Traditional medicine

False appendicitis. Symptoms of appendicitis in adults

Appendix, lat. appendix vermiformis - vermiform appendix, 5-7 cm in length (sometimes 20 cm), 1 cm in diameter, blindly ending, tube-shaped.

Exacerbation of appendicitis can occur at any age. Risk groups include children over 5 years old, adults 20-30 years old, pregnant women. The pathology is equally characteristic of females and males. Very rarely, appendicitis occurs in young children, which is explained by the age-related anatomical feature of the appendix, which has the shape of a funnel and is easily emptied, and the poor development of the lymphoid apparatus of the appendix.

Among all diseases of the abdominal organs that require immediate surgical intervention, appendicitis is the most common. If an attack of acute appendicitis occurs, you need to call an ambulance as soon as possible. If appendicitis is not treated, peritonitis can develop, a complication that can be fatal.

How appendicitis manifests itself, the symptoms and signs of this emergency condition should be known to every person. 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 pinpoint the exact location of the pain (“the whole stomach hurts”). The pain then moves to the right side of the abdomen. This migration of pain is considered a very specific sign of the disease.

Causes of appendicitis

The following causes of inflammation of the appendix are identified:

The appendix is a small extension of the cecum. For most people, it is located on the right side of the abdomen, below the navel. The condition of the intestines can influence which side of a person’s appendicitis is on. If appendiceal peritonitis has developed, then the symptoms are pronounced and acute, the pain of appendicitis is localized, usually on the right side, this is characteristic of the development of an acute inflammatory process in the patient’s body, which requires emergency medical care and surgery to remove the appendix.

Appendicitis can be located in different ways in the peritoneal area, which gives an ambiguous picture in the localization of symptoms; pain can radiate to the right side and to the lumbar region, or to the pelvic area, the patient’s genitals. The nature of the pain varies in intensity, intensifying or subsiding, cramping, and 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. The signal for the onset of the disease is severe pain. At the very beginning, it does not have a relatively clear location. A person may feel like he just has a stomach ache. However, after 4-5 hours, the pain is concentrated closer to the right iliac region.

It is worth noting that the appendix can be located differently in different people, it all depends on the structure of the body. If the process is in a normal position, pain will be observed in the right iliac region. If the process is located slightly higher, then the pain will be on the right under the ribs. Well, if the appendage is lowered down, it will hurt in the pelvic area. Among other things, the patient may be bothered by vomiting and, in some cases, diarrhea.

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

Symptoms of appendicitis

In the case of acute appendicitis, the symptoms are pronounced. An attack of pain occurs in the right iliac region, expressed by a 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 after 1-2 days) - in the right iliac region. More often, the pain is constant, does not radiate anywhere, but intensifies when coughing. prevents the patient from falling asleep, but its intensity is usually low; characterized by a decrease in pain when lying on the right side.

In the first hours of the disease, nausea and vomiting may occur. Stool and gas are often retained. Liquid stools are observed much less frequently (mainly in cases of severe intoxication). Body temperature rises to 37.5-38°, less often remains normal. On the first day from the onset of the disease, the pulse increases to 90-100 beats per minute, blood pressure does not change and only decreases slightly in cases of severe intoxication. The tongue is initially slightly coated and moist, but soon becomes dry.

There are also other symptoms with appendicitis. For example, when examining the abdomen, a lag in breathing in the lower parts of the abdominal wall is often determined. Palpation of the abdomen should be carried out carefully, starting from the left half. In this case, in the right iliac region, as a rule, there is sharp pain, combined with protective tension of the abdominal wall muscles in a limited area. In most patients, light tapping with fingers in various parts of the abdominal wall helps to quickly determine the location of the greatest pain.

However, the symptoms and course of acute appendicitis are not always so characteristic. The clinical picture of the disease can be especially peculiar in children, elderly and senile people, as well as in cases of atypical location of the appendix. In any case, if symptoms similar to appendicitis occur, you should call an ambulance.

It occurs with a dull aching pain in the right iliac region, which can periodically intensify, especially with physical stress.

Signs of appendicitis in women

Women are more prone to inflammation of appendicitis than men, the symptoms of which appear more often at the age of twenty or forty years. This is due to the physiological structure of the female body, the pelvis, so it can proceed differently. They are especially different during pregnancy. Due to the fact that the appendix is located close to the right appendages of the uterus, signs of inflammation are twice as common as in the male population.

During palpation, women experience painful sensations, which indicates inflammation of the abdominal cavity.
If you press a point below a woman’s navel, pain may occur, which intensifies when standing up, which indicates the involvement of the reproductive organs in the inflammatory process.
When examining a woman’s vagina, pain is detected, especially when examining the cervix; with appendicitis, it indicates inflammation of the appendages.

When diagnosing and making a diagnosis, a woman is checked not only for the condition of the appendix, but for the condition of the genital organs as a whole.

Diagnostics

The diagnosis is made based on the characteristic symptoms of appendicitis. The diagnosis of “inflammatory signals” is confirmed by a general blood test. The most reliable method is laparoscopy.

Clarification of the morphological form of appendicitis (catarrhal, gangrenous, phlegmonous) is possible with surgical intervention: a histological examination of the removed appendix is carried out. Instrumental methods include ultrasound, abdominal radiography, irrigoscopy, and computed tomography.

Treatment

The generally accepted tactics for acute appendicitis is surgical removal of the inflamed appendix as early as possible. After 36 hours from the onset of the first symptoms, 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 unnecessary delay.

At the stage of prehospital care for suspected acute appendicitis, bed rest, exclusion of fluids and food, and application of cold to the right iliac region are indicated. It is strictly forbidden to take laxatives, use a heating pad, or administer analgesics until a final diagnosis is established.

Currently, for simple forms of appendicitis, laparoscopic operations that do not require an incision in the abdominal wall are preferred. In this case, an endoscopic instrument is inserted into the abdominal cavity through a small puncture in the tissue. Removing appendicitis using this method allows you to avoid surgical trauma and reduce the recovery period significantly. The risk of developing postoperative complications when removing appendicitis using the laparoscopic method is minimal.

In the case of chronic appendicitis, appendectomy is indicated if there is persistent pain that deprives the patient of normal activity. With relatively mild symptoms, conservative tactics can be used, including eliminating constipation, taking antispasmodics, and physical therapy.

FALSE APPENDICITIS

A group of young guys were sitting at a table in a restaurant. It was not a happy occasion. They remembered their friend who died near Kandahar two years ago. The guys remembered their service in Afghanistan, cursed the spirits, drank vodka and ate steaks. The evening proceeded as usual, as it should on such sorrowful occasions. But the alcohol did its job, and by the end of the evening, smiles appeared on the faces of the kids who had been having fun. They even began to prematurely congratulate one of them on his unborn son, who was soon to be born. "I will soon have a son! Paratrooper!" - the future father swaggered. The evening program was coming to an end, the musicians were leaving their seats, the hall was emptying, and the waitresses were ushering out the lingering visitors. The guys said goodbye at the porch of the drinking establishment. - Well, what about guys?! - Sashka asked jokingly. - Should we go home or continue? - Look for a while. It's already twelve o'clock. All shops are closed. - Sergei muttered dissatisfiedly. — I have a bottle lying around in the refrigerator. - the staggering Sanya did not let up. - I'm going home. - said Vadim. - You know, mine is pregnant, she still has a month to go. I won’t worry her with my long absence. He picked up cruising speed from the spot and went home to a small room with a shared room, where his pregnant wife was waiting for him. The light December frost stung my ears, nose and cheeks, but my soul felt light and pleasant. In the neon light of the lanterns, the snow sparkled and played with multi-colored beads. Measured, confident steps tirelessly brought him closer to the family hearth. Hearing nothing and not paying attention to anyone, Vadya purposefully turned from the main avenue into a long-familiar alley between the Malysh and Kolobok stores. Then the road ran diagonally across the entire yard. Like a tired horse, feeling the approach of its native stall, the legs carried themselves without involving consciousness in this process. Anticipating a tender meeting with his beloved, Vadim felt very good and, crossing the yard, he began to sing at the top of his voice. Of course, his song was about the service that ended last year. About the airborne troops, about how difficult it is to serve there, that these guys can be sent into space, to other planets, without training. In general: “In the landing force we serve as winged ones, but here you can’t help but be an eagle!” Having walked half the yard singing, he was stopped by a daring shout. - Hey asshole, shut up! - Damn, didn’t you understand?! - Vadim stopped and asked louder. - Who is this for? -- You. Don't understand, or what? -Where are you guys? - the singer began to light up from within. - Yes, we are here, waiting for you. Enormous anger, fueled by alcohol, boiled in the young body. Without turning back, without making a detour, Vadka, feeling strong in himself, pushed straight through the snowdrifts. His legs got stuck knee-deep in the snow, but overcoming the natural barrier, he came out to a group of young guys standing at the entrance. Seeing the young guys performing in front of him, whose shoulders were only enlarged by their winter coats, Vadim cooled down somewhat. They were 17-18 years old. It was shameful for the former sergeant to fight with them. - Guys! - he said in a fallen voice. - You scream so much. Have you even served in the army? -- No! But we are very greyhounds! - Oh, that's it. Then I will punish you. With these words, Vadim quickly descended from the snowdrift made by the wipers. He grabbed the two people in front by the collars, hit their foreheads and threw them into the snow. The hats of those who fell flew to the sides. The guy and girl standing at the entrance did not move and did not say a word. They silently watched what was happening. Those who had fallen crawled and moved to get their headdresses. -- Lie! - Vadka barked. - Ointment! Ointment! - one of them yelled. Not understanding what was said and hearing the patter of approaching steps, Vadim turned around. A guy with a face distorted with anger was running towards him from the corner of a five-story building. This is where Vadim should remember the entire arsenal of experience gained in hand-to-hand combat. But feelings prevailed over reason. Instead of delivering a pre-emptive strike, putting a block, or shouting threateningly in the end, he again took on the role of a teacher. He grabbed the guy by the chest and shook him. -Where are you going, son?! Do you want to lie next to me? - Drop your hands, I have a knife! - the guy shouted. This is where Vadim would like to gather again. I would like to smash my forehead into the nose of the freeloader so that he loses his bearings. But here the feeling of easy victory did not go away at all. In Mazi’s lowered hands there was already an open folding bag. With a blow from the bottom up, the knife easily pierced the sheepskin coat, jacket with a body shirt and entered Vadim’s stomach. Having turned somewhat in the living flesh, the blade came out. Everything happened instantly. Vadya stood, continuing to squeeze the lapels of the offender’s winter coat with his fingers. An unpleasant warmth began to spread throughout my body. There was no acute pain, but the dull heaviness in the lower abdomen was making itself known more and more. -Did you just stab me with a knife? - Vadka asked in a dull voice. - Yes, he stabbed!!! - Mazya shouted hysterically and, hitting Vadka’s hands with a fan from below, freed himself and jumped to the side. Standing in complete stupor, trying to comprehend what had happened, the wounded man tried to correctly assess the situation. Anger and rage for what was done to him clouded his eyes. “Now boy, I’m going to kill you.” - he said in a whisper. The tall guy started to run away. Vadim follows him. Having reached the end of the house and turning onto the avenue, he realized that he should not run further. The thought occurred to him that about ten years ago, under approximately the same circumstances, his older friend passed away. He chased after his offender, who stabbed him with a knife, then became exhausted, leaned against the rubble of an unfamiliar house, became exhausted and died quietly. In the morning, people going to work found him frozen. Looking into the distance at the person running away, Vadim turned around and with weakening legs wandered to the ill-fated entrance where people were standing. With every step it became more and more difficult to walk. In my stomach, a locomotive furnace of pain flared up and gained strength. Walking up to the other participants in the events with an unsteady gait, Vadim slowly said: “Call an ambulance, your friend hit me with a knife.” My legs gradually lost strength. Vadim began to fall. An unfamiliar guy and girl grabbed him by the arms and led him into the entrance. The heated Mazya returned and began to spin around the barely moving trio. - Guys, get away from him, let me finish cutting him off! - he constantly repeated. - Get away from here. You've already done a lot of business. - the girl objected. At the entrance, the victim was placed on the steps. He turned pale and lay silent. He opened his eyes only when a woman who came out from the first floor unbuttoned his clothes and began bandaging him. The stairwell was filled with onlookers and police. -Who is it? - asked the sergeant. - Yes, here he is. - One of those present nodded at the lanky one. - You will come with us. - the policeman said briefly. Vadim lay there, and the woman in the dressing gown continued to skillfully bandage him. He was in pain physically and mentally. How so? He’s a grown guy, he served in the army, but he couldn’t cope with these young guys. In the dim light of the entrance light, his eyes focused on the offender. - What did you do, you bastard? - the parched lips said slowly. - I passed through Afghanistan without a single scratch. I was never hooked there. And you got me home. You're a bastard. - Lie down, lie down. - Mazya said condescendingly and mockingly. The ambulance arrived. The woman, a doctor, administered painkillers to Vadka, who was lying with his eyes closed. He was carefully placed on a stretcher and loaded into the UAZ. It was cold in the spacious sanitary department. But Vadim did not feel it. His thoughts were now occupied only by his wife and mother. How will they be informed about what happened? How will they bear this terrible news? He opened his eyes again and saw a woman sitting in front of him in a coat, from under which a white robe was visible. - Mother, will I live? I don't want to die like that. - Well, what are you saying? - She gently took his hand in hers. - Of course you will! The siren of a speeding ambulance was heard throughout the night city. But Vadim didn’t hear her. The pain subsided and he fell asleep. A few minutes later the car drove into the hospital campus and stopped at the door of the surgery. There, the sleeping man was transferred to a hospital gurney and taken to the emergency department. Either the drug took full effect, or the hospital warmth warmed him, but Vadim woke up, looked around and sat down on the cart, leaning his hands back. Everything around was unfamiliar. White walls, a table, a couch covered with a sheet, a medical cabinet. Gradually, reality began to return. For some reason it even became fun. Suddenly the door opened and an elderly woman entered the room. It was clear from her attire that she was a nurse. -Why did you jump up, my dear?! - the old woman screamed. - You can't. Lie down. - Oh, what's wrong? - Vadim swaggered. - Lie down, lie down. Let me help you undress. Like this, like this. - she said, helping to free herself from outer clothing. - Now the doctor will perform an operation on you, sew up the hole and everything will be fine. - I wish grandma could mend this matter quickly. It's too late. My wife is waiting at home. - Vadka said insinuatingly. - As soon as the doctor is free, he will put you in order. They won't be delayed for long. With deft, long-honed movements, the granny helped him undress and covered him with a clean sheet. Under her now lay all naked, but cheerful and cheerful Vadya. Alcohol and probably painkillers agitated the foggy brain. I wanted to dance or, at worst, have endless conversations. Finally, having taken the clothes to the wardrobe, the nurse reappeared in the room. She was holding a small box in her hands. Going to the head, she moved the gurney towards the exit. -Where are you taking me, grandma? “Now I’ll take you to a nook in the corridor and make some preliminary preparations.” - An operation, or what? - Vadka became worried. -- Not really! - the owner of the situation cheerfully announced. - Just keep quiet. And everything will be fine. Vadim wanted to have fun; he did not understand at all the complexity of the misfortune that had befallen him. All the actions performed on him seemed to him like an ordinary, meaningless adventure. There were no worries at all. The cart stopped at the window, in which nothing was visible except the darkness of the night. An elderly woman in a white robe pulled back the sheet and placed a box next to the young man. “And now, dear, we’ll shave you!” - So I already shaved today? - Vadim did not understand what he heard. - Uh, no. Where you shaved, I will not shave. You have places where you are completely overgrown. - Granny smiled welcomingly. With those words, she began her priestly duties. The plastic device taken out of the cardboard packaging ended up in her hands, the Neva blade creaked in the mounting grooves of the razor and the instrument, endowed with special rights, began to crawl through the male jungle. Sensing an encroachment on his intimate life, the owner of the thicket tried to object. - Granny! I beg you very much! Be extremely careful and careful! I have a young wife at home! I still have to live and live! - Vadya became agitated at high notes. - Don't be afraid. - The elderly woman answered quite calmly. “I’ve shaved hundreds of tools like yours in my life.” Nobody complained. - So I can hope? - the patient became completely cheerful with a sly look. - Be calm! Just don't make a mistake yourself. - the cheerful old lady winked. When the procedure was completed, the barber, covering the shaved area with a sheet, disappeared from view. Vadka was lying on a gurney alone in the corridor. No one disturbed him or even initiated him into further actions. Lying down was getting boring. The night was getting darker and the hospital was quiet. The upcoming operation seemed unrealistic. There's no one around. Having made incredible efforts on himself, pulling himself up with his hands by the bumpers attached to the wall for hospital carts, Vadim pushed off with the last of his strength and showed his head in the emergency department. Before his eyes, a doctor appeared sleeping at the table, his head in his hands. He couldn't stand this look. - Doctor, why are you sleeping?! I was recently stabbed to death! Where is your Hippocratic oath! Let's go to the operation! -Are you ready? - the surgeon asked, raising his tired head. - As a pioneer, I am always ready! - Vadim answered bravadoly. - I'm so tired of you. - said the doctor and got up from the table. The nurse arrived on time and unleashed her fiery speech on the prepared patient. She bluntly and recklessly began to set fire to her charge. - Aren’t you ashamed? The doctor just came back from surgery, didn’t have time to rest, and here you are, with your claims. You should be ashamed! - That's what I say! Nice to spend the night! Let's go do the operation, otherwise it won't take long to die. A middle-aged man in a white cap walked up to the gurney, stretched his fingers with masterly movements, grabbed the gurney with both hands, and silently rolled it along the hospital corridor. A second doctor appeared from somewhere. He picked up the cart with his huge hands and the procession set off into the jungle of hospital corridors. Near the elevator, a third doctor approached the stopped cart and looked into Vadim’s face. He smiled cheerfully. - Vadka, what are you doing? “I am,” Vadim answered uncertainly. - Who are you? The doctor removed the gauze bandage and leaned over the gurney. - Zhenya! You? What destinies? - the already cheerful patient was surprised. - Well, of course I am! Recognized? But seven years have passed since we went together on a trip to St. Petersburg. -What are you doing here? Did you graduate from medical school? - Exactly. - confirmed an old friend. - I am your anastasiologist today. -- Great! Then, as soon as you know me, give me more anesthesia. -- Don't worry. As much as necessary. The elevator rose to the third floor and the cart, its long-unlubricated wheels creaking, rolled into the operating room. The merry fellow's mood changed dramatically. Most likely he was affected by the operating room environment. The tense silence and the jingling of medical instruments in it, which the nurse was laying out, did their job. The silent Vadim was transferred to a narrow operating table. Special belts secured the arms and legs. The body began to shiver from the oppressive uncertainty. - It's cold here. Something is shaking me. - Vadya spoke up, shaking. - It's nerves. Don't be afraid, everything will be fine. - Evgeny reassured. - Yes, I’m not afraid. - Vadim began to raise his morale, chattering his teeth. -I'm not afraid of anything at all. Tomorrow morning I'll go punish the boys. “Come on, Anika warrior, let’s patch you up and then you’ll go.” The needle carefully entered the vein and the clear medicinal liquid continued its path through Vadka’s blood vessels. Then the anesthetist pierced the rubber tube of the dropper with a syringe needle and added another liquid to the dropper. Gradually, consciousness became foggy, but Vadim still continued to talk some nonsense. The tongue went numb, the operating room dissolved, the doctors’ voices disappeared... Early winter morning. The room is dark. A weak security light streams through the open doors. A young man lies motionless on a hospital bed. He's sleeping. I haven’t recovered from the anesthesia of the surgery that night. From staying in one position for a long time, my body became numb. Muscles and joints began to ache. Dry mouth. The eyelids lifted heavily, the eyes got used to the darkness and began to slowly explore the unfamiliar room. Little by little the sleeping brain awakens. Consciousness returns. Finally fully remembering last night and its consequences, Vadim finally came to his senses. He wanted to stretch in bed. But I couldn’t bend over. A sharp pain in my stomach made me groan and freeze in an uncomfortable position. He did not recognize his own voice. It was just a quiet moan. The pain went away slowly, and I had to forget about sudden movements. Vadim slowly lowered his hand and felt the cold metal of the bed. He gently tapped his fingernails. At the slight sound, a nurse looked in the door. -Are you awake? How are you feeling? -- Fine. - Vadim stammered barely audibly. His parched lips prevented him from pronouncing words correctly. - Give me some water. “You can’t drink yet.” The woman took a small gauze swab with a clamp, dipped it into a glass of water and wet Vadim’s lips. The moisture began to have its life-giving effect. The patient began to cheat a little. He pressed each new portion of the moistened tampon with his lips and small drops of water penetrated the oral cavity, irrigating it. Three days spent in intensive care gave a positive result. The ruptured intestines began to work and my health began to improve. During this time, Vadim became thin and haggard. They fed him only with droppers and chicken broth through a tube. It also became known that during the operation they not only sewed up the penetrating hole from the knife, but also opened the abdominal cavity, washed the intestines, sewed them up and put them back in place. Now it turns out that it was not Mother Nature who placed the intestines inside Vadim, but a doctor, a high-class professional. On the evening of the day when the patient was transferred to the general ward, he anxiously awaited the appearance of his wife. She didn't know the whole truth. She was informed that her husband was taken to the hospital with an attack of acute appendicitis. Therefore, now, lying in bed, Vadim was scrolling through the answers to possible questions in his head. At the time allotted for visitors, Sveta entered the room. She quietly greeted all the patients and sat down on a chair next to her husband’s bed. Her face showed no alarm. Appendicitis in the modern world, the operation is not complicated, mostly without serious consequences. - Well, how are you? - she asked and tenderly looked into Vadim’s eyes. - Yes, I'm fine. Trifle. How are you? - and he lightly touched his wife’s stomach. - We're good too. - and Sveta smiled sweetly. - We are waiting for you home. Listen, show me your seam. Vadim carefully lowered the blanket and a neat white bandage was revealed underneath. It was about twenty centimeters long and was located clearly in the middle of the abdomen! The men in the room became silent. Knowing the truth, they waited for the end of the conversation. - Is he somehow strange to you? Everyone has it on the side, but you have it in the center. - Nothing surprising. - Vadim objected. - Some people have their hearts on the right! And I have appendicitis closer to the middle. -Are you not lying to me? - Svetlana became worried about something. - I never lie to you! - sounded cheerfully in response. A week later, Vadim left the hospital. The truth about the knife was revealed suddenly, which triggered premature birth. Sveta did not reach the allotted time for three weeks. A completely healthy girl was born into a young family! 3

- this is an acute, less often chronic form of inflammation of the appendage of the cecum - the appendix (vermiform appendix). Depending on the form, it can occur with pain in the right iliac region of varying severity, indigestion (nausea, vomiting, stool and gas retention), and elevated body temperature. When recognizing appendicitis, they rely on positive diagnostic symptoms (Sitkovsky, Bartomier - Michelson, Blumberg - Shchetkin), data from a digital examination of the rectum and vaginal examination, and a detailed clinical blood test. Surgery (appendectomy) is indicated.

General information

Appendicitis is one of the most common pathologies of the abdominal cavity, accounting for 89.1% of the total number of hospitalizations in a surgical hospital. Appendicitis occurs in men and women and can develop at any age; The peak incidence occurs between 10 and 30 years of age. Inflammation of the appendix occurs in approximately 5 out of 1000 people per year. Appendicitis is treated by specialists in the field of abdominal surgery.

Causes of appendicitis

As a rule, polymicrobial flora, represented by Escherichia coli, staphylococci, enterococci, streptococci, and anaerobes, takes part in the occurrence of the disease. Pathogens enter the wall of the appendix enterogenously, that is, from its lumen.

Conditions for the development of appendicitis arise when intestinal contents stagnate in the appendix due to its bending, the presence of foreign bodies, fecal stones, and hyperplasia of lymphoid tissue in the lumen. Mechanical blockade of the lumen of the appendix leads to an increase in intraluminal pressure, circulatory disorder in the wall of the appendix, which is accompanied by a decrease in local immunity, activation of pyogenic bacteria and their penetration into the mucous membrane.

A higher risk of developing appendicitis exists in pregnant women, which is associated with an enlarged uterus and displacement of the cecum and appendix. In addition, constipation, restructuring of the immune system, and changes in the blood supply to the pelvic organs can be predisposing factors to the development of appendicitis in pregnant women.

Pathanatomy

The appendix is a rudimentary appendage of the cecum, having the shape of a narrow elongated tube, the distal end of which ends blindly, the proximal end communicates with the cavity of the cecum through a funnel-shaped opening. The wall of the appendix is represented by four layers: mucous, submucosal, muscular and serous. The length of the process ranges from 5 to 15 cm, thickness – 7-10 mm. The appendix has its own mesentery, which holds it and ensures relative mobility of the appendix.

The functional purpose of the appendix is not completely clear, but it has been proven that the appendix performs secretory, endocrine, barrier functions, and also takes part in maintaining the intestinal microflora and the formation of immune reactions.

Classification

There are two main forms of appendicitis - acute and chronic, each of which has several clinical and morphological variants. During acute appendicitis, simple (catarrhal) and destructive forms (phlegmonous, phlegmonous-ulcerative, apostematous, gangrenous appendicitis) are distinguished. Catarrhal appendicitis is characterized by signs of circulatory and lymph circulation disorders in the appendix, the development of foci of exudative-purulent inflammation in the mucous layer. The appendix swells, its serous membrane becomes congested.

The progression of catarrhal inflammation leads to acute purulent appendicitis. 24 hours after the onset of inflammation, leukocyte infiltration extends to the entire thickness of the appendix wall, which is regarded as phlegmonous appendicitis. In this form, the wall of the appendix is thickened, the mesentery is hyperemic and swollen, and purulent secretion is released from the lumen of the appendix.

If multiple microabscesses form during diffuse inflammation, apostematous appendicitis develops; with ulcerations of the mucous membrane - phlegmonous-ulcerative appendicitis. Further progression of destructive processes leads to the development of gangrenous appendicitis. Involvement of the tissues surrounding the appendix in the purulent process is accompanied by the development of periappendicitis; and his own mesentery – by the development of mesenteriolitis. Complications of acute (usually phlegmonous-ulcerative) appendicitis include perforation of the appendix, leading to diffuse or limited peritonitis (appendiceal abscess).

The clinic of appendicitis in children, the elderly, pregnant women, and in patients with atypical localization of the appendix has its own unique features. In young children with acute appendicitis, the general symptoms inherent in many childhood infections predominate: febrile fever, diarrhea, repeated vomiting. The child becomes inactive, capricious, lethargic; As pain increases, restless behavior may occur.

In elderly patients, the symptoms of appendicitis are usually erased. The disease often has an unreactive course, even with destructive forms of appendicitis. Body temperature may not increase, pain in the hypogastrium is mild, pulse is within normal limits, symptoms of peritoneal irritation are mild, leukocytosis is slight. In older people, especially in the presence of a palpable infiltrate in the iliac region, differential diagnosis of appendicitis with a tumor of the cecum is necessary, which requires colonoscopy or irrigoscopy.

Chronic appendicitis occurs with dull aching pain in the right iliac region, which can periodically intensify, especially with physical stress. The clinical picture of appendicitis is characterized by symptoms of indigestion (persistent constipation or diarrhea), a feeling of discomfort and heaviness in the epigastric region. Body temperature is normal, clinical urine and blood tests are without significant changes. On deep palpation, pain is felt in the right abdomen.

Diagnostics

When examining a patient with acute appendicitis, attention is drawn to the patient’s desire to take a forced position; increased pain with any spontaneous muscle tension - laughing, coughing, as well as in a lying position on the left side due to displacement of the cecum and its process to the left, tension of the peritoneum and mesentery (Sitkovsky's symptom). The tongue is moist in the first hours, covered with a white coating, then becomes dry. When examining the abdomen, the lower parts of the abdominal wall lag behind when breathing.

Palpation of the abdomen if appendicitis is suspected should be carried out with caution. An important diagnostic value for appendicitis is the Rovsing symptom (characterized by increased pain on the right after pushing pressure on the abdomen in the left iliac region) and Shchetkin-Blumberg (increased pain after light pressure and quick removal of the hand from the abdominal wall).

During the surgeon's examination, a digital rectal examination is performed, which allows one to determine pain and overhang of the anterior wall of the rectum due to the accumulation of exudate. A gynecological examination in women reveals pain and protrusion of the right vaginal vault. In the blood of acute appendicitis, a moderately pronounced leukocytosis of 9-12x10*9/l is detected with a shift in the leukocyte formula to the left and a tendency for changes to increase over 3-4 hours. Ultrasound of the abdominal organs in acute appendicitis reveals the accumulation of a small amount of free fluid around the enlarged appendix.

Acute appendicitis should be differentiated from right-sided renal colic, acute cholecystitis and pancreatitis, examination on a chair, ultrasound of the pelvic organs. In children, appendicitis is differentiated from ARVI, childhood infections, coprostasis, diseases of the urinary system and gastrointestinal tract.

In the diagnosis of chronic appendicitis, contrast radiological studies are used - radiography of the passage of barium through the large intestine, irrigoscopy. Colonoscopy may be necessary to rule out cecal neoplasms.

Treatment of appendicitis

A generally accepted tactic for acute inflammatory processes is surgical removal of the appendix as early as possible. At the stage of prehospital care for suspected acute appendicitis, bed rest, exclusion of fluids and food, and application of cold to the right iliac region are indicated. It is strictly forbidden to take laxatives, use a heating pad, or administer analgesics until a final diagnosis is established.

In acute appendicitis, an appendectomy is performed - removal of the appendix through an open incision in the right iliac region or by laparoscopy. In case of appendicitis complicated by diffuse peritonitis, a median laparotomy is performed to ensure a thorough inspection, sanitation and drainage of the abdominal cavity. In the postoperative period, antibiotic therapy is carried out.

According to surgeons, appendectomy for chronic appendicitis is indicated if there is persistent pain that deprives the patient of normal activity. With relatively mild symptoms, conservative tactics can be used, including eliminating constipation, taking antispasmodics, and physical therapy.

Prognosis and prevention

With timely and technically competent surgery for appendicitis, the prognosis is favorable. Working capacity is usually restored within 3-4 weeks. Complications of appendectomy may include the formation of postoperative inflammatory infiltrate, interintestinal abscess, abscess of the pouch of Douglas, and the development of adhesive intestinal obstruction. All of these conditions require emergency readmission. The causes of complications and death in appendicitis are delayed hospitalization and untimely surgical intervention.

Appendicitis is a severe inflammation of the caecum in humans. Most often, this disease is observed between the ages of ten and forty years. It is considered the leader in emergency abdominal surgery. Let's take a closer look at the signs and symptoms of appendicitis in children and adults, as well as much more.

Most often, acute appendicitis develops for the following reasons:

Important! Doctors believe that frequent drinking and poor diet also increase the risk of appendicitis.

What else provokes the development of inflammation of the appendix, read.

Types and forms of appendicitis

There are the following forms of appendicitis:

The acute form of inflammation is considered the most common. In this case, the patient will require urgent surgical treatment, since otherwise the inflamed intestine can cause serious complications in his condition.
Chronic appendicitis can develop in both women and men. Its appearance is usually facilitated by a previously suffered acute illness. In this condition, pathological processes of a dystrophic nature will occur in the human appendix.

How not to confuse inflammation of the cecum with appendicitis, read.

Chronic appendicitis can cause repeated tissue damage for quite a long time, heal and scar again. Also, sometimes this form of inflammation provokes the transformation of a process of the intestine into a cyst, which will be accompanied by the accumulation of fluid and the appearance of dropsy. This is a serious condition that requires urgent surgical attention.

In addition to the forms, there are also types of appendicitis. These are:

Simple appendicitis. It is expressed by mild symptoms, which greatly complicates its diagnosis. In this case, only the upper part of the abdominal cavity may hurt.

Quite often, with this type of appendicitis, doctors observe the patient’s condition for a long time and are in no hurry to perform an operation. During this time, the patient undergoes blood tests and an X-ray examination.

Phlegmous appendicitis is accompanied by severe pain in the lower right abdomen. Also, the patient’s temperature often rises, the heartbeat quickens and the tongue becomes dry. When palpating the abdomen, a person will feel pain. The muscles of the abdominal walls themselves are very tense.

With the phlegmous form of inflammation, the vermiform appendix of the intestine may increase in size. Also, pus sometimes accumulates in it. This condition is very dangerous, because in the absence of timely treatment, the appendix can burst within a few hours, and then all the pus will penetrate into the abdominal cavity.

The perforated form at the initial course is somewhat similar to the simple one, however, fecal stones can form in the patient’s abdominal cavity due to holes in the appendage. In this condition, toxins appear in the patient’s blood, causing a severe deterioration in the person’s general condition.

Characteristic signs of a perforated form of intestinal inflammation will be low blood pressure, nausea, increased heart rate and severe abdominal tension.

The gangrenous form of intestinal inflammation is considered the most dangerous. In this condition, the cells of the appendix simply die, which leads to a complete absence of pain or its weakening. At the same time, the person becomes very weak and pale. His body temperature may rise, vomiting, and nausea may occur. On palpation, the abdomen is tense, and bloating may also be observed.

As medical practice shows, the gangrenous form of appendicitis develops within twelve hours after the initial inflammation and the manifestation of the main symptoms. Next, the appendix ruptures and its contents spill into the patient’s abdominal cavity. In the absence of timely treatment, death can occur.

It is worth mentioning separately about the so-called false appendicitis. Its manifestations may develop not due to inflammation, but due to parallel symptoms. Symptoms of this condition may include nausea, pain, and diarrhea.

Common appendicitis syndromes

The first signs of appendicitis largely depend on its form, the gender of the patient, as well as the physiological state of the person (if the inflammation occurred during pregnancy, for example).

There are four main syndromes that may indicate the development of appendicitis:

Pain syndrome. In this case, the pain can be very different and also localized in different areas of the abdominal cavity, but most often in.
Dyspeptic syndrome involves the appearance of disorders in the patient’s gastrointestinal tract.
The inflammatory syndrome is accompanied by a sharp increase in body temperature.
Peritoneal syndrome is accompanied by shortness of breath, weakness and tension in the abdominal muscles of a person.

Important! Quite often, common signs of appendicitis are confused with ordinary food poisoning or stomach upset. In this case, a person may not consult a doctor at all, believing that the disease will go away “on its own.” This is actually a huge mistake and can lead to a ruptured appendix. For this reason, it is better not to take risks and immediately consult a doctor when the first signs appear.

How to identify signs of appendicitis yourself

To make it easier to understand that this is appendicitis, when the first suspicions arise, you should do the following:

A person needs to lie down on a flat, hard surface and press on the stomach in the area of pain. If even with slight pressure there is a clearly visible pain in the right side of the abdomen, then you need to urgently consult a doctor. This is a dangerous sign of acute inflammation.
Under normal conditions, the abdomen should be soft when pressed. If the abdominal cavity is hard, then this may be a sign of intestinal inflammation.
You can also straighten up and walk around a little. If there is inflammation of the intestine, then it is impossible to do this without pain. Usually the pain subsides only when the person turns sideways and brings his legs to his chest.

Main symptoms

The following main signs of inflammation are distinguished:

Increased body temperature.
Chills.
Fever.
Increased sweating.
Constipation.
Nausea and vomiting, which is often repeated.
Diarrhea with blood particles.
Severe pain in the lumbar area, which is similar to colic in the kidneys.
False urge to go to the toilet.
Sharp pain in the abdomen. The localization of pain can be very different.
Dyspepsia.
Darkening of urine.
Decreased appetite.
Pallor.

Dangerous manifestations of appendicitis

The insidiousness of this disease is that sometimes it can manifest itself with completely different (uncharacteristic) symptoms. This will significantly complicate the diagnostic process.

Dangerous symptoms of appendicitis are those manifestations that distract from the main disease or indicate the development of peritonitis.

Moreover, in women, such manifestations of the disease can be confused with inflammatory diseases of the gynecological part, and in children - with intestinal colic, which is often inherent in them.

The most dangerous signs of acute inflammation are:

Black feces are a very dangerous sign. It may indicate intestinal bleeding.
Pain that suddenly subsides after sudden onset of pain may indicate a rupture of the walls of the appendix.
Constant vomiting.
Softening of the abdomen after its hardness upon palpation may also indicate intestinal rupture.
Sudden temperature changes.
Disturbance in the patient's consciousness (delusional state, confusion, etc.) This may indicate severe intoxication of the body. In this condition, a person requires urgent medical attention.

Clinical diagnosis of appendicitis symptoms

Diagnosis of appendicitis should always take place in a hospital setting by conducting the following studies on the patient:

General blood and urine analysis.
Anamnesis collection.
Ultrasound of the abdominal cavity.

In addition, a prerequisite for detecting appendicitis is to inform the doctor about such a symptom as pain. The fact is that it is the painful syndrome that is the main symptom of this pathology, so it is very important in differentiating appendicitis.

To avoid distortion of the patient’s clinical indications, it is prohibited to give him painkillers before a diagnosis is made.

When palpating the abdomen, the doctor may ask about the following manifestations of pain:

Localization of pain. It can be on the left, right and middle of the abdominal cavity. The pain can also radiate to the heart and kidneys.

If pain is observed in the right area of the abdomen, this means that the appendix is located at a close distance from the walls of the peritoneum.

Change in pain. With inflammation of appendicitis, a person may experience pain when coughing, lifting his leg, right arm, or simply lying on his back.
Nature of pain. In this case, a person may be bothered by cramping, dull, aching, or stabbing pain. The worst thing is if, after acute pain, the patient’s symptom disappears (this may indicate the development of peritonitis).

Important! The manifestations of appendicitis also largely depend on its neglect. For example, if this is acute inflammation, then its signs will be pronounced. In the chronic form of the disease, a person will be bothered by more muted symptoms.

Features of appendicitis in men

This disease usually appears in men between the ages of twenty and thirty. Teenagers also often get sick.

It was noted that intestinal rupture most often occurs in men. This may be due to advanced diagnosis of appendicitis.

Inflammation in men is characterized by pain in the groin when the examining doctor palpates the abdomen.

Inflammation of the intestine in women

Women usually suffer from appendicitis from about the age of twenty. When diagnosing this disease, it is very important to differentiate it from inflammation of the appendages and ectopic pregnancy.

Intestinal inflammation in children

Inflammation of the intestine in young children is always difficult to diagnose, since the child cannot really explain where and how it hurts. He may cry, be fussy, and not clearly indicate his symptoms.

Typically, acute inflammation in children is manifested by severe pain. It is not difficult to identify it - you just need to lift the child’s right leg and try to bend it at the knee. If pain occurs in the right side of the abdominal cavity, this is a clear sign of appendicitis.

Doctors can also use another diagnostic method - applying pressure to the abdominal cavity and then abruptly removing the hand. In this case, pain will also be felt, indicating inflammation of the intestine.

Additional signs of acute intestinal inflammation in children are:

Weakness and decreased mobility of the baby.
Pain that gets worse when walking and jumping.
Vomit.
In young children, it is possible to observe the right leg being pulled towards itself in a bent state.
Tongue taxation.
Increased heart rate.
Diarrhea.

Manifestations in older people

Appendicitis in older people occurs calmly, without pronounced symptoms. In this case, a person may only suffer from pain in the abdominal cavity. The temperature is slightly elevated or normal.

Important! The weak severity of appendicitis symptoms in older people does not mean that they easily tolerate the disease. On the contrary, patients in the older age group are more susceptible to complications and death.

Features of the course in pregnant women

Detecting appendicitis during pregnancy is a very difficult task, at any stage of its course.

Usually in this condition the appendix moves slightly towards the liver. This makes it difficult to identify the source of inflammation.

Diagnosis of the disease, in addition to testing, involves identifying pain while lying on the right side and on the back.

A woman may also be prescribed an MRI and ultrasound of the abdominal cavity. If acute inflammation is detected, urgent surgical intervention is required. The period of gestation does not matter. The main task of such an operation, in addition to removing the inflamed intestine, will also be to preserve the pregnancy.

What not to do if you suspect appendicitis

Before visiting a doctor, you should know what not to do so as not to harm yourself:

You should not take painkillers, laxatives and antipyretics, as they will eliminate important symptoms of the disease.
You should not take any bowel medications as they may cause a chemical reaction and further rupture of the appendix.
You cannot eat or drink anything, as urgent surgery may be required after diagnosis.
Do not apply ice or a warm compress to the sore spot.
You cannot engage in physical activity. It is best to call an ambulance to take the person to the hospital.