Appendicitis is the acute inflammation of the branch of the cecum. This is one of the most common diseases of the abdominal cavity. It can carry a serious threat to the patient's life and requires urgent surgical intervention. The signs of appendicitis in adults and children are quite similar and depend on the degree of inflammation. Although the manifestations of the disease are noted at any age, but most often remove the appendix to women in young or middle age( 15-35 years) than men or children.
- Causes of
- First signs of
- Symptoms of
- Types of
- Complications of
- Diagnosis of
- Treatment of
- Diet of
- in child
- During pregnancy
- Prevention of
Causes of
The appendix in the human intestine serves to purify the body of foreign bodies, toxins and toxins. Therefore, the main cause of inflammation of appendicitis is, first of all, a mechanical occlusion of the lumen of the appendix. This leads to accumulation of mucus in it, activation of intestinal flora, enlarging the lumen 2-3 times, inflammation of mucous membranes, thrombosis of blood vessels and gradual necrosis of the walls of the appendix.
After the process is filled with pus, and the bottom of the ulcer reaches the outer shell of the mucosa, "appendicitis bursts."The outpouring of purulent contents( peritonitis) into the sterile abdominal cavity is a real catastrophe for the organism, accompanied by numerous complications.
In addition, the cause of appendicitis is believed to be:
- Obstruction of the lumen of the appendage by calculous stones or parasites.
- Blocking of foreign bodies: grape or pomegranate seeds, sunflower husks, small fish or meat bones, etc. Small stones, small solid objects such as plastic parts of the designer most often clog up the appendix in children.
- Congenital bend of the process or squeezing it with scar or adhesions in chronic gastrointestinal diseases( colitis, cholecystitis, enteritis, adnexitis, etc.).
- Chronic constipation and a lack of vegetable fiber in the diet, which inhibits intestinal motility.
- Vascular vasculitis or malfunction of the endocrine system.
- Some infectious diseases( typhoid, tuberculosis, amoebiasis, etc.).
The firstsigns
The development of appendicitis begins with moderate pain in the epigastric region and / or umbilical zone. In some cases, the pain syndrome does not have a clear localization and covers the entire abdominal cavity. It intensifies or abates with walking, sudden movements, coughing, sneezing, feces, with the change of the position of the body in bed.
As the disease progresses( after several hours), the pain increases slightly and moves to the right iliac segment. During this period, there may be a slight increase in temperature, a lack of appetite, nausea, a general malaise.
When the pain intensifies even more( up to spasmodic and intermittent), it is clearly localized in the right lower quadrant, and the fever begins - these are signs of an acute stage of appendicitis.
to table of contents ^Symptoms of
In acute attacks of appendicitis, pain can spread to the lower back and become harsh with urination. In adults, sometimes there are inflammations of nearby organs: cystitis, right-side adnexitis. It is accompanied by nausea and vomiting of a reflex character, frequent urination, a liquid stool, sweating, palpitations, sometimes an increase in blood pressure.
Short severe sharp pain, twisting the entire body and the same sharp relief, indicates the rupture of the wall of appendicitis. During this period, vomiting stops, fever increases, the temperature rises to 39oC, the pain syndrome completely passes.
In women, the development of appendicitis can be accompanied by pathologies and progression of genital tract diseases.
to table of contents ^Species
- Acute appendicitis is an inflammatory-necrotic lesion of the appendix of the cecum, requiring immediate surgical intervention.
- Chronic - a rare form of the disease, which is accompanied by sclerotic and atrophic changes in the walls of the appendage.
- Catarrhal( simple) appendicitis - covering only the mucous membrane. It is manifested by a slight thickening of the walls of the appendix and with mild inflammation.
- Superficial - affects the submucosal and part of the muscular membrane.
- Destructive( complex) - associated with necrosis and decay of the entire thickness of the mucous membranes of the process, followed by perforation( the formation of a through hole) and peritonitis. It is subdivided into a phlegmonous one with an increase in the process and thrombosis of blood vessels, braiding its walls, and gangrenous with complete necrosis and decomposition of the appendix tissues.
Complications of
The rupture of the appendix wall causes peritonitis - spillage of pus on the peritoneum, which leads to infection of blood and can cause death of the patient.
Possible complications after acute appendicitis more than 2 days ago:
- peria-pendicular abscess;
- purging of purulent peritonitis;
- abscess or sepsis of the abdominal cavity;
- acute pylephlebitis.
Possible complications after removal of acute appendicitis are divided into early, late and general.
To early, up to 2 weeks after surgery, are:
- abdominal cavity lesion( infiltration and suppuration of the surgical suture, formation of hematomas and accumulation of pus);
- internal organs( intra-abdominal bleeding, intestinal obstruction, acute postoperative pancreatitis, etc.).
To late, more than 2 weeks after the operation, include:
- lesions of the abdominal membranes( ligature fistula, inflammatory infiltrate of the abdominal wall, postoperative hernia, keloid scar, neurinoma of the rumen);
- lesions of the abdominal cavity( sticks, inflammatory infiltrate or peritoneal abscess, formation of intestinal fistula, or development of adhesions).
To general include:
- cardiovascular disease( thrombophlebitis, phlebothrombosis, vascular embolism, myocardial infarction, etc.);
- defeat of the respiratory system( bronchitis, pneumonia, abscess or gangrene of the lungs, pleurisy);
- urinary tract infection( cystitis, acute renal failure, delay or difficulty urinating) and other complications.
Diagnosis
Symptoms of inflammation of the appendix can be tried out independently. To do this, take a horizontal position( preferably on a hard surface) and maximally relax your stomach. With your right hand, gently press down on the lower right side of the abdomen. If a sharp withdrawal of the hand produces a sensation of acute pain, this indicates appendicitis.
Clinical examination consists of palpation of the right iliac segment of the abdomen, at which some muscle tension is felt, and the patient marks various pains in nature. The pain is aggravated when the femoral artery is clamped, with a sharp retraction of the abdomen, when the thigh is unbent in the patient's position on the left side.
Laboratory tests( analysis of blood, urine and other biological fluids) today do not allow to reliably determine the acute stage of the disease without surgical intervention. In some cases, nonspecific changes are noted( increase in the number of leukocytes or protein in the blood, the rate of erythrocyte sedimentation, etc.), but one can not carry out an unambiguous diagnosis on them.
Hardware Research:
- ultrasound. Appendicitis is diagnosed in the absence of peristalsis, an increase in the lumen of the appendage, the accumulation of fluid around the process or in the cavity of the small pelvis, the accumulation of a large number of "free gases."
- Radiography. In the early stages of the disease, little informative. In 10-20% of all cases, a cluster of fecal stones can be seen. With a leaky peritonitis, signs of an intestinal obstruction are revealed.
- Fluoroscopy with contrast agent is used for suspected chronic inflammation.
- Computed tomography is quite informative. Can be used for differential diagnosis to exclude tumors of the cecum, detection of abscess, infiltration or other complications of peritonitis.
Treatment of
The main method of treatment of acute appendicitis in adults is appendectomy - a surgical intervention aimed at removing the inflamed vermiform appendage. The operation is recommended to be performed as soon as possible after diagnosis, in order to prevent the development of peritonitis.
Conservative treatment consists of intravenous administration of antibiotics, saline and ensuring the outflow of intra-abdominal abscess, if any. Therapy of perforated appendicitis continues until the elimination of existing clinical symptoms( fever and temperature, abnormalities of the gastrointestinal tract, abnormalities of the leukocyte blood formula, etc.).If the antibacterial treatment has given quick results( less than 5 days), then you can switch to oral medication.
In case of doubt or with chronic appendicitis, it is recommended to adhere to a specialized diet, to conduct repeated blood tests and palpation of the pathological site. If there is an improvement in the patient's condition, he is released home the next day. If the pain intensifies, then continue the administration of antibiotics intravenously and prepare for appendectomy.
to contents ^Diet
The diet for chronic appendicitis should include:
- a large number of fresh fruits and vegetables rich in fiber, berries, herbs;
- whole grains porridge( buckwheat, pearl barley, millet, etc.), oatmeal, brown rice, coarse bread, bran;
- dried fruits, freshly squeezed juices, legumes;Acid products.
Diet after removal of appendicitis:
- In the early days - low-fat chicken broth, liquid potato, pumpkin, squash, apple puree, unsweetened natural yogurt, rice boiled on water, boiled chopped chicken.
- In the following days it is recommended to continue to stick to liquid, soft or ground foods, gradually introduce fresh fruits and vegetables, cereals, greens. It is desirable to drink as much water as possible.
Child
Symptoms of appendicitis in children are almost completely similar to manifestations of the disease in adults. Of the differences, we can note weakness, tearfulness, mood swings, pallor of the skin, thirst. The child can complain that the tummy is hurting, but can not accurately indicate the location of pain localization. During the game, often squatting or lying on one side, pulling his legs to his chest to find the most comfortable position and ease pain.
Distinctive features of children's appendicitis:
- is almost always an acute form of the disease;
- develops very quickly, much faster than in adults;
- masks for other diseases( poisoning, dysentery, gastroenteritis, enterovirus infections, bile stasis, urological or children's infectious diseases, etc.).
The child is examined and diagnosed by a pediatric surgeon; he also approves the surgical procedure:
- laparoscopy, if the appendix is not yet perforated;
- with acute appendicitis or peritonitis conducts a banded operation with complete purification of the abdominal cavity from spilled pus and with the installation of outgoing catheters.
In pregnancy
The development of acute appendicitis is a fairly common cause of surgical surgical intervention in pregnant women. Features of the female body during this period make it very difficult to diagnose the disease in time, which in most cases leads to a complicated stage and causes the termination of pregnancy.
This is due to:
- Hormonal, metabolic and physiological reconstitution of the body when the clinical picture is indistinct.
- Weakening of the muscles of the anterior abdominal wall and displacement of internal organs by a growing uterus.
Early operation of the appendix allows you to avoid complications and save the life of the mother and child. Acute appendicitis in pregnancy is characterized by chronic aching or acute pain in the zone of localization of the process of the cecum. In pregnant women, the main symptom of appendicitis is a significant increase in pain when turning from the left to the right side, when the uterus with the fruit presses on the inflamed area.
to contents ^Prevention
For preventive maintenance it is recommended that:
- monitor health, timely treatment of constipation;
- try not to swallow the husk of sunflower seeds, do not eat grapes, pomegranate and other berries with bones;
- do a gymnastics or massage the stomach in the intestinal area at night;
- to eat properly and regularly;
- drink more purified water, vegetable juices, whole cow's milk, herbal decoctions.