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Symptoms of appendicitis in adults and children

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Appendix, lat. appendix vermiformis - a worm-shaped process, 5-7 cm in length (sometimes 20 cm), 1 cm in diameter, blindly ending, tubular shape.

Aggravation of appendicitis can occur at any age. Risk groups are children over 5 years old, adults 20-30 years old, and pregnant women. Pathology is equally characteristic of the female and male sex. Very rarely, appendicitis occurs in young children, which is explained by the age-related anatomical feature of the appendix, which has a funnel shape and is easily emptied, and the weak development of the lymphoid apparatus of the process.

Among all diseases of the abdominal cavity, which require urgent surgical intervention, appendicitis is the most common. If there was an attack of acute appendicitis, you need to call the ambulance team as soon as possible. If appendicitis is not treated, peritonitis can develop - a complication that is fatal.

How appendicitis manifests, the symptoms and signs of this emergency should be known to everyone. The main symptom of appendicitis in adults and children is pain. It occurs in the upper abdomen or near the navel, sometimes it is not possible to accurately indicate the place of pain (“the whole stomach hurts”). Then the pain moves to the right side of the abdomen. This migration of pain is considered a very specific symptom of the disease.

Causes of Appendicitis

There are the following reasons for the development of inflammation of the appendix:

  1. The combination of mechanical blockage of the lumen of the appendix and activation of the intestinal microflora. Fecal stones, enlarged lymphoid follicles, a foreign body (accidentally swallowed), a tumor formation, and an accumulation of parasites can cause a blockage. In the place of occurrence of such a "tube", an accumulation of mucus occurs, microorganisms actively proliferate. Inside the lumen, the pressure rises, the vessels are compressed, the outflow of blood and lymph is disturbed. Result: inflammation and necrosis of the appendix.
  2. According to some data, the risk of developing appendicitis is higher in people suffering from stool retention for many years. Due to the slow movement of fecal masses through the digestive tract, such people are more likely to have fecal stones.
  3. The same can be said about those people whose diets are saturated with protein food and poor in plant fiber. Fiber facilitates the promotion of intestinal contents, improves the work of peristalsis.
  4. Vascular theory suggests that the cause of appendicitis is systemic vasculitis (vasculitis - inflammation of the vascular wall).
  5. Infectious theory has not received any confirmation or denial. It is believed that some infectious diseases (for example, typhoid fever) can independently trigger the development of appendicitis.

Which side is appendicitis?

An appendix is ​​a small process of the cecum. For most people, it is located on the right side of the abdomen, below the navel. On which side appendicitis a person can be affected by the intestinal condition. If appendicular peritonitis develops, the symptoms are pronounced and acute, localization of appendicitis pains is usually on the right side, this is typical for the development of an acute inflammatory process in the patient's body, which requires emergency medical care and an appendix removal operation.

Appendicitis can be differently located in the peritoneal region, which does not give an unambiguous picture in the localization of symptoms, pain can be given both to the right side and to the lumbar region, or to the pelvic area, the patient's genitals. The nature of pain has a different intensity, intensifying or subsiding, cramping, can last for a long time or for a short time.

Signs of appendicitis

There are many different signs of appendicitis in adults and children. Signal is the beginning of the disease is a strong pain. At the very beginning it does not have a relatively clear location. A person may feel that he just has a stomach ache. However, after 4-5 hours, the pain concentrates closer to the right iliac region.

It should be noted that the appendix in different people may be located differently, it all depends on the structure of the body. If the process has a normal position, then the pain will be observed in the right iliac region. If the appendix is ​​located slightly higher, the pain will be on the right under the ribs. Well, if the process is down, it will hurt in the pelvic region. In addition, the patient may be disturbed by vomiting, and in some cases diarrhea.

Other popular signs of appendicitis include the following: dry tongue, dark urine, fever, which can reach 40 degrees, pregnant women may experience increased pain while turning from the left side to the right.

Appendicitis symptoms

In the case of acute appendicitis, the symptoms are pronounced. There is an attack of pain in the right iliac region, a pronounced local and general reaction of the body. As a rule, pain in acute appendicitis begins suddenly.

At the beginning of an attack, they are often localized in the epigastric region, in the navel or throughout the abdomen, and after a few hours (sometimes in 1-2 days) - in the right iliac region. More often, pain is permanent, does not radiate anywhere, but intensifies with coughing. The pain in the abdomen does not allow the patient to fall asleep, but its intensity is usually small, it is characterized by a reduction in pain in the position on the right side.

In the early hours of the disease, nausea and vomiting may occur. The chair and gases often linger. Liquid feces are observed much less frequently (mainly with severe intoxication). Body temperature rises to 37.5—38 °, rarely remains normal. The pulse in the first day of the onset of the disease quickens to 90-100 beats per 1 minute, the blood pressure does not change and only decreases slightly with severe intoxication. The tongue is initially slightly coated and moist, but soon becomes dry.

Also with appendicitis, there are other symptoms. For example, when examining the abdomen, they often determine the lag in breathing of the lower sections of the abdominal wall. Palpation of the abdomen should be carried out carefully, starting from the left half of it. At the same time, in the right iliac region, as a rule, there is a sharp pain, combined with the protective tension of the muscles of the abdominal wall in a limited area. In most patients, a light tapping of the fingers in different parts of the abdominal wall helps to quickly establish the place of the greatest pain.

However, the symptoms and course of acute appendicitis are far from always so characteristic. The clinical picture of the disease in children, the elderly and the elderly, as well as the atypical arrangement of the appendix can be especially peculiar. In any case, if symptoms of appendicitis appear, it is necessary to call an ambulance.

Chronic appendicitis occurs with aching dull pains in the right iliac region, which can periodically increase, especially during physical exertion.

Diagnostics

The diagnosis is made on the basis of the characteristic symptoms of appendicitis. Confirm the diagnosis of "inflammatory signals" of a general blood test. The most reliable method is laparoscopy.

Specification of the morphological form of appendicitis (catarrhal, gangrenous, phlegmonous) is possible during surgical intervention: a histological study of a remote appendix is ​​carried out. From instrumental methods using ultrasound, radiography of the abdominal cavity, irrigoscopy, computed tomography.

A common tactic for acute appendicitis is the earliest surgical removal of the inflamed appendix. After 36 hours from the moment the first symptoms appear, the probability of perforation (rupture) of the appendix is ​​16-36% and increases by 5% every subsequent 12 hours. Therefore, after confirming the diagnosis, the operation should be performed without undue delay.

At the stage of prehospital care in cases of suspected acute appendicitis, bed rest, exclusion of fluid and food intake, application of cold to the right iliac region are shown. It is strictly forbidden to take laxative drugs, the use of hot water bottles, the introduction of analgesics before the final diagnosis.

Currently, with a simple form of appendicitis, laparoscopic surgeries that do not require an abdominal wall incision are preferred. In this case, an endoscopic instrument is inserted into the abdominal cavity through a small puncture in the tissues. Removal of appendicitis in this way allows you to avoid operating injury, and reduce the recovery period at times. The risk of postoperative complications when appendicitis is removed using the laparoscopic method is minimal.

In the case of chronic appendicitis, an appendectomy is indicated if persistent pain syndrome is noted that deprives the patient of normal activity. With relatively mild symptoms, a conservative tactic can be applied, including constipation, antispasmodic medication, physiotherapy.

The first signs of appendicitis

There are several stages in the development of the inflammatory process: the early, destructive and the stage of complications. Symptoms of acute appendicitis occur suddenly. Without any prodromal signs. Rarely a couple of hours before the onset of the clinic of acute inflammatory process in patients with nonspecific symptoms - weakness, loss of appetite. For the early stage, the unfolded manifestations are typical:

  • Sudden pain - at first the syndrome is localized in the umbilical region or epigastrium, is dull, non-intense. When changing the position of the body, pain in appendicitis increases. After a few hours, the syndrome shifts to the right.
  • Nausea, vomiting - at first the patient begins to feel sick. Then, in response to the experienced pain syndrome, a single vomiting occurs.
  • Dyspepsia - increasing intoxication is accompanied by violations of the act of defecation - constipation or diarrhea.
  • Fever - in patients with a rise in temperature to 38-39 ° C.

The content of the article

  • The main symptoms of appendicitis
  • Appendicitis: Symptoms, Diagnosis and Treatment
  • Appendicitis: Symptoms and Treatment

The main symptom of appendicitis is pain, which is diverse in nature. It can occur suddenly, observed in the navel, lower back, in the right lower half of the abdomen and the epigastric region. The pain in most cases appears acute, less often pulling and cramping. It is enhanced by coughing and tension in the anterior abdominal wall while walking and climbing. There are unpleasant feelings mainly in the morning and in the late afternoon.

Common symptoms of appendicitis

Lack of appetite, loose stools, nausea, vomiting - all of these are among the most common causes of appendicitis. Often they can be accompanied by painful and frequent urination. This is due to the fact that the disease is progressing. Inflammations began to shift to the bladder and ureter.

In order to reduce pain, you can take an antispasmodic drug. However, you can not drink more than 2 tablets. Only one use is allowed. To reduce the pain, it is impossible to make cold compresses on the stomach and use heating pads. All this will only lead to increased inflammation.

An increase in weakness and malaise - these are also appendicitis symptoms. They are noted by patients when in a worm-shaped shoot strong inflammatory processes are observed. Along with these symptoms, there may be fever with chills. As a rule, it is not possible to bring it down with ordinary medicines.

Irregular gait is also a symptom of appendicitis. Patients while walking bend to the right side, and with their hand hold the stomach, thereby protecting it from tremors and reducing pain. With a deep breath, they note sharp pains in the suprapubic area, which are of a short duration.

Discoloration of the skin is another major symptom of appendicitis. Along with this, the patient may have a weak pulse and low blood pressure. When you press on the stomach with your finger, a localized pain arises, and the muscles tense strongly.

What to do if you find symptoms?

If you discover one or more symptoms of appendicitis, consult a doctor as soon as possible. It is necessary to undergo a thorough examination in order to confirm the presence of such a disease. On the basis of its results, it will be clear whether surgery is required, or the reason lies not in the presence of appendicitis, but in something else.

How appendicitis develops

The causes of appendicitis are still not fully understood. There are several theories of the development of the disease. There is no consensus on the leading etiological factor in the scientific community.

Possible causes of inflammation of the appendix:

  • mechanical blockage of the opening between the cecum and the appendix,
  • intestinal infection
  • disorders of the nervous regulation of the vessels of the intestinal wall,
  • excessive production of serotonin by the APUD system cells in the appendix,
  • peristalsis and constipation,
  • features of the diet (lack of plant fiber in the menu, an excess of protein and fat).

In the early stages of appendicitis, edema of the mucous membrane and submucous membrane of the appendix is ​​observed, impairment of the outflow of contents into the cecum, deterioration of microcirculation in the arterioles, venules and capillaries, activation of microflora. The first symptoms of appendicitis are associated with the development of the initial symptoms of inflammation.

Appendicitis pain

The discomfort and pain during appendicitis in the first stages is felt in the epigastrium or in the central part of the abdomen. After a few hours in the classic case with a typical localization of the appendix, the discomfort migrates to the right iliac region.

If the patient has anatomical features of the appendix, the pain can move from the epigastrium to the lumbar region, the right or left hypochondrium, to the umbilical region.

The first signs of appendicitis at close proximity of the appendix to the ureters or internal genitals include frequent urination, irradiation of uncomfortable sensations in the groin area.

In the initial stages of inflammation, the pain syndrome is quite moderate, but the intensity of unpleasant sensations is constantly increasing.

Important: In case of acute abdominal pain, you should not take painkillers until you see a doctor.

Disorders of the digestive tract

Nausea, vomiting and loose stools occur with appendicitis reflexively. They appear again after the onset of acute pain.

In acute appendicitis, loss of appetite occurs a few hours before the appearance of abdominal discomfort. Patients do not refuse to receive water.

Nausea is persistent growing character. But vomiting is observed only 1-2 times. Loose stools occur in a small percentage of patients.

The frequency of symptoms of disorders of the digestive tract:

  • loss of appetite - 99-100% of cases
  • nausea - 40% of cases
  • vomiting - 20% of cases
  • diarrhea - 10% of cases.

How is the general reaction of the body to appendicitis? Patients from the first hours there is fever (subfibril). Increased body temperature is a manifestation of the immune system. In the early stages of inflammation of the appendix fever does not exceed 37.5-38 degrees Celsius.

Important: If acute abdominal pain is combined with fever, seek medical attention immediately.

Early signs of appendicitis in children

The symptoms of the disease at the initial stage depend on the age of the patient. The first signs of appendicitis in adults and children can vary dramatically. Preschool children often have an atypical onset of the disease. The first manifestations of inflammation of the appendix can be high fever, vomiting, deterioration of the general condition.

Small children suffer from discomfort worse and can hardly describe their state of health. The development of acute pain is indicated by the forced position of the child’s body (pursed legs), increased crying on the hands of adults.

Tips for parents: Do not apply a heating pad (warm diaper) to the baby’s belly. Give the child enough water, do not insist on eating.

Symptoms of the disease in men and women

Features of appendicitis in representatives of different sexes are associated with the location of internal organs in the pelvis, the likelihood of pregnancy or ovarian apoplexy in women.

Inflammation of the appendix occurs in men 2 times less. Probably the involvement in the pathological process of the appendix happens with oophoritis, salpingitis, endometritis, colpitis.

Tip: Women with chronic pelvic inflammatory disease should undergo a full course of treatment by a gynecologist. Eliminating the infection process in the genitals, you reduce the risk of appendicitis.

Women usually develop appendicitis between the ages of 20 and 40 years. This period of life is characterized by high fertility. The first signs of appendicitis in women may resemble ectopic implantation of the ovum, the onset of spontaneous abortion or ovulation. Для исключения проблем половой системы необходимо пройти ультразвуковую визуализацию органов малого таза.The diagnosis of appendicitis is established after an examination by a gynecologist.


Unfortunately, the inflammation of the appendix is ​​often found in pregnant women. Surgical intervention in this regard is the most common abdominal surgery in expectant mothers. The first signs of appendicitis in pregnant women are hardly noticeable. Blurred clinical picture often leads to late diagnosis of the disease. In addition, difficulties in identifying appendicitis are associated with a change in the position of the appendix in pregnant women. After 20 weeks, the characteristic acute pain is usually fixed in the right hypochondrium, and not in the iliac region. To identify inflammation of the appendix in expectant mothers check the symptoms of Michelson and Taranenko.

In men, the first signs of appendicitis more often fit into the classic picture and are easier to evaluate. To confirm the diagnosis, the doctor should check the symptoms of Horn, LaRock, Britten.

During pregnancy

During pregnancy, a woman constantly feels discomfort and abdominal pain - this is due to the development of the child. Waiting for a child can easily provoke inflammation of the appendix. Pathology is caused by the growth of the uterus, which squeezes the appendix, disrupting the blood supply. How to determine appendicitis in a pregnant woman?

All signs characteristic of inflammation of the process in adults, adolescents and children in pregnant women are less pronounced or manifest later. The doctor determines the disease by analysis of urine and using ultrasound. The main symptoms of appendicitis in pregnant women:

  • heat,
  • nausea,
  • soreness in the right abdomen,
  • stomach upset,
  • vomiting.

The first symptoms of appendicitis

How inflammation of the appendix will appear depends on the age and sex of the patient. However, there are common first signs of appendicitis, which are suitable for all cases:

  • lumbar spine pain,
  • weakness,
  • high body temperature,
  • increased sweating
  • increase in heart rate,
  • often repeating vomiting, after which there is no improvement.

What are appendicitis pains?

The appearance of painful sensations is associated with the penetration of the infection in the appendix with its subsequent spread to nearby tissues. The pain is usually sharp, which gradually becomes more intense. The duration of the attack is from a minute to several hours. Localization and the nature of pain in appendicitis is blurred, since it covers almost the entire peritoneum. Silent soreness may mean perforation of the intestinal wall, which requires an urgent delivery of a person to the hospital.

With acute

In the acute course of the disease, the pain is aggravated by any movement of the patient, physical exertion or coughing. Sometimes the pain goes through contractions. Other clinical indicators of inflammation - vomiting, nausea, stool retention, occur frequently, but are not regular. Further examination reveals other signs of acute appendicitis: immobility or lag of the anterior abdominal wall, increased leukocytes in the blood, high fever. For the final diagnosis, symptoms are identified by the authors.

Chronic

Not one year in a row a person may be disturbed by the chronic course of the disease. At home, it is difficult to determine the presence of inflammation of the appendix, since the clinical picture resembles the feeling of heaviness with nutritional errors. When chronic appendicitis is present, the symptoms are aggravated by physical exertion, sneezing, coughing, during bowel movements. Most have an intestinal upset in the form of regular diarrhea or constipation.

If appendicitis is suspected

The very first manifestation of inflammation of the intestinal appendix is ​​heaviness in the middle of the abdomen or to the right in the ileal-inguinal region. If you press on this area and then abruptly release, the patient feels a sharp pain. If after such actions a person fails to walk with a straightened back, and is most comfortable for him only lying in a bent position, the progression of the pathology is confirmed. Similar symptoms in appendicitis are the reason for calling an ambulance.

Classification

Appendicitis can proceed in an acute and chronic form. The acute form is divided into the catarrhal course of the disease and destructive, which, in turn, can have several forms:

  • phlegmonous,
  • phlegmonous and ulcerative,
  • apostematous,
  • gangrenous.

Chronic appendicitis is also divided into several forms. He might be:

  • residual,
  • primary chronic
  • recurrent.

All these forms of chronic appendicitis differ in sclerotic and atrophic processes occurring in the appendix. The growth of granulation tissue in the walls of the appendix and its lumen, the formation of adhesions between the surrounding serous membranes can occur. In case of accumulation of serous fluid in the lumen of the vermiform process, a cyst is formed.

Appendicitis in children and adults: causes, symptoms and treatment

Very often, the patient does not pay attention to the pain in the abdomen immediately, but after a few hours or even days. This is due to the fact that the first signs of appendicitis in adults develop gradually and are uncertain. There are difficulties with the definition of a specific area of ​​pain. When taking pain medication pain can subside altogether and be felt only with sudden movements and a deep breath or cough.

Appendicitis: signs in adults

  • Constant pain, which in the first hours is localized in the navel, then goes down to the right.
  • Nausea and vomiting.
  • Increase in body temperature to subfebrile.

If these symptoms (signs) of appendicitis in adults appear, then you should not hope that everything will resolve itself. We need to call an ambulance. An experienced team of doctors can easily identify such a dangerous disease that requires immediate hospitalization, as appendicitis. Signs in adults, as already mentioned, may be blurred. To clarify the diagnosis before the arrival of doctors you can conduct a self-diagnosis.

This is done as follows: in the lower abdomen on the right, you need to press firmly with two fingers (middle and index), while the pain should not be felt. Then the fingers are removed, and the pain increases dramatically. If such a test was positive, i.e. everything works out as described, and nausea and, in some cases, vomiting may also be present, then most likely these are the first signs of appendicitis in adults. Now we will describe them in more detail.

Symptomatology

With the diagnosis of appendicitis, the symptoms in adults may be somewhat blurred, but they all boil down to the following:

  1. First, there is pain in the abdomen, which is not clearly localized. It can manifest itself in the navel, epigastrium or have a blurred character (all over the abdomen). The pain is constant, sometimes it can be cramping. After an hour or more, it concentrates in the lower abdomen to the right. This symptom of moving pain is called Kocher-Volchkov. Irradiation of pain is usually not observed. This is only possible with an atypical location of the appendix. In this case, the pain may go to the groin or lumbar region.
  2. Patients, as a rule, have no appetite. This symptom is called anorexia.
  3. Following the pain, nausea develops, and there may be a single vomiting. These signs of appendicitis in adults are reflex in nature and develop as a result of peritoneal irritation.
  4. Subfebrile temperature may rise, but this is not always the case. Signs of acute appendicitis in adults, such as fever, vomiting, and anorexia, are called Murphy’s symptoms.

With the appearance of such signs in a patient, acute appendicitis may be suspected. Sometimes these major appendicitis symptoms in adults are accompanied by frequent urination, stool disorders (diarrhea), rapid pulse and, in rare cases, an increase in pressure. Other uncharacteristic symptoms of this disease can be observed in the elderly, children and pregnant women, as well as with the atypical location of the appendix of the cecum. What signs of appendicitis in adults are observed most often, we examined. Now let's talk about the features of the development of this disease in women, and also consider what danger it carries during pregnancy.

Features of the diagnosis of appendicitis in women

Representatives of the beautiful half of humanity are more likely to have an error in the diagnosis of this disease than men. This is due to the fact that sensations during the development of this disease can be confused with pain during menstruation or a painful reaction when an inflammatory process occurs in the gynecological region of the pelvic organs. This error may occur when the atypical location of the appendix.

To clarify the final diagnosis in a hospital, a woman other than a surgeon must also see a gynecologist. A distinctive symptom of inflammation of the appendix from the gynecological pathology is the fact that in the latter case, vomiting, nausea and upset stool are not characteristic.

What is dangerous appendicitis during pregnancy?

Obviously, any surgical intervention, especially when it is performed in the abdomen of a pregnant woman, can cause miscarriage or premature birth. But besides this, it is dangerous in the following states:

  • development of fetal hypoxia,
  • placental abruption and premature fetal aging,
  • the occurrence of acute intestinal obstruction,
  • postoperative infection,
  • violation of the contractile activity of the uterus during labor,
  • the development of bleeding in the postpartum period.

Thus, we looked at all the possible appendicitis symptoms and signs of disease in adults. Now let's pay attention to the features of the development of this ailment in children.

Complications

In some cases, the course of the disease is complicated by the following processes:

  • abscess of the abdominal cavity, which can be appendicular, subphrenic, interintestinal or Douglas depending on the site of localization,
  • thrombophlebitis of the pelvic or iliac veins, this may be the cause of a very serious condition - pulmonary embolism,
  • peritonitis, in case of rupture of the appendix,
  • the formation of postoperative infiltration,
  • the development of adhesions in the postoperative period, which can provoke intestinal obstruction.

If there are signs of inflammation of appendicitis in adults or children, it is indicated as soon as possible to make an appendectomy, i.e. removal of the appendix to avoid serious complications of this disease. This operation is carried out on an emergency basis - no later than an hour after the exact diagnosis.

At the stage of first aid, bed rest is recommended. It is strictly forbidden to take any food and drink. You can not take painkillers, laxatives and other drugs to clarify the final diagnosis, apply cold or heat.

After an accurate diagnosis of appendicitis is established (signs in adults and children are described above), the patient is placed in the surgical department and appendectomy is performed. With uncomplicated course, this operation is done with a laparoscopic method.

After that, the patient is transferred to resuscitation for several hours, where he is under constant medical supervision. After the patient finally withdraws from anesthesia, he is transferred to the surgical department. On the 5th day, the sutures are usually removed and the patient is transferred to outpatient treatment.

With a complicated course of this disease, the patient remains in the clinic, and his discharge will be delayed until the undesirable consequences are eliminated and the general condition stabilizes.

With an uncomplicated course of the disease and a well-performed operation in a timely manner, the appendix does not pose a threat to life. The patient’s full working capacity is restored after 4 weeks.

The reasons for the development of complications of appendicitis, as a rule, are untimely hospitalization and delayed surgery. In severe cases, it can even lead to death.

Risk groups

Aggravation of appendicitis can occur at any age. Risk groups are children over 5 years old, adults 20-30 years old, and pregnant women. Pathology is equally characteristic of the female and male sex. Very rarely, appendicitis occurs in young children, which is explained by the age-related anatomical feature of the appendix, which has a funnel shape and is easily emptied, and the weak development of the lymphoid apparatus of the process.

Elderly people rarely get to the operating table, since the lymphoid tissue in old age undergoes reverse development. However, this does not mean that these population groups are insured against appendicitis exacerbation - a patient of any age with suspected appendicitis is subject to a thorough examination.

Causes of acute appendicitis in adults

There are several reasons provoking the development of acute appendicitis:

  • Occlusion of the appendix with undigested food particles, feces. The vermiform appendix bears this name for good reason - not only is it thin and narrow, but the appendix also has great mobility. The blockage of the appendix leads to stagnation of its contents and inflammation of the wall.
  • Hit in the wall of the appendix conditionally pathogenic and pathogenic intestinal flora - Escherichia coli, staphylococci, enterococci, streptococci, anaerobes under certain conditions - hyperplasia of the lymphoid tissue, inflection of the process and the impossibility of its emptying,

The first and second causes of appendicitis are interrelated, since the stagnation of the contents of the process creates ideal conditions for the pathological reproduction of bacteria and their penetration into the wall of the appendix.

  • In the West, a separate cause of appendicitis exacerbation is identified - fuzobacteria entering it, causing necrotization of the processes of the process. These bacteria are characterized by the ability to quickly cause purulent-inflammatory processes, but they are very sensitive to the action of antibiotics. In our country, it is not customary to single out the fuzobacterial theory of appendicitis into a separate column, and the conservative treatment of appendicitis, which is very common in Western countries, is used very rarely.
  • Infectious and parasitic diseases of the intestine - typhoid fever, yersiniosis, amebiasis, tuberculosis and others.
  • Nutrition with a high content of protein foods, contributing to the excessive formation of protein breakdown products in the intestines and the development of processes of decay.
  • Tendency to constipation - the impossibility of timely emptying of the intestines and the creation of conditions for the active reproduction of bacteria.

Spanish scientists studied 3,000 cases of acute appendicitis and concluded that in almost 40% of cases an attack of appendicitis was triggered by the use of roasted seeds or chips, most often in children under 14 years of age.

Stage catarrhal appendicitis (first twelve hours)

A typical picture of appendicitis begins with discomfort and pain in the stomach, often in the evening or at night. Very often, these pains resemble the manifestations of gastritis and are not intense, have a dull character, so people do not give them a strong meaning. In the same period, nausea occurs and there is a single vomiting. It is believed that nausea in appendicitis has a reflex nature, and often in older people this symptom may be mild, which sometimes leads to a late diagnosis.

After a few hours, the pain moves to the lower right abdomen (with right-sided appendix). The nature of the pains changes - they become oppressive and pulsating with increasing intensity. There may be diarrhea, urination becomes more frequent. There is a subfebrile condition with a slight further increase in temperature above 37 C.

Gradually, within six to twelve hours from the onset of the disease, the typical symptoms of general intoxication of the body develop - weakness, rapid heartbeat, dry mouth, malaise. The pains become difficult to bear and even more intense.
The abdomen at this stage remains soft, but painful with pressure from the right side.

This stage is considered the most favorable for the operation, but most patients go to the doctor later.

Stage of phlegmonous appendicitis (end of the first day)

During this period, the pain is clearly localized in the iliac region on the right, are pulsating and intense feeling. There is a constant feeling of nausea, there is tachycardia up to 90 beats per minute. The temperature fluctuates within 38 C. On examination of the abdomen, the lag of the right side in the process of breathing becomes noticeable. The abdomen becomes tense in the lower right part, which indicates the beginning of the transition of the inflammatory process to the peritoneum. At this stage, all diagnostic symptoms (slips, Shchetkin-Blumberg, Sitkovsky, Bartome-Michelson, Rovsing) become positive and the diagnosis becomes obvious.

At this stage, the patient most often falls on the operating table.

Stage of gangrenous appendicitis (second or third day)

На данной стадии наблюдается мнимое облегчение боли – происходит отмирание нервных окончаний аппендикса, что и приводит к уменьшению чувствительности. At the same time, symptoms of general intoxication of the body are increasing - severe tachycardia appears, vomiting may occur. The temperature drops, sometimes even below 36 C. The abdomen is swollen, there is no peristalsis. Palpation of the localization process of the appendix causes severe pain.

Stage perforated appendicitis (end of the third day)

The moment of perforation of the appendix wall is accompanied by acute pain, localized in the right lower abdomen, with increasing intensity. Relief periods are absent, pain is permanent. Repeated vomiting occurs. The patient experiences strong tachycardia, the stomach becomes swollen and tense, peristalsis is completely absent. White bloom on the tongue acquires a brown color. Body temperature rises to critical values. The outcome of perforation of the appendix - purulent diffuse peritonitis or local abscess.

It is worth noting that the indicated terms and stages of the progression of appendicitis are conditional - perhaps a hidden or fulminant course of the disease.

How to determine appendicitis in a child can be found in our article Signs of appendicitis in children.

Atypical appendicitis forms and their symptoms

In some cases, the classical clinical picture is absent, but the pathological process develops in the body. There are several atypical forms of appendicitis.

Empyema is a rare form of the disease, characterized by the manifestation of a painful symptom right away in the right iliac region with less intensity and a slow increase in symptoms. Manifestations of intoxication (fever, chills, weakness) are observed only by 3-5 days from the onset of the disease.

Retrocecal appendicitis (5-12% of cases). It is characterized by mild first symptoms of peritoneal irritation, high temperature rises and a predominance of semi-liquid stool with mucus in the symptoms. Sometimes patients experience only lower back pain radiating to the right thigh.

Pelvic appendicitis is characteristic of the female (9-18% of cases). There is a violation of urination (dysuria), diarrhea with mucus, symptoms of peritoneal irritation and intoxication (temperature) are poorly expressed. The pain is felt in the lower abdomen, radiating to the navel.

Subhepatic appendicitis is characterized by a painful symptom in the right hypochondrium.

Left-sided appendicitis - is characterized by a classical clinical picture, but with localization of pain in the left iliac triangle. Therefore, the question which side hurts appendicitis on the right or on the left is an ambiguous answer. Left-sided appendicitis occurs in 2 cases when the cecum is excessively active or when a person has a reverse arrangement of internal organs.

Appendicitis in pregnant women of the second half of pregnancy is characterized by moderate severity of the pain symptom with localization of pain closer to the right hypochondrium, little pronounced temperature reaction and weak symptoms of peritoneal irritation.

Symptoms of chronic appendicitis

Chronically appendicitis in adults is registered very rarely, no more than 1% of all cases. Symptoms are characterized only by occasionally arising periodic pains, which are aggravated by coughing, walking. When relapse of chronic appendicitis occurs, its symptoms are identical to acute appendicitis, the body temperature can be either subfebrile or normal. The clinical picture resembles pyelonephritis, peptic ulcer, chronic cholecystitis, chronic gynecological and other diseases of the abdominal cavity.

Differential diagnostics

The diagnosis of acute appendicitis is made on the basis of:

  • patient survey data
  • physical examination data
  • laboratory blood tests (leukocytosis in dynamics),
  • data from ultrasound examinations of the abdominal cavity (American experts consider ultrasound as a poorly informative method for determining appendicitis, which has many diagnostic errors, recommending CT),
  • temperature reaction.

It is necessary to differentiate this pathology from acute gastroenteritis and pancreatitis, covered perforation of gastric or duodenal ulcer, intestinal dyskinesia, renal colic, and pleuropneumonia. With an atypical location of the appendix, the disease is differentiated from gynecological and urological pathology, cholecystitis.

When in doubt in the diagnosis resorted to laparoscopic appendix. This diagnostic procedure allows you to accurately establish the diagnosis and when it is confirmed immediately proceed to the laparoscopic appendectomy.

Treatment of acute appendicitis

Removal of the inflamed vermiform appendix is ​​a generally accepted therapeutic tactic. When an appendix is ​​removed at an early stage of the disease, a minimally invasive laparoscopic operation is performed. With the development of symptoms of peritonitis, abdominal surgery is indicated. Sometimes the operation begins with laparoscopy, and ends with abdominal surgery (when the inflammatory process goes beyond the limits of the process).

The postoperative period averages 7-10 days and depends on the amount of surgery, the stage of the pathological process and postoperative complications. The sooner the appendectomy is performed (ideally at the catarrhal stage), the faster the patient can return to normal life. Therefore, at the slightest suspicion of appendicitis, it is impossible to delay the visit to the doctor.

Conservative treatment is rarely used for the mild symptoms of appendicitis and intoxication and the presence of contraindications to surgery. With the progression of the process in any case, remove the appendix.

In the West, intravenous antibiotic therapy is practiced, which is started as early as possible (see uncomplicated appendicitis can be treated with medication). In our country, antibiotic therapy is indicated in the postoperative period.

Prognosis and complications of acute appendicitis

Complications of acute appendicitis include: limited abscess of the abdominal cavity, appendicular infiltration, diffuse peritonitis and pylephlebitis.

With timely conduct appendectomy favorable prognosis. If appendicitis is complicated by peritonitis, more extensive surgical intervention is required, followed by drainage of the abdominal cavity and serious antibiotic therapy, the recovery period is prolonged.

If a person does not seek medical help, the disease is fatal due to peritonitis and acute intoxication of the body. Extremely rarely, appendicitis passes spontaneously with the formation of inflammatory infiltrate. However, this should not be counted on, since in the future such an outcome of acute appendicitis results in the formation of adhesive processes and foci of inflammation in the abdominal cavity.

Any acute pain in the abdomen, aggravated by coughing, movement, accompanied by low fever, nausea, diarrhea or constipation, as well as involuntary tension of the abdominal muscles - a reason for immediate medical attention!

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