Appendicitis (appendicitis) is an inflammatory process of a small appendix of the caecum, called the appendix. The word "appendix" in Latin means "appendage", and the ending "itis" indicates inflammation.
According to statistics, among all surgical diseases, appendicitis occupies approximately 89% of cases in terms of prevalence and is in first place. It is more common in people of young working age from 18 to 35 years. The prevalence of this disease in women is 2 times higher than in men.
Classification
Appendicitis can occur in 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-ulcerative;
- apostematic;
- gangrenous.
Chronic appendicitis is also divided into several forms. Hemaybe:
- residual;
- primary-chronic;
- recurrent.
All these forms of chronic appendicitis are distinguished by sclerotic and atrophic processes occurring in the appendix. There may be proliferation of granulation tissue in the walls of the appendix and its lumen, the formation of adhesions between the surrounding serous membranes. In the case of accumulation of serous fluid in the lumen of the appendix, a cyst is formed.
Appendicitis in children and adults: causes, symptoms and treatment
Very often, the patient pays attention to abdominal pain not immediately, but after several hours or even days. This is due to the fact that the first signs of appendicitis in adults develop gradually and are uncertain. Difficulties arise with the definition of a specific area of localization of pain. When taking painkillers, the pain may completely subside 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 single vomiting.
- Increase in body temperature to subfebrile.
If similar symptoms (signs) of appendicitis in adults appear, then you should not hope that everything will resolve itself. You need to call an ambulance. An experienced team of doctors can easily identify such a dangerous disease that requires immediatehospitalizations like appendicitis. Signs in adults, as already mentioned, can 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 hard with two fingers (middle and index), while pain should not be felt. Then the fingers are removed, and the pain increases dramatically. If such a test turned out to be positive, i.e. everything turns out as described, in addition, there may be nausea, and in some cases vomiting, then most likely these are the first signs of appendicitis in adults. Now let's describe them in more detail.
Symptomatics
When diagnosed with appendicitis, the signs in adults may be somewhat blurred, but still they boil down to the following:
- First, there is pain in the abdomen, which is not clearly localized. It can manifest itself in the navel, epigastrium, or be blurred (throughout the abdomen). The pain is constant, sometimes it can be cramping. After an hour or a little more, it concentrates in the lower abdomen on the right. This symptom of the movement of pain is called Kocher-Volchkov. Irradiation of pain is usually not observed. This is possible only with an atypical location of the appendix. In this case, the pain may radiate to the groin or lumbar region.
- Sick people usually have no appetite. This symptom is called anorexia.
- Following the pain, nausea develops, and there may be a single vomiting. These signs of appendicitis in adults arereflex character and develop due to irritation of the peritoneum.
- Subfebrile temperature may rise, but this does not always happen. Signs of acute appendicitis in adults such as fever, vomiting, and anorexia are called Murphy's sign.
When such signs appear in a patient, acute appendicitis can be suspected. Sometimes these main symptoms of appendicitis in adults are accompanied by frequent urination, stool disorders (diarrhea), rapid pulse and, in rare cases, increased pressure. Other uncharacteristic symptoms of this disease can be observed in the elderly, children and pregnant women, as well as in the atypical location of the appendix of the caecum. 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 diagnosing appendicitis in women
The representatives of the beautiful half of humanity are more likely to make an error in diagnosing this disease than men. This is due to the fact that the sensations during the development of this disease can be confused with pain during menstruation or a pain reaction when an inflammatory process occurs in the gynecological region of the pelvic organs. This error can occur with an atypical location of the appendix.
To clarify the final diagnosis in a medical institution, a woman, in addition to a surgeon, should also be examined by a gynecologist. A distinctive symptom of inflammation of the appendix from pathologygynecological is the fact that in the latter case, vomiting, nausea and stool disorder are not typical.
Symptoms of appendicitis in pregnancy
Signs of appendicitis in adult women are the same as in men. The exception is pregnant women. According to statistics, the incidence of appendicitis during pregnancy is about 5%. A representative of the beautiful half of humanity, who is preparing to become a mother, with this disease, an atypical form can be observed (in case of displacement of the appendix).
Diagnosis of appendicitis during pregnancy is usually straightforward. The symptoms are the same as in other adults. Difficulties may arise in the last trimester of pregnancy if the nature of the pain is cramping. Patients, as a rule, take a forced position of the body lying on their back with legs bent at the knees and pulled up to the stomach. The pain is localized most often on the right in the iliac region, but in late pregnancy it may appear higher. Also, in the last months of pregnancy, the surgical treatment of appendicitis and the postoperative period of rehabilitation cause concern. Therefore, it is extremely important to make a correct diagnosis.
Causes of appendicitis during pregnancy
This ailment occurs due to the fact that during the period of bearing a baby, a greatly enlarged uterus can affect the caecum and change its position. Also, the appendix can be infringed by an enlarged uterus, as a result of which it is disturbedblood supply. This sometimes leads to an inflammatory and even gangrenous process. The cause of appendicitis in pregnant women is also a change in hormonal levels. During the bearing of a child, women often experience stool disorders, namely constipation, which can also provoke this pathology.
How dangerous is appendicitis during pregnancy?
Obviously, any surgical intervention, especially when carried out in the abdominal cavity of a pregnant woman, can cause miscarriage or premature birth. But besides that, 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 childbirth;
- development of bleeding in the postpartum period.
Thus, we have considered all the possible symptoms of appendicitis and signs of the disease in adults. Now let's pay attention to the features of the development of this disease in children.
Appendicitis symptoms in older children
Symptoms in older children are similar to those in adults. We can only add that such patients often occupy a forced position of the body, in which the intensity of pain decreases. They lie on the back or right side. In addition, the temperature rises to 38 degrees and even higher. The pulse does not match the parameters of the increase in body temperature and is very fast.
When examining the oral cavity, a wet tongue is noted, on which there is a white coating. A dry tongue is a bad sign. This may indicate the development of a gangrenous course of the disease and peritonitis. In children of this age, stool retention may occur with this disease.
Symptoms of appendicitis in young children
In babies, signs of the disease in question can be suspected in the following cases:
- Baby is crying and won't allow examination.
- The baby pulls the right leg to the stomach and curls up.
- Temperature in small patients diagnosed with appendicitis often rises above 38 degrees, can reach 40.
- Pulse is fast and consistent with elevated temperature.
- Loose, frequent stools.
- Urination can be painful and frequent. When urinating, the baby cries.
- Young children may vomit repeatedly.
- The child is restless, refuses to eat, cannot sleep, constantly asks for water.
What are the signs of appendicitis in adults and children, we now know. Consider the possible dangerous consequences of this disease.
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 location;
- thrombophlebitis of the pelvic or iliac veins, thiscan cause a very serious condition - PE;
- peritonitis, in case of appendix rupture;
- formation of postoperative infiltrate;
- development of adhesive process in the postoperative period, which can provoke intestinal obstruction.
Treatment
If there are signs of inflammation of appendicitis in adults or children, then it is shown to do an appendectomy as soon as possible, i.e. removal of the appendix to avoid severe complications of this disease. This operation is carried out on an emergency basis - no later than an hour from the moment an accurate diagnosis was made.
At the stage of first aid, bed rest is recommended. It is strictly forbidden to take any food and drink. Do not take painkillers, laxatives and other drugs until the final diagnosis is clarified, 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 an appendectomy is performed. This operation for uncomplicated course is done by laparoscopic method.
After that, the patient is transferred to the intensive care unit for several hours, where he is under the constant supervision of medical personnel. After the patient finally recovers from anesthesia, he is transferred to the surgical department. On the 5th day, stitches are usually removed and the patient is transferred to outpatient treatment.
In the complicated course of this disease, the patientremains in the clinic, and his discharge will be postponed until the undesirable consequences are eliminated and his general condition stabilizes.
Forecast
With an uncomplicated course of the disease and a timely and competently performed operation, appendicitis does not pose a threat to life. Full working capacity of the patient is restored after 4 weeks.
The causes of complications in appendicitis, as a rule, are untimely hospitalization and late surgery. In especially severe cases, this can even lead to death.
