Inflammation of the appendix is a disease that many of us know only by hearsay. Among the symptoms that everyone hears is acute pain in the abdomen. However, the symptoms of the disease are not limited to pain alone. And in cases where appendicitis occurs in an elderly person, there may be practically no pain. It is very important to pay attention to other symptoms of appendicitis in yourself or a loved one in time and immediately consult a doctor and provide timely qualified assistance. Appendicitis, the diagnosis of which includes a number of studies, can lead to peritonitis, which, in turn, can be fatal.
Causes of Appendicitis
Doctors don't know exactly why some people get inflamed appendix. However, there is an opinion that problems with the intestines, fecal stones, helminthic invasions, constipation, pregnancy and anomalies in the development of the process become the impetus for the development of the disease. Wrongnutrition can also provoke inflammation of the process of the caecum. No wonder we were told as children that dirty seeds could lead to appendicitis surgery.
In any case, it is impossible to protect yourself from appendicitis. With a formidable diagnosis, both newborn babies, pensioners and he althy young people get to the hospital. Appendicitis, the diagnosis of which is to differentiate the disease from a number of other he alth problems, requires immediate surgical intervention.
Stages in the development of appendicitis
Inflammation of the appendix has its beginning and logical conclusion. Acute appendicitis, the diagnosis of which includes a number of measures to identify the problem and differentiate the disease, goes through several stages, each of which smoothly passes into the next. This is:
- Appendicitis catarrhal. At this stage, the inflammatory process affects only the appendix.
- The superficial stage is characterized by progressive inflammation with primary damage to the mucosa. During this period, leukocytes and blood are found in the lumen of the process.
- At the phlegmonous stage, the entire appendix becomes inflamed, including the outer shell of the process.
- Phlegmonous-ulcerative stage is characterized by the appearance of ulcers on the mucous membrane of the appendix.
- The last stage is gangrenous, characterized by necrosis of the walls of the process and a breakthrough of its contents into the peritoneal cavity.
Given that only two to four days pass from the onset of inflammation to the stage of peritonitis, thenyou should consult a doctor who will apply all methods for diagnosing appendicitis when the first symptoms of the disease are detected.
Common symptoms of acute appendicitis in adults
Like any other disease, inflammation of the process of the caecum has its own symptoms. The general symptoms of acute appendicitis depend on the stage of inflammation, the location of the process, and even the age of the patient. At the first stage of development of acute appendicitis, nausea, single or repeated vomiting occurs, which, unlike food poisoning, does not bring any relief. The person begins to complain of severe weakness and feeling unwell, loss of appetite and some problems with defecation. Diagnosis of appendicitis in adults at this stage is almost impossible, since such disorders are characteristic of a number of acute and chronic diseases.
The next stage is a coated tongue, first wet, later dry. The patient's temperature rises to 38 degrees, and the rectal temperature is higher than body temperature not by 1, but by several degrees. The pelvic location of the process leads to loose stools; the appendix, located in close proximity to the bladder, causes urination disorders. Loss of appetite, including anorexia, is noted in 90% of cases of inflammation of the process of the caecum. If the patient continues to eat normally, then, most likely, a differential diagnosis of acute appendicitis is necessary, which will allow us to detect another disease with a similarsymptoms.
Local symptoms
Given that the general symptoms are characteristic of a number of other diseases, it is very difficult to make an accurate diagnosis in the first hours. However, after 4 hours, local symptoms join the general symptoms, which make it possible to differentiate the inflammation of the appendix and provide the necessary medical assistance to the patient. This is:
- Aching dull pain. Moreover, the pain becomes noticeable before the development of general symptoms. It is localized either throughout the abdomen, or in the umbilical or right iliac region. With the pelvic location of the process, pain occurs above the bosom, and in the prehepatic - in the hypochondrium. But more often, doctors are faced with the so-called Kocher's symptom, when pain in a few hours from the epigastric region moves to the right iliac region.
- Gradually the pain progresses and from aching it becomes acute, sometimes giving to the genital area, lower back or right thigh. Particularly vividly, patients feel discomfort during movement or coughing. Often, doctors ask the patient to cough in order to accurately determine the nature and location of the pain.
- Pain abruptly receded? This is also one of the symptoms of the disease, reporting the necrosis of nerve cells in the process. Moreover, the symptom is truly formidable, preceding the deterioration of the patient's condition and peritonitis.
- The tension of the muscles of the abdominal wall also indicates peritonitis (in the case of a retrocecal location of the process, the muscles of the lower back tense). When the abdomen is touched, the muscles reflexively contract, demonstrating thatinflammation reached the visceral peritoneum.
- There is hypertension of the skin in the right iliac region.
- The muscles of the right side of the abdomen seem to lag behind when breathing, which indicates muscle tension.
- In thin patients, the navel slightly shifts to the right side.
- Diagnosis of appendicitis at home includes palpation. It is enough to press on the iliac region and abruptly tear off the brush - the pain will immediately increase.
- Rectal examination for appendicitis reveals rectal tenderness. More precisely, its front wall.
Additional home diagnostic methods
To identify pathological reflexes and differentiate the disease, the following methods are also used:
- Dubois symptom - pain when pressing on the occipital points of the vagus nerve.
- Moskovsky's symptom - dilated right pupil.
- There are also points in the abdomen, pressing which causes an attack of pain in appendicitis. But only a doctor knows their exact location, so you should wait for the ambulance to arrive.
Appendicitis in children
The difficulty in diagnosing appendicitis in children is that due to their age they cannot tell about their feelings. Moreover, the younger the child, the faster the disease progresses. Almost all the symptoms of childhood appendicitis are common, which is why it is necessary to consult a specialist for any of them. First, the child changes hishabitual behavior, ceases to actively move, becomes lethargic and apathetic. Later, other symptoms appear to differentiate the disease.
Newborn babies refuse to breast or bottle, the fontanel sinks, the tongue becomes dry. There is necessarily a strong tension in the iliac right region. Diagnosis of acute appendicitis in children is to monitor the position of the child. Babies usually lie on their right side with their knees bent. Older children can sit leaning forward.
When the doctor palpates the right iliac region, the child instinctively pulls the right leg to the stomach and pushes the doctor's hand away from him. Diagnosis of appendicitis in children of preschool and school age always includes the question "where exactly does it hurt?". Traditionally, the child points to the navel. With the course of the disease, the pain can move to the area where the inflamed process is located. Lethargy, nausea, vomiting, constipation preceding pain, tachycardia, and fever are also symptoms of appendix inflammation.
Acute appendicitis in expectant mothers
Pregnant women are not immune from such an unpleasant disease as appendicitis. Diagnosis is complicated by the fact that general symptoms, such as abdominal pain, nausea and vomiting, are characteristic of toxicosis in the initial stages of pregnancy. With the growth of the uterus, it becomes more difficult to determine the development of symptoms of the disease. Some methods for diagnosing acute appendicitis in the second and thirdtrimesters may not give results. For example, the symptoms of peritoneal irritation are not determined, the pains are not localized in the right iliac region, but above, palpation is ineffective due to the growing uterus covering the process. Because of this, aching, dull or cramping pain can be mistaken for symptoms of an impending miscarriage.
Given the difficulty in diagnosing appendicitis in pregnant women, you should immediately go to a hospital examination and pass all the necessary tests to accurately determine the nature of the problem without harming either the expectant mother or her baby. Suspicion of appendicitis? Differential diagnosis will help to verify the correctness of the diagnosis or refute it. Modern medicine allows you to remove the appendix during pregnancy without harm to he alth. The main condition for success is timely diagnosis and prevention of complications, such as peritonitis. Unfortunately, in the case of phlegmonous or gangrenous appendicitis, a caesarean section is required. Only after that it is possible to remove the appendix, clean the abdominal cavity and save the woman.
Appendicitis in old age
Appendicitis, which occurs in older people, is the most dangerous. This is due to the erasure of almost all the symptoms of the disease. The pain syndrome is mild, there are practically no dysuric and dyspeptic disorders, the temperature remains normal. Do not note in older people and tachycardia, an increase in ESR and leukocytosis, characteristic of attacks of acute appendicitis. because ofage-related flabbiness of the abdominal wall does not appear and a protective reaction from the abdominal muscles. That is why older patients should respond as clearly as possible to any changes in their condition. At the slightest suspicion of inflammation of the appendix, it is necessary to call a doctor who can conduct a complete examination of the patient.
Complications of appendicitis
The acute form of the disease can lead to the destruction of the appendix or its spontaneous amputation. In this case, purulent masses go beyond the process, which leads to local or diffuse inflammation of the peritoneum. With the phlegmous form, the development of empyema, a purulent lesion that spreads to the peritoneum, rectum and neighboring tissues, is possible. This forms purulent foci that reach fatty tissue.
Thrombophlebitis of the appendix threatens with no less serious consequences, provoking the development of septic thrombophlebitis of the portal vein and branches. This leads to blockage of the liver veins and the development of purulent specific inflammations. Considering such complications, the treatment of appendicitis must be started immediately, without postponing "tomorrow" and not hoping for "maybe it will pass."
Chronic appendicitis
There is such a thing as chronic, not acute appendicitis. The clinic, diagnosis and treatment of the disease differ from the picture of acute inflammation of the appendix. In fact, the chronic form is a consequence of acute inflammation. In the appendix, dystrophic and sclerotic processes occur, accompanied by tissue destruction. Inflammations arise and heal, forming scars and adhesions, ulcers and infiltrates may appear. In some cases, chronic appendicitis leads to the fact that the process is transformed into a cyst, the breakthrough of which is no less dangerous than the breakthrough of the appendix itself. It is worth noting that the chronic form is an extremely rare phenomenon, observed in only 1 out of 100 cases. Do you suspect you have chronic appendicitis? Diagnosis, treatment and subsequent medical support takes place in a hospital.
Diagnosis
Diagnosis of appendicitis at home should be as accurate as possible, since a mistake and subsequent medication, for example, from poisoning, can lead to sad consequences. This will not only complicate the diagnosis, but also worsen the patient's condition. Appendicitis, the differential diagnosis of which is to some extent possible at home, does not tolerate self-treatment. Before the arrival of doctors, you can not take any medicine or apply a heating pad to the sore spot, trying to alleviate the discomfort. Such "care" for the patient can lead to premature peritonitis and other possible complications.
You were taken to the hospital with a preliminary diagnosis of appendicitis? Ultrasound diagnosis of appendicitis will allow you to differentiate the disease and take timely measures to get rid of the problem. Also, in the diagnosis, abdominal radiography, computed tomography, and irrigoscopy are used. After surgery, the morphological form of the disease is specified anda histological examination is underway.
Appendicitis treatment
Traditionally, an adnexa is removed by surgery. The most commonly used method is laparotomic appendectomy, in which the inflamed process is removed through a dissected section of the abdominal wall. With such an operation, due to small holes, there is practically no postoperative scarring, and the use of a telescopic tube makes it possible to make the surgical intervention as accurate as possible. The duration of the postoperative period is reduced, the possibility of adhesions and the development of a chronic form of the disease is minimized.
Antibacterial therapy after surgery is prescribed if there is an inflammatory effusion in the pelvis. In the catarrhal form, antibiotics are not used. The peculiar scar that remains after the operation makes it possible to accurately determine that the appendix has been removed, in the event of a hospital admission with similar symptoms in the foreseeable future. That is why, when performing other operations in the iliac region, the appendix is always removed, even if it is not inflamed, so as not to disorient the other specialist. Appendicitis, the diagnosis and treatment of which should be carried out as soon as possible, is a “one-time” disease. That is why in case of repeated symptoms, it is necessary to contact specialists who can identify a disease with similar symptoms.
