiniosis, tuberculosis, typhoid fever, and others, have been shown to be a direct cause of appendicitis.
Bacteria multiply rapidly in the worm-shaped tumor cavity and cause inflammation, increased mucus synthesis, edema, and venous stagnation in the intestine. As a result, the worm-like tumor may become necrotic, the organ wall may rupture, and all intestinal masses (pus, feces) may enter the abdominal cavity, causing peritonitis.
Risk factors for developing appendicitis in children include constipation, vomiting, overeating, craving for sweets, dysbacteriosis, and insufficient fiber with food.
Appendicitis is rare in children under 2 years of age (it can also develop in newborns). This, of course, is due to the child's diet and the insufficient formation of lymph nodes in the worm-like tumor. In children, the appendix is ​​wide and short, making it easier for objects to return to the intestines. From the age of 6, the appendix narrows and lengthens, and the lymph nodes there become larger, increasing the risk of inflammation.
CLASSIFICATION
There are acute and chronic forms of appendicitis.
There are the following types of acute appendicitis:
Appendicitis: a weak inflammation of a worm-like tumor that resolves within 3-4 hours;
Catarrhal appendicitis: superficial inflammation of a simple, worm-like tumor that does not damage organ tissue;
Destructive appendicitis:
Complicated appendicitis.
Phlegmonous appendicitis (with or without perforation): is characterized by purulent inflammation of the appendix, damage to the mucous membrane, and accumulation of pus. In this case, the worm-like tumor turns gray;
Gangrenous appendicitis (with or without perforation): Appendicitis is caused by thrombosis of the blood vessels, the worm-shaped tumor is greenish-black in color and has a foul odor, and the child's general condition worsens.
SIGNS
Symptoms of appendicitis in children depend on the age of the child, the location of the appendix, the type and degree of inflammation.
Young children are weak, reluctant to play games, and refuse to eat. The main symptom of appendicitis is pain.
Babies often try to protect their painful areas: lie on their left side, bend their legs at the knees, cry when you hold the child, resist when you try to examine the abdomen, push with your hands.
The child's body temperature rises to 38 oC, sometimes even higher. The child is pale, palpitations, vomiting and diarrhea are observed. The younger the child, the more often he returns, and the body becomes dehydrated quickly.
Appendicitis is difficult to diagnose in children aged 3-4 years: the disease begins suddenly, is not always typical, and sometimes manifests itself with lightning symptoms. Children are not able to clearly identify the area of ​​pain, and often use their hands to indicate pain in the umbilical region or the entire abdomen.
In children, not all of the above symptoms are observed, and inflammation of the appendix can develop without symptoms, leading to peritonitis within a few hours. In this case, the pain spreads throughout the abdomen, the child is pale, the body temperature rises to 40 oC, the abdomen is swollen and constipated.
The most dangerous aspect is that parents think that appendicitis does not occur at this age and associate the child's condition with food (food poisoning, overeating). Some parents even start treatment on their own. If no surgery is performed, the worm-shaped tumor ruptures (observed in 25-50% of children), resulting in long-term hospitalization.
At the age of 6-7 years, the child can show a sore spot in the abdomen. In the classic form, the pain first appears around the umbilicus, then (after 2-3 hours) moves to the right subcostal area. Pain in the lower part of the appendix between the right ribs, in the posterior region of the appendix, in the lumbar region, in the pelvic region of the appendix, in the symphysis of the pelvis or in the upper part of the appendix.
Appendicitis is characterized by persistent pain, which results in sleep disturbances, weakness, refusal to eat, vomiting, and constipation.
Body temperature can be above 37,5 oC, sometimes very high or normal. In older children, the pulse rate and body temperature change. Normally, the pulse rate rises to 1 when the body temperature rises by 10 degree. In appendicitis, the pulse rate is higher than the body temperature.
When the appendix is ​​located in the pelvic region, there is an increase in urinary excretion in cases of appendicitis.
In catarrhal appendicitis, the tongue is moist, the root of the tongue is white, in the phlegmonous type the tongue is wet, but the tongue is completely white, and in the gangrenous form the tongue is dry and completely white.
The most common age for appendicitis is 9-12 years. Although appendicitis is often a classic form of appendicitis, it is more difficult to diagnose appendicitis in children than in adults. Children of this age continue to attend school even if they have abdominal pain. However, as the inflammation progresses and the child's general condition suddenly worsens, appendicitis becomes more complicated.
Chronic appendicitis is very rare among children. Symptoms of recurrent appendicitis may develop, with occasional fever and vomiting.
COMPLICATIONS
Timely surgery should be performed to avoid complications. If appendicitis is not treated in time, a number of complications can occur:
Perforation is a rupture of an organ that results in peritonitis (inflammation of the peritoneum);
Appendicular infiltrate - limited peritonitis, entrapment of the intestinal loops, cartilage and peritoneum;
Appendicular abscess is a localized purulent abscess that may appear in or near the area of ​​a worm-like tumor;
Bowel obstruction;
Sepsis is the spread of microorganisms from an inflamed organ to the bloodstream and to other organs.
DIAGNOSTICS
On palpation of the abdomen, the doctor identifies a painful spot in the right subcostal area, and several of the symptoms characteristic of appendicitis are positive. The following methods are used in the diagnosis of appendicitis:
Palpation of the child's abdomen;
Laboratory tests - general analysis of blood and urine, stool analysis as directed, coprogram;
Instrumental examinations: abdominal, pelvic ultrasound, electromyography, abdominal radiography or computed tomography in case of difficulties in diagnosis, as well as laproscopy to make a definite diagnosis;
Adult girls also need a pediatric gynecological examination.
Abdominal vision and palpation use localized or localized pain, lagging abdominal muscles during respiration, abdominal muscle stiffness, and specific peritoneal symptoms (Shetkin-Blumerg, Voskresensky, Rovsing symptoms).
Parents cannot diagnose appendicitis on their own: they need the help of a qualified doctor to diagnose the above symptoms and perform tests. In young children, the time he sleeps is also used to identify signs.
Blood tests show an increase in the number of leukocytes in the case of appendicitis, neutrophilia. In the urine analysis can be found erythrocytes, leukocytes, protein in the urine.
In young children, electromyography may be used to determine if the abdominal muscles are tense. One of the most reliable tests for the detection of appendicitis (accuracy up to 95%): UTT (UZI) examination. This test can help detect not only appendicitis, but also the amount of fluid that accumulates in the abdomen, infiltrates, and abscesses.
Sometimes a child is seen in a hospital setting for a diagnosis within 6-12 hours.
THE TREATMENT
Basic rules for parents:
If you have any pain in the abdomen, do not use painkillers on your own - it will be difficult to make an accurate diagnosis;
It is not possible to give the child emollients and enemas;
Neither hot nor cold can be applied to the painful area, they accelerate the inflammatory process;
Do not give the child too much fluid: if the diagnosis of appendicitis is confirmed, the child should not be allowed to eat or drink water for anesthesia or surgery. If the child is very thirsty, moisten his lips with a cotton ball soaked in water;
If you have abdominal pain, see a doctor immediately.
After the diagnosis of appendicitis, surgery is performed, regardless of whether it is chronic or acute. Surgery is performed in two ways: the traditional open method or the laproscopic method. In both cases, general anesthesia is given.
The surgery can take 30-60 minutes. The results of timely treatment are positive. After the operation, the child should not drink fluids, you can wet your lips. The composition of the food is also prescribed by a doctor. If there are no complications, the child is allowed to go home in 5-8 days.
Laproscopic method is effective because it is less traumatic: the surgeon makes a small incision and removes the inflamed appendix using special tools. The boy recovers quickly after such a surgical procedure. However, in the most severe forms of appendicitis, the open method is used.
In the destructive form of appendicitis, the child is prepared for surgery 2-4 hours before surgery: infusion therapy (intravenous fluids to relieve intoxication) and antibiotics are prescribed. In this form of the disease, surgery is a little more difficult and the child is treated in the hospital longer after the operation. Once a child is allowed to go home, he or she should be monitored by his or her parents, and a doctor should be consulted immediately if the child develops a fever or other symptoms.
In 15-20% of children, postoperative complications of appendicitis perforation (rupture) are observed (abscess formation in the abdominal cavity). Treatment of such complications is carried out on an individual basis (removal of pus from the abdomen, administration of antibiotics and detoxification therapy). Spastic disease may also develop after destructive appendicitis.
Mortality from appendicitis in children is 0,1-0,3%.
PREVENTION
Parents need to know the child's diet, bowel movements, early detection and treatment of chronic and acute diseases.
Which doctor should I see?
If the child has persistent abdominal pain, it is necessary to call an ambulance. At the hospital, the child is examined by a surgeon, anesthesiologist, gynecologist, and ultrasound specialist. Surgery is performed if indicated.
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