It is difficult to overestimate the importance of timely diagnosis of acute appendicitis. Indeed, ignoring the characteristic signs can cause peritonitis and lead to death. One of them is a symptom of Kocher. But, unfortunately, it is not observed in all patients.
Symptom Description
There are quite a few signs that the patient has started inflammation of the appendix. But one of the very first is the following symptom. At first, pain occurs in the
epigastric region. It is also called epigastric. It is located immediately below the xiphoid process - the shortest part of the sternum, to which the ribs in front converge.
The symptom of Kocher-Volkovich is that 1-3 hours after the onset of pain, a person notes that they are moving into the iliac region. As a rule, they are localized below, on the right side of the abdominal wall.
To alleviate the condition, patients often take this position: they lie on the right side, the legs are bent at the knees and pulled to the stomach.
Characteristic signs of appendicitis
In the initial stages, not everyone is able to suspect an
inflammation of the appendix. Often problems begin with a feeling of discomfort in the digestive tract. There are
pains in the epigastric region, sometimes they are localized in the navel. This is a symptom of Kocher with appendicitis. Many note feelings of colic, bloating and feelings of fullness. After the release of gases or defecation, the condition may improve briefly.
But the pain intensifies after 1-3 hours. Paroxysmal sensations are replaced by constant. The pains are bursting and pressing in nature. Discomfort moves down the abdomen. Moreover, any movement and load only worsen the situation. The pains are aggravated by deep breaths, coughing, walking, riding on vehicles (with shaking). This is observed equally in both adults and children.
Localization of the inflamed process
Knowing that the Kocher symptom is observed in acute appendicitis, you can diagnose the onset of this disease. Also, by the localization of pain, you can understand exactly where this organ is located. With the standard classic version of the arrangement, it will be on the right side. But if the pain is localized elsewhere, then it is possible that it is placed differently. This must be remembered during the diagnosis.
So, if the pains are concentrated in the area of the womb and lower right side of the abdomen, then the pelvic position of the inflamed organ can be observed. When it is located in the area of the medial (middle) line of the body, discomfort will be localized in the navel area.
Sometimes the pain is concentrated in the lower back, groin, and genitals. This may indicate that the appendix is located behind the cecum. True, in this case, it is important to conduct a differential diagnosis and exclude renal pathologies or lesions of the ureter.
Rarely enough pain in the lower left abdomen is observed. This means that the appendix is located non-standard. He along with the cecum is on the left.
Diagnostics
In order to determine appendicitis, it is not enough to know only the symptom of Kocher. There are a number of other signs by which an accurate diagnosis can be made. So, the patient can not sit down from a supine position without assistance. This is called a Bailey symptom.
The pain intensifies when the patient tilts to the left. This is also a characteristic symptom called a symptom of Volkovich. The condition worsens even if you try to bring the right leg to the stomach.
Mendel’s symptom is that when fingers strike the front of the abdomen with pain, the pain aggravates in its iliac right side. It is positive in 80% of cases.
To determine the onset of peritonitis, a slightly different diagnosis is carried out. Kocher's symptom is determined only in the initial stages of the disease. With the development of inflammation, it is no longer observed. If the patient press on the right iliac region and sharply take his hand, then after this the pain intensifies. This symptom is called the Shchetkin-Blumberg symptom. It is observed in 98% of patients with incipient peritonitis.
Footprint in medicine
Swiss surgeon Kocher was the first to determine that inflammation of appendicitis begins with pain in the epigastric region under the
xiphoid process. He lived in the 19th and early 20th centuries. It was in his honor that this sign of the onset of inflammation of the process of the cecum was named.
Kocher's symptom is observed with exacerbation of appendicitis. Therefore, timely diagnosis is so important. The movement of pain from the epigastric to the right iliac region is called a Kocher-Volkovich symptom.
But not only this symptom was named in honor of this surgeon. Kocher symptom is also known among endocrinologists. It lies in the fact that when looking upward, the movement of the eyeball lags behind the speed of movement of the upper eyelid. In this case, between the edge of the iris and the upper skin fold becomes visible sclera. This is a sign of toxic diffuse goiter.
Kocher is also known as the inventor of a number of special surgical instruments. So, for example, clamps for blood vessels, stomach, probes through which operations on the digestive organs are performed, drainage tubes made of glass are used by modern doctors.