In the article, we will figure out which side appendicitis is in a person and what are its symptoms. This pathology is an inflammatory process in the appendix, which moves away from the cecum. This is one of the most common ailments in surgery.
The essence of pathology
Appendicitis is one of the most common surgical diseases of the abdominal cavity, the proportion of which is 89.1 percent. Appendicitis can occur in both men and women at any age. The culmination of the incidence is observed in the category of patients from ten to thirty years. The development of the inflammatory process in the appendix occurs in five people out of a thousand per year. Appendicitis is subordinate to abdominal surgery, or operative gastroenterology.
What is an appendix?
This is an appendage of the cecum with a vestigial character. Outwardly, it is an elongated narrow tube, the distal side of which has a blind end, and the proximal side is connected to the cavity of the cecum using a funnel-shaped opening.
How to determine appendicitis at home is interesting to many.
There are four layers in the wall of the appendix: serous, muscular, submucous and mucous. The length of the appendix is from five to fifteen centimeters, and the thickness is from seven to ten millimeters. The appendix has its own mesentery, which holds it and ensures the mobility of this process.
Its functional purpose has not been fully clarified, but it has been proved that the appendix has the following functions: barrier, endocrine and secretory. In addition, he is involved in maintaining the intestinal microflora and the formation of immune responses. Everyone should know the signs of appendicitis.
Disease classification
Two main types of appendicitis are distinguished - chronic and acute. Each of them has several morphological and clinical options. In acute appendicitis there are catarrhal (simple) and destructive forms (gangrenous, apostematous, phlegmonous and ulcerative and phlegmonous).
With catarrhal appendicitis in adults, there are symptoms of a disorder of lymph and blood circulation in the appendix, the appearance of foci of purulent-exudative inflammation in the mucous layer. The appendix increases, its serous membrane acquires a full-blooded character. There is an attack of appendicitis.
Due to the development of catarrhal inflammation, a purulent ailment occurs in an acute form. A day after the start of the process, leukocyte infiltration spreads to the entire thickness of the appendix wall, and this is regarded as phlegmonous appendicitis. This form is characterized by a thickening of the process wall, edema and hyperemia of the mesentery, the release of purulent secretion from the lumen of the appendix.
Signs of inflammation of appendicitis, of course, are pronounced. But sometimes the picture is blurry. If a large number of microabscesses form during inflammation of a diffuse nature, then apostematous appendicitis is formed; if there are ulcerations in the mucosa, then phlegmonous and ulcerative appendicitis develops. The progression of destructive processes in the future becomes the cause of gangrenous appendicitis. When the tissues that surround the appendix are involved in the purulent process, periappendicitis accompanies it, while mesenteriolitis develops in the mesentery. Complications of the acute (mainly phlegmonous and ulcerative) type of appendicitis is perforation of the process, which leads to delimited or diffuse peritonitis, or appendicular abscess.
Among the types of chronic appendicitis, primary chronic, residual and recurrent forms are distinguished. The course of the disease is characterized by sclerotic and atrophic processes in the process, destructive and inflammatory changes with further growth in the appendix wall and the lumen of the granulation tissue, the appearance of adhesions between the tissues and the serous membrane. When serous fluid accumulates in the lumen, a cyst appears.
The signs of appendicitis will be discussed in more detail below, but for now, let's talk about the causes of this pathology.
Causes of appendicitis
Appendicitis develops, as a rule, due to the polymicrobial flora, which is represented by staphylococci, anaerobes, streptococci, Escherichia coli and enterococci. Pathogens enter the appendix wall in an enterogenic manner, that is, from the lumen.
Appendicitis develops with stagnation of the intestinal contents in the appendix due to its inflection, the presence of fecal stones and foreign substances in the lumen, and lymphatic hyperplasia. Mechanical blocking of the lumen causes an increase in pressure inside it, circulatory defects in the appendix wall, which is accompanied by a decrease in local immunity, an increase in the activity of pyogenic bacteria and their further introduction into the mucosa.
Food
Of particular importance are the nutritional characteristics and the specificity of the location of the process. This predisposes to the formation of appendicitis. It is known that due to excessive consumption of meat and a person’s tendency to constipation, a large number of protein decay products accumulate in the intestinal contents, and this creates an excellent environment for the existence of pathogenic flora. In addition to mechanical causes, appendicitis develops due to parasitic and infectious diseases - typhoid fever, yersiniosis, intestinal tuberculosis, amoebiasis, etc.
In pregnant
Pregnant women are more likely to develop appendicitis. This is due to the displacement of the appendix and cecum due to an increase in the size of the uterus. Also predisposing factors in pregnant women are constipation, changes in the blood supply to the pelvic organs, and the transformation of the immune system.
Signs of appendicitis
If acute appendicitis has a typical form, then pains are observed on the right side in the iliac region, pronounced general and local reactions. In this case, an attack of pain most often develops sharply. Initially, it spreads or is localized most often in the region near the navel and in the epigastrium. After a few hours, there is a concentration of pain with appendicitis in the iliac region on the right side.
If the appendix is not atypical, then unpleasant symptoms can be felt in the lumbar region, in the right hypochondrium, above the pubis and around the pelvis. The pain syndrome in the acute form of appendicitis is expressed all the time, worsens during laughter or coughing, decreases on the right side in the supine position.
Early symptoms
Typical early signs of appendicitis are symptoms of a digestive upset: vomiting, nausea, diarrhea, gas and stool retention. Tachycardia and subfebrile condition are noted. Intoxication is especially pronounced with appendicitis of a destructive form. The course of the disease can be complicated by abscesses of the peritoneal cavity - Douglas, interintestinal, subphrenic and appendicular space. In some cases, thrombophlebitis of the pelvic or iliac veins is formed, which can become a source of pulmonary embolism.
In children and the elderly
A particular specificity of signs of inflammation of appendicitis is in the clinic of pathology in the elderly, pregnant women, children, and patients with an atypical arrangement of the appendix.
For young children with acute appendicitis, the following symptoms characteristic of various childhood infections are observed: diarrhea, febrile temperature, frequent vomiting. The child's activity decreases, he becomes lethargic and moody. An increase in pain syndrome may cause anxiety.
The attack of appendicitis in the elderly is somewhat different. Elderly patients with appendicitis usually have an erased clinical picture. The disease often passes reactively, including with destructive types of the disease. Body temperature does not always increase, pain in hypogastrium is insignificant, pulse within normal limits, signs of abdominal irritation are weak, slight leukocytosis. Patients of an older age, especially if there is a palpable infiltrate in the ileal region, need differential diagnosis of pathology with a tumor in the cecum. For this purpose, irrigoscopy or colonoscopy is necessary.
If appendicitis is diagnosed in pregnant women, then the pains can be localized much higher than the location of the ileal region due to the uterus being pushed up by the enlarged uterus. Other symptoms of appendicitis may be milder. Acute appendicitis in pregnant patients should be distinguished from the risk of spontaneous miscarriage, as well as premature birth.
In the chronic form, dull aching pains are noted with appendicitis in the iliac region on the right. They can periodically increase, especially during physical exertion.
The appendicitis clinic is characterized by signs of digestive disorders (persistent diarrhea or constipation), feelings of heaviness and discomfort in the epigastric region. Body temperature is within normal limits, clinical blood and urine tests do not have pronounced changes. During deep palpation, pain in the abdomen on the right is felt.
How is appendicitis diagnosed?
Diagnosis of the disease
Acute appendicitis must be distinguished from almost all pathologies of the peritoneal cavity organs. This is facilitated by the specific location of the appendix, as well as the absence of typical symptoms. How to determine appendicitis at home? Appendicitis is diagnosed on the basis of a medical examination and questioning, ultrasound information, as well as laboratory blood tests. During pressure on the stomach, pain on the right intensifies, but they become especially strong with a sharp elimination of finger pressure on the wall of the peritoneum.
At the request of the patient to stand on tiptoe, he cannot do this because of increased pain. The number of leukocytes can either increase or decrease, however, there is always a sudden neutrophilic shift. Diagnosis of appendicitis should be timely.
Treatment features
Acute appendicitis is generally accepted as a tactic for surgical removal of the affected appendix as quickly as possible.
If there is a suspicion of such a disease, then before treatment in a medical institution, the ingestion of food and liquid is excluded, the application of cold to the iliac region to the right and bed rest are indicated. It is strictly forbidden to drink laxatives, use heating pads, and also administer analgesics until the diagnosis is fully established. What is the operation to remove appendicitis?
In the acute form, an appendectomy is performed, that is, the removal of the process using laparoscopy or through an open incision in the iliac region on the right. With a complication of appendicitis by peritonitis, a median laparotomy is performed . In the period after surgery, the patient takes antibiotics.
In the chronic form, an operation to remove appendicitis is indicated - appendectomy, if persistent pain syndrome is observed, which deprives the patient of normal activity. If the symptoms are mild, then conservative treatment is used, which includes the use of antispasmodics, physiotherapy and the elimination of constipation.
Forecast
Which side is the person’s appendicitis, it is very important to know in order to have time to determine it.
If the operation is carried out on time and correctly, then the forecast is favorable. Usually disability is restored after three to four weeks.
The complications may include the appearance of inflammatory infiltrate after surgery, an abscess of the intestinal and Douglas spaces, the development of obstruction of the intestinal adhesions. These conditions need re-emergency hospitalization.
Such complications, as well as a fatal outcome, can be a consequence of late hospitalization, as well as an operation performed inopportune.
We examined the signs and treatment of appendicitis.