Acute appendicitis is an inflammation of the appendix of the intestine. Appendicitis can be simple and destructive, phlegmonous, gangrenous and perforated. Occurs as a result of the development of infection in the appendix.
Acute appendicitis is characterized by an acute onset. More often, pain immediately appears in the right lower abdomen. Sometimes it occurs first in the epigastric region or throughout the abdomen, followed by a transition to the right lower abdomen. The severity can vary, often it is moderate and constant. Pain is especially pronounced with destructive appendicitis.
It is quite rare to experience cramping. An attack of pain can last from several minutes to several days. If the pain lasts more than a day, this indicates severe inflammation. With the development of necrosis of appendix tissue, the pain weakens, but then intensifies again and becomes diffuse. At the same time, the patient begins to feel sick and vomit. As a rule, such manifestations indicate the development of inflammation of the peritoneum (peritonitis).
Stool with appendicitis is often normal, sometimes there is constipation, and very rarely - diarrhea. If the inflamed appendix is located near the wall bladder, then urination disorders appear. With destructive forms of appendicitis, an increase in the body to 38 degrees is noted. With gangrenous appendicitis, the pulse quickens before the temperature rises.
The patient lies calmly in bed, but sometimes shows anxiety and tries to find a position in which the pain would subside. When palpating the abdomen, sharp pain is noted in the lower right part. It can vary greatly in intensity. The location of the greatest severity of pain depends on the location of the appendix of the intestine. In addition to severe pain, muscle tension is noted in this area of the abdomen. The pain may intensify when the patient is positioned on the left side.
If the diagnosis of “acute appendicitis” is accurately established or if it is suspected, the patient should be immediately taken to surgical department. Such patients should absolutely not be given food or drink, prescribed painkillers or given an enema. You need to put an ice pack on your stomach. When the diagnosis is beyond doubt, patients undergo emergency surgery.
In atypical cases, with erased signs of the disease, they wait for some time, but always in a hospital setting. The operation is postponed in advanced types of appendicitis, in the presence of the so-called appendicular infiltrate. In this case, anti-inflammatory and antibacterial treatment, and the operation is performed as planned, when the infiltrate resolves.
Based on materials from the book " Quick help in emergency situations."
Kashin S.P.
Appendicitis is a lesion of the appendix, an extension of the cecum. This is the most common disease in organ surgery abdominal cavity.
The main cause of appendicitis is considered to be a violation of the outflow of contents from the appendix. This condition can occur when it is blocked by feces, various worms or tumors. In children, it is more often caused by small toys.
Inside the appendix, mucus is constantly produced, which over time accumulates inside under conditions of obstruction (blockage). This leads to rapid increase pressure, due to the small size of the cavity of the appendix. This stagnation of mucus provokes the proliferation of pathogenic microorganisms. As pressure increases, ischemia (decreased blood circulation) occurs in the mucous membrane of the appendix. The appendix increases in size, and the lining becomes thinner and becomes an excellent entry point for bacteria.
Anyone can get appendicitis, regardless of age and gender. Appendicitis is the most common surgical operation that requires immediate intervention. This disease, unfortunately, has no cure. medicines, it only requires surgical intervention. At the first alarming symptoms You should immediately call an ambulance, otherwise the appendix may rupture and the contents will spill out into the abdominal space and will call dangerous complication which is called peritonitis. This, in turn, often leads to death.
Although appendicitis is a fairly common disease, the diagnosis is sometimes difficult to make even for an experienced surgeon. To make a correct diagnosis, anamnesis is collected (asking the patient about his disease).
The main complaint that patients make is pain. Quite often it occurs at night, or closer to the morning. The pain is localized in the umbilical area, but can also spread throughout the abdomen. After a few hours, it goes into the iliac region on the right. Appendicitis is often accompanied by nausea and single vomiting.
When examining such a patient, an elevated body temperature can be detected, which rises to 38.5 degrees. Heart rate increases. In some cases it can reach 120 beats per minute.
Dangerous symptoms of appendicitis are:
First aid for appendicitis must be provided correctly, otherwise complications can be provoked.
About 70-75% of all cases acute abdomen accounts for acute appendicitis.
The occurrence of inflammation in the appendix is associated with diplococcus, staphylococcus and streptococcus. E. coli and anaerobic bacilli join later. Inflammatory processes play a certain role in the development of appendicitis neighboring organs(typhlitis, inflammation of the uterine appendages).
Depending on the pathological changes, the following two types of acute appendicitis are distinguished: 1) acute catarrhal, or simple (uncomplicated) and 2) destructive. The latter is divided into phlegmonous with possible transition to purulent, gangrenous, perforated.
Catarrhal appendicitis often has the following clinical picture. The attack occurs suddenly and the first sign is pain. Severe pain occurs near the navel, spreads to the right side of the abdomen and to the epigastric region. Later it is localized in the right iliac region. The patient experiences nausea and sometimes vomiting. As a rule, stool is retained and gases do not pass away. The temperature rises to 38° and above. The pulse is increased.
A blood test reveals an increase in the number of leukocytes to 10,000-15,000. The tongue is dry and somewhat coated. When palpating the area of the cecum, pain is determined. If you apply light pressure to this area and then quickly remove your fingers from abdominal wall, the patient experiences sharp pain. When palpating (with small jerky pressure) the area sigmoid colon in the left half of the abdomen the patient feels pain in the right iliac region (Rovsing's symptom).
By comparatively palpating the left and right iliac regions, one can establish the tension of the abdominal muscles in the area of the cecum (muscular protection). If the patient is not operated on for some reason at this time, the symptoms may sometimes subside during the first two days. In other cases, phlegmonous appendicitis may develop. At the beginning of its development, purulent appendicitis may be no different from the catarrhal appendicitis described above, but soon it becomes more severe course. General condition The patient is seriously ill, the temperature rises even more, repeated vomiting occurs, and the pulse continues to increase. In the area of the cecum, you can sometimes feel an infiltrate
The symptom of peritoneal irritation (muscle protection) in this area is pronounced. A blood test reveals high leukocytosis, significant neutrophil shift leukocyte formula, neutrophils may have pronounced toxic granularity. All this symptomatology serves as a warning against possible perforation of the appendix. Perforation at purulent appendicitis leads to the development of general purulent peritonitis.
Gangrenous appendicitis usually has an even more severe clinical picture than purulent appendicitis.
If in the first hours of the disease acute appendicitis is not diagnosed and the patient is not sent to a surgical hospital (sometimes the patient himself does not resort to medical help or calls a doctor belatedly), then for a relatively short term Perforated appendicitis with symptoms of peritonitis may develop (Fig. 13).
The temperature after a short rise may decrease and remain at low-grade levels or from the very beginning does not exceed 37.2-37.5°. Pulse is frequent, poor filling. Blood pressure falls. The abdomen is swollen and acquires a “board-like” density. Breathing is frequent and shallow. The face is pale with a bluish tint, covered with sticky sweat. Facial features change (sunken eyes, pointed nose).
In a blood test, due to the areactivity of the body, leukocytosis may not be detected, but when studying the leukocyte formula, a characteristic significant neutrophil shift towards young forms is revealed (band shift, the presence of young neutrophils) and toxic granularity of neutrophils.
Figure 13. Normal and gangrenous appendix with perforations
The diagnosis of acute appendicitis is made mainly on the basis the following symptoms: acute onset of the disease, local pain signs, phenomena of peritoneal irritation, elevated temperature and leukocytosis with a neutrophil shift. In typical cases, the diagnosis is beyond doubt, but diagnostic errors, unfortunately, are still quite common.
These errors are of two kinds. In some cases, appendicitis is mistaken for some other disease of the abdominal cavity, which also requires urgent surgical intervention. In this case, patients are urgently hospitalized and thereby avoid serious consequences. In other cases, as often happens, appendicitis is mistaken for a foodborne illness.
Such a diagnostic error leads to the fact that in the treatment of patients measures that are completely unacceptable for appendicitis are used (laxatives, enemas, etc.), and patients are hospitalized belatedly.
When the process is localized on the right, appendicitis must be differentiated from acutely developed gynecological diseases: inflammation of the right appendages, ectopic pregnancy, torsion of an ovarian cyst, etc. Anamnesis can help with the diagnosis. Disease of the female genital organs can be detected during a gynecological examination.
Diagnostic errors often occur in cases where the symptoms of acute appendicitis are not clearly expressed. Relatively slight pain in the right iliac fossa and low-grade fever sometimes there is no suspicion of developing appendicitis and the patient stays at home. Later there may be severe symptoms general diffuse peritonitis.
The patient was sent home with an offer to see him the next day. By morning next day the temperature rose to 38.8°, the abdominal pain, which was already pronounced and widespread, resumed. A doctor called to the house diagnosed acute peritonitis and, with a diagnosis of acute abdomen, sent the patient to the hospital, where surgical intervention was urgently performed.
During the operation, gangrenous appendicitis with a breakthrough of the appendix was diagnosed. The patient recovered.
Enemas and laxatives for appendicitis are strictly prohibited. You should also not use heating pads. Ice is placed on the patient's stomach.
Despite the severe pain, before being sent to the hospital, the use of narcotic drugs is not allowed, as they obscure the picture and can lead to a false diagnosis and change the idea of the severity of the patient’s condition when he is admitted to the hospital.
It should be remembered about the advantages of early surgery performed in the first 24-36 hours from the onset of the disease, and severe consequences delayed diagnosis and late hospitalization. If the patient refuses surgery, he should be persuaded to go to the hospital and under no circumstances attempt treatment at home.
Patients and their relatives should know that they should immediately seek medical help in all cases of acute pain in the stomach. It is necessary to clarify that in case of abdominal pain, taking laxatives and painkillers (opium, etc.) without a doctor’s prescription is strictly prohibited.
In the body of every person there is a worm-like appendage of the cecum, the inflammation of which is called appendicitis. Inflammation can result in complications - phlegmon, rupture of the appendix, etc.
With purulent inflammatory processes people have been familiar with the appendix since ancient times. So one of the mummies was discovered in this area postoperative incision, and the first image of the appendage of the cecum was presented to the world by Leonardo da Vinci. IN modern world appendectomy is performed not only in large, but also in small hospitals, including local ones. According to statistics, about one million operations to remove a purulent appendix are performed in Russia every year.
Appendicitis begins to develop at the moment when pathogenic bacteria from the intestines invade the appendix. The microflora familiar to the intestines, which lives in it constantly and performs the necessary functions, participating in metabolic processes, can in some cases become the cause of the disease. The vermiform appendix is a closed cavity, and even if absolutely innocent microbes penetrate it, when they multiply they begin to pose a threat to health. When growing pathogenic microflora a purulent process begins to develop in the appendix.
IN official medicine stands out separately chronic form appendicitis and acute form of appendicitis. Because the symptoms of chronic appendicitis are often vague, many doctors dismiss it as a disease. We are not talking about cases where the patient’s complaints are a consequence of a previous attack of appendicitis in acute form. Although, under certain conditions, the chronic form can take an acute course.
The most early symptom acute appendicitis is acute, sudden pain in the upper abdomen or in the navel area close to the right ilium. Gradually painful sensation transferred from the umbilical region to the right iliac region. Once it appears, the pain does not go away and intensifies during coughing. In acute appendicitis, nausea and vomiting appear, although there are cases when it is absent. As a rule, pain and nausea are accompanied by stool retention. The tongue becomes dry and coated, body temperature rises to 37.8-38.5 degrees. There is poor discharge of gases, and sometimes diarrhea occurs. A person's heart rate increases.
If you suspect acute appendicitis, conduct an examination of the abdomen: with great care, gradually palpate first the iliac region on the left side, and then the hypochondrium on the same side, smoothly move to top part abdomen, from which transfer palpation to the iliac region with right side. If you are having an attack of acute appendicitis, you will most likely feel sharp pain in the latter area.
The location and severity of the appendix most depend on the location of the appendix. painful sensations. This place can be easily identified by lightly tapping your fingers on the walls of the peritoneum. Since in acute appendicitis they are looking for a painful area, and not a point, they feel the stomach not with their fingertips, but with the entire plane of their palm. In the patient, in addition to sharp pain in the right iliac region, protective muscle tension in the local area is added.
At times, inflammation affects only the mucous membrane of the appendix. In this case, the process goes out after 1-2 days, which does not at all indicate a successful outcome. No doctor can predict with complete confidence the further course of events, which at times is fatal. The fact is that at any time the pus contained in the appendix can break into the abdominal cavity and cause a serious complication in the form of peritonitis. For this reason, if you suspect appendicitis, you must immediately call to the house " ambulance", especially when it comes to a child. Sometimes a person’s life directly depends on how quickly the inflamed appendage is removed.
When diagnosing acute appendicitis in a patient urgently hospitalized in the surgical department. This measure help is vital and does not depend on the form of appendicitis, the age of the patient, or the time that has passed since the onset of the disease.
When acute appendicitis develops, the patient should under no circumstances be given painkillers, so that the “blurred” symptoms of the disease do not prompt him to refuse timely medical care. IN in this case You can't waste a minute of time. In addition, it is forbidden to give laxatives for appendicitis, as they can lead to the development of peritonitis.
For a patient with suspected acute appendicitis, until professional treatment is provided medical care Bed rest should be provided. In this case, it is necessary to ensure that the patient does not eat spicy and fatty foods.
As first aid for acute appendicitis, you can apply a heating pad to the sore spot. cold water or an ice pack. The first symptoms of an “acute abdomen” must be assessed as a catastrophe in the abdominal cavity, and an ambulance should be called without delay. If the diagnosis is confirmed, the patient will undergo urgent surgery to remove the appendix and cleanse the abdominal cavity of purulent accumulations.
The most favorable results are obtained by surgery performed on the first day after the exacerbation. Any time delay regarding necessary operation, may result in the development of a severe complication incompatible with the life of the patient.
