Appendicitis: signs, symptoms and treatment

Appendicitis is an inflammation of the appendix of the cecum. Today, this disease occurs most often among all surgical pathologies.

Appendicitis can develop at any age, more often at 10-19 years. However, in recent years, cases of the disease in people aged 30 to 69 years have become more frequent. Men get sick more often than women.

Classically, the appendix is ​​located on the right, in the iliac region (located between the lower ribs and the pelvic bones, similar to a depression).

But sometimes the appendix can be located elsewhere. This is not some kind of pathology, these are the characteristics of the body. There are the following options for the location of the appendix:

• pelvic or descending. Occurs in 45% of cases;
• lateral or ascending - 20%;
• medial or in the navel - 20%;
• front -5%;
• intraperitoneal - 5%.

It is important to remember about different options for the location of the appendix, since in these cases the symptoms of the disease will differ slightly from the classic course of appendicitis.

The length of the process is about 8 cm. The mucous membrane of the appendix contains many lymph nodes. Their number reaches a maximum by the age of 17, and as they age, their number decreases.

These lymph nodes provide immune defense. In addition, the appendix is ​​involved in digestion, secreting alkaline juice, and in stimulating intestinal motility by releasing hormones.

But the removal of the appendix does not affect the body in any way.

Classification of the disease

Downstream, appendicitis is divided into:

• simple (catarrhal). In this case, the inflammatory process is localized only in the mucous membrane of the appendix;
• phlegmonous - inflammation spreads to all walls of the appendix. He is swollen, there is pus in his lumen. Such changes are formed after 6-24 hours from the onset of the development of pathology;
• gangrenous - purulent inflammation that captures all layers of the appendix and extends beyond it into the abdominal cavity. Time of formation of gangrenous appendicitis - from 1 to 3 days;
• perforated - violation of the integrity of the wall of the appendix. Purulent contents enter the abdominal cavity, inflammation of the peritoneum (peritonitis) occurs. This phenomenon is life threatening;
• complicated by appendicular infiltration, appendicular abscess, peritonitis (inflammation of the peritoneum), sepsis, purulent inflammation of the intestine.

Causes

Why does appendicitis occur? At the moment there is no exact answer to this question.

The main cause of the disease is considered to be a violation of the movement of food from the appendix. The exit from the appendix can be blocked by stones, parasites, food, lymph nodes, and a tumor.

And since the appendix continues to produce mucus, the pressure in the appendix rises, an inflammatory process occurs. In addition, bacteria contribute to the appearance of appendicitis: Escherichia, streptococci, bacteroids, lactobacilli.

In elderly patients, the disease can develop due to a blood clot in an artery that supplies the appendix.

Improper diet can also cause appendicitis. So, with a lack of fibers that a person receives with vegetables and fruits, there is a violation of the movement of feces through the intestines.

The feces are compacted, stones are formed that block the exit from the appendix.

Frequent constipation leads to a violation of the movement of food through the intestines and its entry into the appendix.

Allergic reactions in the appendix. Since the appendix is ​​an immune organ due to the presence of lymphoid tissue, allergic reactions can develop in it.

Symptoms

How to understand that you have appendicitis? It is possible to independently determine the disease only if the appendix is ​​located classically: in the right iliac region.

Then the patient has the following symptoms of the disease:

• pain. She appears more often at night, in the midst of full health. Sometimes it can occur in the afternoon or late afternoon. First, soreness occurs in the epigastrium (in the navel and 2-3 cm above it), less often in the left half of the abdomen. After a while, the pain moves to the right iliac region. The pain syndrome is constant and can be of varying intensity (weak, strong, moderate). However, unbearable pain is not typical for appendicitis.
  With atypical locations of the appendix, soreness can be observed in the right hypochondrium, in the groin, in the lower back on the right;
• nausea and vomiting, and the latter does not bring relief. Vomiting may occur 1.2 or 3 times. Vomiting more than three times, usually, with appendicitis in adults, does not occur. In children, repeated vomiting is possible;
• diarrhea or constipation - appear rarely, in only 10% of cases;
• in adults, the temperature rises to 37-38.5 ° C, in children, the numbers may be higher;
• if in the first hours of the development of the patient's pathology they do not operate, then the pain syndrome increases, the abdomen becomes hard on palpation (probing) and swollen. The heart rate accelerates, the tongue becomes dry, vomiting is repeated;
• with a retrocecal arrangement of the appendix, the pain is first localized in the epigastrium, and later in the lower back on the right. Nausea and vomiting are rare. The disease can begin with two to three times loose stools, mixed with mucus. The pain can "give" to the genitals, right leg. Temperature above 38.5 ° C;
• with a pelvic appendix, soreness first appears in the epigastrium, then above the bosom. As with the classic version, a single vomiting may occur. Urination becomes more frequent and painful. False urge to defecate appears. The stool becomes thin with mucus. The temperature does not rise to high numbers. On palpation, pain is detected above the pubis and in the groin-iliac region. The abdomen is not tense. In the urine, protein and red blood cells can be detected;
• with a laterally located process, pain first occurs in the epigastrium, then moves to the right hypochondrium. Nausea and single vomiting are characteristic;
• with the medial location of the appendix, the patient complains of severe pain throughout the abdomen, the abdominal wall is tense and swollen, and frequent diarrhea may join.

The listed symptoms are not all the features characteristic of appendicitis. It is important to know that in the elderly, children and pregnant women, inflammation of the appendix proceeds differently. Let's talk about these features.

Features of appendicitis in old age

In elderly people, the appendix becomes inflamed extremely rarely, since, in most cases, it ceases to function or its lumen completely disappears.

Since the pain threshold rises in old people, the pain is less intense, it is impossible to establish exactly where it is localized. The abdomen is practically not tense.

There may be slight tension in the right iliac region. There is no temperature, as well as nausea with vomiting.

The symptoms of other chronic diseases that an elderly person has (diabetes mellitus, heart failure, hypertension, etc.) come to the fore.

Due to these features of the course of the disease, the elderly often experience diagnostic errors, and the diagnosis is not made on time.

Features of appendicitis in childhood

In children, the lymph nodes in the appendix are still poorly developed, so the clinical picture of the disease is different.

It is important to understand that the younger the child, the more severe the appendicitis proceeds and the greater the likelihood of rupture of the appendix and the outpouring of its contents into the abdominal cavity.

In children, soreness is observed throughout the abdomen, but the abdominal wall is more tense on the right. The temperature is high: 38 ° C and more. Characterized by repeated vomiting, diarrhea.

The child does not sleep well, is restless. If he is lying, then a characteristic posture indicates appendicitis: on the back or on the right side, the legs are brought to the stomach, the child's hands are on the right iliac region.

Features of appendicitis in pregnant women

Appendicitis in pregnant women is rare. More often the appendix becomes inflamed in the first half of pregnancy, while appendicitis proceeds classically.

In the second half of pregnancy, soreness is also first localized in the epigastrium, then shifts to the right. But the pain is mild, women do not attach importance to it and, like vomiting, is associated with pregnancy.

The abdomen is weakly tense. The tension is detected above the right iliac region. If the pregnant woman is late, the muscles of the peritoneum may not be tense at all.

Appendicitis for pregnant women is a dangerous disease that can lead to fetal death. Therefore, such women are immediately hospitalized and under the supervision of a gynecologist and surgeon.

What diseases does appendicitis look like?

The described symptoms can also be observed with other pathologies:

• peptic ulcer of the stomach and duodenum;
• intestinal obstruction;
• acute pancreatitis;
• acute cholecystitis;
• pyelonephritis;
• renal colic;
• cystitis;
• urolithiasis disease;
• ectopic pregnancy;
• ovarian rupture;
• inflammation of the fallopian tubes;
• torsion of the ovarian cyst;
• lower lobe pneumonia on the right;
• myocardial infarction;
• ascoridosis;
• inflammation of the myocardium (myocarditis)

Only a doctor can make a differential diagnosis of appendicitis with the listed pathologies. Therefore, if you experience any abdominal pain, you should consult a specialist.

Which doctor to contact

When the above symptoms appear, in no case should you wait! You should immediately call an ambulance and be examined in a surgical hospital.

After all, only a surgeon can determine exactly what caused the pain in the abdomen.

It is the surgeon who will prescribe the necessary examination, and if in doubt, he will conduct diagnostic laparoscopy. Women may need to consult a gynecologist.

Diagnostics

How is appendicitis diagnosed? To do this, you need to undergo a comprehensive diagnosis. Inflammation of the appendix can be detected using laboratory and instrumental research methods.

Laboratory methods:

• complete blood count - an increase in the number of leukocytes and ESR;
• general urine analysis - there are no changes. But this study is necessary for the differential diagnosis with diseases of the genitourinary sphere;
• the study of inflammatory effusion from the abdominal cavity is performed after the operative removal of the appendix. It is necessary in order to determine with what antibacterial drugs the patient's treatment should be continued;
• morphological examination of the appendix - also performed after surgery. Allows you to confirm the diagnosis.

Instrumental research methods:

• computed tomography of the abdominal organs - allows with a high degree of probability to diagnose appendicitis. But this study is not carried out in pregnant women and young people due to high radiation exposure;
• Ultrasound or MRI of the abdominal organs - these methods are used in case of contraindications to computed tomography. However, they more often give the wrong answer about the presence of appendicitis;
• diagnostic laparoscopy - under general anesthesia, a patient is made three small punctures in the abdominal cavity, into which instruments and a laparoscope with a camera are placed. On the screen, the doctor sees the patient's abdominal cavity. The surgeon finds the appendix and assesses its viability. If necessary, the appendix is ​​removed immediately. Removal is carried out if the appendix is ​​thickened, red or purple in color, there are white overlays on it, or perforation is traced (violation of integrity).

Complications of appendicitis

Why is appendicitis dangerous? Inflammation of the appendix can lead to complications of varying severity. And so that they do not arise, you need to diagnose and treat inflammation of the appendix in time.

Complications of appendicitis:

• appendicular infiltration is an inflammatory process that covers the appendix and nearby organs. It is formed in 2-3 days if the inflamed appendix was not removed in a timely manner. The patient complains of weakness, temperature, slight pain in the right iliac region. On palpation, you can find a tumor-like formation on the right. If the course is favorable, then within three weeks the soreness stops, the temperature decreases, the tumor-like formation dissolves. After three months, the appendix is ​​removed to avoid relapse;
• appendicular abscess - occurs with suppuration of the appendicular infiltrate. The temperature becomes high, constant, the patient's condition deteriorates sharply. The patient complains of night sweats, pain in the right iliac region. Leukocytes and ESR are increased;
• in the postoperative period, there are complications such as hematomas (bruises), suppuration, bleeding. In the abdominal cavity, abscesses, fistulas in the intestines, adhesions, inflammation of the peritoneum (peritonitis) are possible. Less commonly, there is pneumonia, sepsis, heart failure, thrombosis. In the late postoperative period, hernias and scars are possible.

Treatment

Treatment of simple acute appendicitis is operative. Treatment of complicated forms depends on the type of complication.

Conservative treatment

Drug treatment for inflammation of the appendix is ​​possible only with the development of an appendicular infiltrate and a dense infiltrate.

In these cases, the patient is prescribed bed rest, antibiotic therapy, diet and cold on the stomach.

After the acute period has passed, they switch to setting heating pads and prescribe physiotherapy. The appendix is ​​removed 3 months after the appendicular infiltrate has been removed.

Surgery

With appendicitis, surgical removal of the appendix is ​​indicated. However, the operation is not permitted in all cases. There are also contraindications to the surgical treatment of appendicitis:

• appendicular infiltrate;
• dense infiltration that cannot be divided during surgery;
• appendicular abscess - suppurative infiltration. It is removed by drainage through the abdominal cavity;
• infectious shock.

The main method for removing the appendix is ​​laparoscopic appendectomy. Under general anesthesia, three small punctures are made in the patient's abdomen.

Instruments and a laparoscope with a video camera are inserted into them. Then the abdominal cavity is inflated with a small amount of gas so that all organs are clearly visible.

The surgeon locates the appendix, assesses its viability, and, if necessary, removes it. The vessels are cauterized, gas is released, the holes in the abdomen are sutured.

This method of treatment allows the patient to go home in three days. Virtually no cosmetic defect remains.

But with the development of peritonitis, sepsis, pregnancy, the removal of appendicitis is performed in an open way.

At the same time, the duration of rehabilitation increases, the patient can leave the hospital only after a week. Also, with an open method of removing the appendix, the likelihood of complications increases.

Rehabilitation

Within a month after the surgical treatment of appendicitis, it is recommended to eat as many vegetables and fruits as possible.

Fatty, fried foods, pickles, pickles, smoked meats should be excluded from the diet. Avoid drinking alcoholic and carbonated drinks, strong tea and coffee.

Physical activity should also be limited for at least three weeks after surgery.

Conclusion

Appendicitis is an inflammation of the appendix. The disease can occur at any age, more often at 10-19 years. The incidence is higher in men.

The cause of appendicitis can be blockage of the lumen of the appendix with stones, parasites, food, and a tumor. Possibly a violation of blood supply due to thrombosis.

The appearance of the disease is influenced by constipation, unhealthy diet, allergic reactions. The symptoms of appendicitis depend on the location of the appendix.

Almost always there is epigastric pain, which moves to the right iliac region. Characterized by nausea, one- or three-time vomiting, fever, diarrhea, or constipation.

In some cases, pain appears above the bosom or in the right hypochondrium, frequent urination, diarrhea mixed with mucus. In older people, the clinic is smoothed, pain and tension of the abdominal muscles are weak.

In children, vomiting, diarrhea and high fever prevail. In pregnant women, soreness and muscle tension are mild; a woman's vomiting is usually attributed to pregnancy.

Appendicitis is dangerous for pregnancy, as a miscarriage or death of the fetus is possible. Diagnosis of the disease is based on laboratory and instrumental methods.

From laboratory methods, a general analysis of blood and urine, a study of an abdominal effusion, a morphological study of the appendix are used.

But more important are diagnostic laparoscopy, CT, MRI and ultrasound of the abdominal organs. Treatment of acute uncomplicated appendicitis is only operative.

Appendicitis complicated by loose or dense infiltration is treated conservatively. After laparoscopic appendectomy, the patient is discharged home on the third day.

During the rehabilitation period, a diet and limitation of physical activity for a month is recommended. After conservative treatment of the infiltrate, a planned appendectomy is performed in 3 months.

Appendicitis is a serious illness that requires immediate diagnosis and treatment.

Therefore, if any of the symptoms described here appear, you must urgently call an ambulance, or contact a surgeon, and for women - a gynecologist and surgeon.