Appendicitis

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Definition and classification of the disease

Appendicitis is a worm-like tumor located in the lower part of the intestine - an inflammation of the appendix. Usually the appendix is ​​a small tube with a diameter of 7-10 mm and a length of 50-150 mm. It starts with a blind spot, gradually narrows, and there is no way out.

The function of the appendix is ​​unclear. Previously, the appendix was considered a simple rudiment and was left over from the distant animal ancestors of humans, who were mostly fed on plants, and is now considered unnecessary. To date, there are compelling reasons to prove that it plays an important role in endocrine and immune processes, as well as in the formation of intestinal microflora. People who have had their appendix removed have been shown to have problems with a sufficient number of beneficial microorganisms in the gut. However, the appendix is ​​not one of the vital organs for the body.

As a rule, inflammation of the appendix is ​​acute in nature. As a result of the disease, pus accumulates in the tumor and cannot be easily removed due to the narrowing of the tumor. The appendix enlarges and begins to ache. Eventually, this causes the appendix wall to rupture and pus to leak into the abdominal cavity. This, in turn, can lead to acute peritonitis, sepsis, or abscess in the abdomen, which can lead to death with a high probability. The most serious injury is pyelonephritis, which leads to liver damage, inflammation of the portal vein, and a very high mortality rate.

The disease progresses very rapidly and usually lasts more than 2-4 days, rarely a week. Spontaneous healing of acute appendicitis is rare. Sometimes a protective infiltrate can develop from the surrounding tissue around the affected appendix, but this formation can also lead to abscesses. Therefore, the disease requires surgical intervention and medical treatment. With timely treatment of the disease, the outcome will be positive.

Occasionally, patients with acute appendicitis develop chronic appendicitis. The manifestation of this condition is 100 times less than in acute disease. Usually, surgical treatment is not required.

Acute appendicitis is divided into simple (catarrhal) and destructive forms with complications. Without proper treatment, simple appendicitis almost always turns into a destructive appendix.

The main stages of development of appendicitis:

  • Catarrhal;
  • Phlegmonosis;
  • Gangrene;
  • Perforative.

Causes of appendicitis

The causes of appendicitis in adults are not yet fully understood. However, scientists point out that there is no single cause of appendicitis that is common to all patients. Each patient may have their own causes. In most cases, appendicitis is caused by occlusion of the entrance to the appendix. The reasons for the blockage can be different - for example, the ingress of tube stones or foreign bodies. Adhesions caused by compression of the upper part of the appendix due to cholecystitis or enteritis are also one of the causes of occlusion.

Bacteria also play a major role in the development of appendicitis - enterococci, streptococci, staphylococci and Escherichia coli. Often, there is a combination of these two factors. Prolonged retention of the contents of the tumor leads to a decrease in its internal immunity and the creation of conditions for the entry of pathogenic bacteria. There are also spasms of the blood vessels that supply blood to the tumor as the main causes of appendicitis. Another cause is an injury to the abdominal cavity, which can lead to injury or displacement in the appendix.

Factors contributing to the development of the disease include frequent constipation, impaired intestinal peristalsis, lack of plant fiber in the diet, overeating, a number of infectious diseases of the gastrointestinal tract, the presence of parasites. The origin of the disease is influenced by hereditary factors, as well as weakened immunity due to bad habits, stress, lack of vitamins and trace elements.

There is a high incidence of appendicitis in pregnant women - there is a shift in the appendix due to enlargement of the uterus. In certain diseases of the uterus, inflammation can spread from the center to the appendix.

Signs and symptoms of appendicitis

Symptoms are very important for early diagnosis of appendicitis. Their presence allows to exclude the possibility of the presence of other diseases of the gastrointestinal tract that are not associated with appendicular inflammation.

The main symptoms of appendicitis in adults include:

  • Occurrence of pressure, including acute abdominal pain;
  • Temperature rise;
  • Nausea;
  • To return.

The first signs and symptoms of acute appendicitis do not always allow a clear diagnosis of the disease. Initially, the disease may be similar to other illnesses, so patients may mistakenly think that the pain is not dangerous and is caused by a simple abdominal pain, gastritis, or kidney stones.

The main symptoms of appendicitis are constant pain in the abdomen. As a rule, acute pain occurs suddenly, often at night or in the morning. In the catarrhal stage, the pain first spreads to the entire abdominal cavity or appears in its upper part (epigastric region). But then the pain shifts to the lower abdomen, below the navel, and slightly above the waist.

The process of squeezing the center of pain is called the “Koxer” symptom and is one of the main symptoms of the disease. This symptom is often a sign of appendicitis, not about other diseases of the gastrointestinal tract. This process occurs a few hours after the onset of the disease. Over time, the nature of the pain also changes, it intensifies, throbs, and tightens. The pain intensifies with laughter and coughing, deep breathing, and decreases slightly when bent to the right or when the legs are folded and brought closer to the abdomen. The pain can also be transmitted to the right foot and felt while walking. The pain is usually almost imperceptible when pressing on the inflamed area, but if the abdomen is suddenly released, a strong pain will appear. Tension of the abdominal wall is noted.

As the disease progresses, the pain may subside for some time. However, this does not mean that healing is taking place, it only indicates necrosis (death) of the appendix wall tissue, including the nerve endings. However, pressing the lower area of ​​the umbilicus is still very painful. After this stage, a perforation occurs in the appendix wall, the pus spreads to the abdominal cavity, and the pain reappears several times more intensely.

Keep in mind that sometimes the appendix can be located on the left side, so the left side of the abdomen hurts. In some cases, the pain may be felt right under the ribs, in the groin area, at the waist.

Symptoms of appendicitis in adults also include symptoms of gastrointestinal tract disease. First, it’s nausea. Occasionally vomiting and diarrhea may be observed. However, diarrhea in appendicitis is usually specific to children, less common in adults. Delayed defecation, a feeling of dryness in the mouth is observed. Delayed urination (dysuria) may occur if the tube is abnormally located. Often tachycardia is detected - 90-100 heartbeats per minute.

In the early stages of the disease, the temperature rises to + 37- + 38 ° C. Later, the temperature may drop even more than usual, but in the final stage, it rises again to a higher level before the pus is expelled - + 39- + 40ºC. In this case, the pain is significantly increased.

When appendicitis occurs in the elderly, its symptoms may be vague and may not be noticeable until the disease has reached a destructive stage. The pain may be transient, there may be some nausea, and the fever may not be observed at all. However, this does not mean that appendicitis is milder in the elderly. In contrast, the complications of appendicitis in the elderly are very severe.

It is difficult to diagnose appendicitis in children (under 5 years of age). This is because the symptoms of appendicitis in adults are usually more pronounced than in children. Sometimes appendicitis in a child looks like a simple gastrointestinal disease. The pain is often not localized in the bowel, and sometimes the child is unable to determine where it is hurting. In this case, adults should pay attention to symptoms such as fever (+38 ° C), the appearance of a white rash on the tongue, diarrhea. However, these symptoms can also appear in other diseases, so the child should be referred to a specialist.

Atypical forms of appendicitis

There are also several atypical forms of appendicitis, in which the symptoms may differ from the usual symptoms.

  • Emipiema. A form of appendicitis that develops slowly, in which case there are no Koxer symptoms and the pain suddenly appears under the umbilicus.
  • Retrocecal appendicitis. A weak symptom of peritonitis is characterized by diarrhea. The pain is most often felt in the lumbar region and then spreads downward.
  • Left-sided appendicitis. It has a classic clinical appearance, but the pain is felt on the left side.
  • Chanoq appendicitis. More common for women. Rise in temperature, dysuria, pain spreads to the chest.

What should I do if I suspect appendicitis?

In case of suspicion of appendicitis, you should call a doctor. The basis for consulting a doctor is a constant pain in the abdomen, which does not disappear for 6 hours. Antibiotics, diarrhea, and other medications for the stomach should not be taken until a doctor arrives, especially painkillers, as they can alter symptoms at the time of diagnosis. It is also forbidden to put heat on the area of ​​pain and the abdomen in general, it accelerates the rupture of the appendix. Bed rest is recommended. It is best to refrain from eating. When you see a doctor, you should be told about all the signs, symptoms, the area and nature of the pain.

Diagnosis of appendicitis

For diagnosis, mainly visual inspection and palpation are used. The main symptoms are sharp pains in the right lower abdomen. However, these methods are not always reliable. Ultrasound, MRI and computed tomography, blood and urine tests are also used. When examining the blood, attention is paid to the high level of leukocytes in the blood (leukocytosis). Diagnostic laparoscopic examination can also be performed by puncturing the anterior abdominal wall.

It should be noted that the symptoms of acute appendicitis can be difficult to diagnose because they are very similar to those of the gastrointestinal tract and other diseases. Such diseases include either acute gastroenteritis, pancreatitis, ulcers (especially in the case of perforation), intestinal and kidney pain, inflammation of the uterus, stretching or tearing of the abdominal muscles. Therefore, it is important to distinguish appendicitis from other diseases, which in most cases do not require urgent surgical intervention.

Treatment of appendicitis

Appendicitis is usually treated surgically. This involves removal of the appendix (appendectomy surgery). In some cases, treatment with antibiotics is also added. Sometimes conservative treatment is possible without removing the appendix, and in this case antibiotics are prescribed. As a rule, such measures are applied in cases where there are any instructions against the operation.

The appendix removal procedure is performed conventionally, through an open incision, or by laparoscopic method. During the first 12 hours after surgery, bed rest and eating should be avoided. During the recovery period, the effects of the disease can be treated with antibiotics. The duration of the recovery period depends on at what stage of the disease the operation was performed and usually lasts 1-2 weeks.

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