In medicine, the term "acute appendicitis" refers to the development of an inflammatory process in the appendix of the caecum. The disease can occur in people of any age and gender. The only treatment for it is surgery. If you do not seek medical help in time, the appendix bursts in most cases, as a result of which complications can develop, leading to death. If inflammation of the appendix is suspected, an ambulance should be called immediately.
Development mechanism
In the human body, the appendix is located in the right iliac region. It is a kind of continuation of the caecum, its length is about 8 cm. It can be located in the abdominal cavity in different ways, and therefore a thorough diagnosis must be carried out before its removal.
Long timedoctors were convinced that the appendix does not perform any vital functions in the body, which was explained by the preservation of the patient's previous level of he alth after its removal. But in the process of numerous studies, it was found that the appendix is part of the immune system and is responsible for the production of hormones that improve intestinal motility. Nevertheless, its absence does not affect the patient's he alth due to the launch of compensatory processes.
Despite this, inflammation of the appendix can even lead to death. This is due to the rapid development of the process, in which pronounced morphological changes occur in it, accompanied by the appearance of pronounced symptoms.
In surgery, acute appendicitis is usually divided into several stages:
- Initial. This stage is characterized by the absence of any changes in the process. Another name for it is appendicular colic.
- Catarrhal. At this stage, reddening of the mucous membrane occurs, it swells. In the process of diagnosis, the doctor may detect sores. The patient does not feel severe symptoms, many do not have them at all. When going to the hospital at the catarrhal stage, in most cases it is possible to avoid postoperative complications.
- Phlegmonous. It is characterized by the rapid development of the pathological process, which covers almost the entire process. Acute phlegmonous appendicitis occurs, as a rule, one day after the onset of inflammation. There is a thickening of the walls of the appendix,blood vessels dilate, the organ itself increases significantly in size. Often, acute phlegmonous appendicitis is accompanied by the formation of pathological foci filled with pus. In such cases, the integrity of the walls of the process is violated, through the holes its contents penetrate into the abdominal cavity. The operation performed at this stage often leads to complications in the form of wound suppuration.
- Gangrenous. A feature of this stage is its rapid development. There is a blockage of blood vessels by blood clots, the tissues begin to die and decompose, the intestinal walls are covered with purulent plaque. In the absence of qualified medical care at this stage, extensive peritonitis develops, leading to death.
There have been cases when acute appendicitis ends in recovery without treatment, but they are rare. In this regard, it is necessary to contact a specialist or call an ambulance team at the first warning signs.
In the International Classification of Diseases (ICD), acute appendicitis is assigned the code K35.
Reasons
Pathology develops due to the vital activity of infectious agents and provoking factors. Pathogenic microorganisms can enter the appendix both from the intestines and from more distant foci (in this case, they are carried by the blood or lymphatic fluid).
In most cases, the development of acute appendicitis is provoked by the following pathogens:
- viruses;
- salmonella;
- intestinalchopsticks;
- enterococci;
- Klebsiella;
- staphylococci.
The occurrence of inflammation is affected not only by the vital activity of pathogens, but also by many provoking factors. These include:
- intestinal pathologies in the acute stage;
- worm infestations;
- motility disorder;
- anomalies in the structure of the appendix;
- a large number of fecal stones in the process;
- decrease in blood circulation;
- narrowing of the lumen by foreign objects;
- clots;
- vasospasm;
- unbalanced diet, diet;
- defects in the body's defense system;
- prolonged exposure to stress;
- adverse environmental conditions;
- intoxication.
Thus, the start of the inflammatory process occurs in the presence of general, local and social factors.
Symptoms
Acute appendicitis is always accompanied by pain. At the earliest stage, they are paroxysmal in nature. In this case, there are no other signs of the inflammatory process. Initially, discomfort may be localized in the navel or solar plexus. Gradually, they shift to the right iliac region. In addition, the pain may radiate to the rectum and lower back. Other areas of response are possible.
The nature of the pain in acute appendicitis is constant, it does not stop and intensifies during coughing andsneezing. The sensations become less pronounced if you take a position lying on your back and bend your knees.
In addition, the following conditions are symptoms of acute appendicitis:
- nausea;
- vomit;
- diarrhea;
- high body temperature;
- bloating;
- burp;
- loss of appetite;
- lethargy, drowsiness;
- tongue coating (wet first, then dry).
You need to see a doctor if the above symptoms appear. Approximately on the third day, the disease passes into a late stage, characterized by the spread of the inflammatory process to nearby tissues and organs, as well as a rupture of the appendix. Self-recovery is a rarity; in such cases, the acute form of the pathology becomes chronic.
Diagnosis
If you suspect an attack of acute appendicitis, you must call an ambulance or go to the clinic yourself. For an accurate diagnosis, consultation with a therapist and surgeon is required.
During the appointment, the doctor conducts an initial diagnosis of acute appendicitis, including:
- Poll. The specialist must provide information regarding all the symptoms present, indicate the time of their occurrence and severity.
- Inspection. The doctor evaluates the condition of the surface of the tongue, measures body temperature and blood pressure, and performs palpation.
Then the patient needs to donate blood andurine for analysis. Research is carried out by express methods. To exclude other possible pathologies, the doctor directs the patient to an x-ray and ultrasound. When confirming the presence of acute appendicitis, surgical intervention is indicated.
Surgical treatments
In most cases, the removal of the appendix is carried out urgently. A planned appendectomy is performed if the inflammation is chronic.
The patient's state of agony is the only contraindication to the operation. Acute appendicitis in such cases is not advisable to treat. If the patient has serious illnesses, doctors use conservative methods of therapy so that his body can endure surgery.
The duration of the operation is 50-60 minutes, while the preparatory stage takes no more than 2 hours. During this time, they conduct an examination, put a cleansing enema, insert a catheter into the bladder, shave off the hair in the desired area. With varicose veins, the limbs are bandaged.
After the implementation of the above measures, the patient is taken to the operating room, where he is given anesthesia. The choice of the method of anesthesia depends on the age of the person, the presence of other pathologies, the weight of his body, the degree of nervous excitement. Children, the elderly and pregnant women are usually operated under general anesthesia.
Surgical intervention is carried out in one of the following ways:
- Classic.
- Laparoscopic.
The algorithm for performing a standard operation for acute appendicitis includes the following steps:
- Providing access to the process. The surgeon makes an incision in the right iliac region with a scalpel. After dissection of the skin and adipose tissue, the doctor enters the abdominal cavity. Then he finds out if there are obstacles in the form of adhesions. Loose adhesions are separated with fingers, dense ones are cut with a scalpel.
- Bringing out the necessary part of the caecum. The doctor removes it by gently pulling on the wall of the organ.
- Removing the appendix. The doctor performs ligation of blood vessels. Then a clamp is applied to the base of the appendix, after which the appendix is sutured and removed. The stump obtained after cutting off is immersed in the intestine. The final stage of removal is suturing. These steps can also be performed in reverse order. The choice of technique depends on the localization of the appendix.
- Wound closure. It is done in layers. In most cases, the surgeon closes the wound tightly. Drainage is indicated only in cases where the inflammatory process has spread to nearby tissues or purulent contents are found in the abdominal cavity.
A more gentle method of appendectomy is laparoscopic. It is less traumatic and easier to tolerate by patients with severe diseases of the internal organs. Laparoscopy is not performed at the late stage of acute appendicitis, with peritonitis and some pathologies. This is due to the fact that using this method it is impossible to fully examine the abdominal cavity and carry out a thoroughrehabilitation.
Laparoscopic surgery is performed as follows:
- The surgeon makes a 2-3 cm long incision in the navel. Carbon dioxide enters the hole (this is necessary to improve visibility), and a laparoscope is inserted into it. The doctor examines the abdominal cavity. If there is even the slightest suspicion about the safety of this method, the specialist removes the instrument and proceeds to a classic appendectomy.
- The doctor makes 2 more incisions - in the right hypochondrium and in the pubic area. Tools are inserted into the resulting holes. With their help, the doctor captures the appendix, bandages the blood vessels, excised the process and removes it from the abdominal cavity.
- The surgeon performs sanitation, if necessary, installs a drainage system. The final step is suturing the incisions.
If there are no complications, the patient is taken to the ward. Otherwise, he is transferred to the intensive care unit.
Possible Complications
In the first 24 hours after surgery, the patient is worried about pain, and body temperature may rise. These are normal conditions that are the result of surgical treatment of acute appendicitis. A feature of pain is its localization exclusively in the area of tissue dissection. If it is felt elsewhere, medical attention is required.
In any case, after an appendectomy, doctors constantly monitor the patient's condition. This is due to the frequent occurrence of various complications. Acute appendicitis is a pathology in which exudate can form in the focusinflammation, as a result of which the risk of suppuration in the area of tissue dissection increases. According to statistics, it occurs in every fifth patient.
In addition, the following complications may develop after an appendectomy:
- peritonitis;
- seam divergence;
- abdominal bleeding;
- adhesive disease;
- thromboembolism;
- abscess;
- sepsis.
To reduce the risk of negative consequences, you must follow the doctor's recommendations and contact him immediately if warning signs appear.
Features of the postoperative period
Patient care is carried out in accordance with a special document - clinical guidelines. Acute appendicitis is a pathology, after surgical treatment of which the patient must be in the hospital for 2 to 4 days. The average length of stay may be increased for complicated forms of the disease.
The recovery period is individual for each person. Young patients return to their usual way of life after about 1.5-2 weeks, for children and the elderly, this period increases to 1 month.
The first day after an appendectomy is considered the most important. During this period, the patient is forbidden to eat and drink liquids in large quantities. It is allowed to offer him every half an hour 2-3 teaspoons of still mineral water. During this period, bed rest must be strictly observed. After 24 hours, the attending physician decides whetherwhether the patient can get up and move around independently.
During the patient's stay in the hospital, no special treatment is required, all efforts are aimed at restoring the body after surgery. If there are no complications, the patient is discharged after a few days.
During the rehabilitation period, each person must observe the following rules:
- In the first 7 days after the appendectomy, it is necessary to wear a bandage. For the next few months, it must be worn during any physical activity.
- Stay outside every day.
- Do not lift heavy objects for the first 3 months after surgery.
- Do not engage in high-intensity exercise, do not swim until a scar forms.
- Avoid sexual intercourse for the first 2 weeks after surgery.
Just because high-intensity exercise is banned for several months, it doesn't mean that the patient should lead a sedentary lifestyle during the recovery period. Physical inactivity is no less dangerous - against its background, constipation, congestion develop, and muscle tissue atrophies. 2-3 days after the operation, light exercises should be performed regularly.
Features of food
Mode and diet must be adjusted after the treatment of acute appendicitis. In the postoperative period, diet plays an important role. Patients after appendectomy are assigned table No. 5.
Basic principles of this diet:
- You need to eat 5-6 times a day, but in small portions(max. 200 g).
- The first 3 days the consistency of food should be puree. In the same period, it is necessary to exclude products that increase gas formation.
- It is forbidden to eat too cold or hot food.
- The basis of the menu should be boiled or steamed foods. It is necessary to drink enough fluids (water without gas, fruit drinks, compotes, herbal tea).
You can return to your usual routine and diet 2 months after the operation. The transition process should be gradual.
What to do if you suspect an attack
If certain rules of behavior are not observed, the risk of developing complications of acute appendicitis increases. To reduce the likelihood of their occurrence, you must immediately call an ambulance.
Before she arrives, you need:
- Put the patient to bed, he is allowed to take any position in which the severity of pain becomes less.
- Apply a cold heating pad to the affected area. This will help slow down the development of the inflammatory process. It is forbidden to warm the diseased area, this leads to a rupture of the appendix.
- Offer some water every half hour.
Simultaneously with the implementation of the above activities, it is necessary to collect things that the patient will need in the hospital. It is not recommended to give a person painkillers - they distort the clinical picture.
In closing
Inflammation of the appendix of the caecum is currently not arare. In surgery, acute appendicitis is divided into several forms, each of which has a specific symptomatology. If you suspect inflammation of the appendix, it is recommended to call an ambulance team. Timely surgical intervention significantly reduces the risk of developing various complications. In the ICD, acute appendicitis has the code K35.
