Inflammation of the appendix is a disease that many of us know only by hearsay. Among the symptoms that everyone has heard is acute pain in the abdomen. However, the symptoms of the disease are not limited to pain alone. And in cases where appendicitis occurs in an elderly person, there may be practically no pain. It is very important to pay attention to other symptoms of appendicitis at home or in a loved one in time and immediately consult a doctor and provide timely qualified help. Appendicitis, the diagnosis of which includes a number of studies, can lead to peritonitis, which, in turn, can cause death.
Causes of Appendicitis
Doctors cannot give an exact answer why some people have an inflamed appendix. However, there is an opinion that the impetus for the development of the disease is problems with the intestines, fecal stones, helminthic infestations, constipation, pregnancy and abnormalities of the appendix. Improper nutrition can also provoke inflammation of the process of the cecum. No wonder in childhood we were told that dirty seeds can lead to surgery to remove appendicitis.
In any case, it is impossible to protect yourself from appendicitis. With a formidable diagnosis, both newborn babies, pensioners and healthy young people get to the hospital. Appendicitis, the diagnosis of which is to differentiate the disease from a number of other health problems, requires immediate surgical intervention.
Stages of Appendicitis
Inflammation of the appendix has its origin and logical conclusion. Acute appendicitis, the diagnosis of which includes a number of measures to identify the problem and differentiate the disease, goes through several stages, each of which gradually proceeds to the next. It:
- Catarrhal appendicitis. At this stage, the inflammatory process affects only the appendix.
- The superficial stage is characterized by progressive inflammation with primary damage to the mucous membrane. During this period, leukocytes and blood are detected in the lumen of the process.
- At the phlegmonous stage, the entire appendix is inflamed, including the outer membrane of the appendix.
- Phlegmonous and ulcerative stage is characterized by the appearance of ulcers on the mucous membrane of the appendix.
- The last stage is gangrenous, characterized by necrosis of the walls of the process and a breakthrough of its contents into the peritoneal cavity.
Given that from the onset of inflammation to the stage of the occurrence of peritonitis, only two to four days pass, then you should consult a doctor who will apply all methods for diagnosing appendicitis when the first symptoms of the disease are detected.
Common symptoms of acute appendicitis in adults
Like any other disease, inflammation of the process of the cecum has its own symptoms. Common symptoms of acute appendicitis depend on the stage of inflammation, the location of the appendix, and even the age of the patient. At the first stage of the development of acute appendicitis, nausea occurs, single or repeated vomiting, which, unlike food poisoning, does not bring any relief. A person begins to complain of severe weakness and a feeling of malaise, loss of appetite and some problems with bowel movements. Diagnosis of appendicitis in adults at this stage is almost impossible, since such disorders are characteristic of a number of acute and chronic diseases.
The next stage is a coated tongue, first wet, later dry. The patient's temperature rises to 38 degrees, and rectal above the body temperature is not 1, but several degrees. The pelvic location of the appendix leads to the appearance of loose stools; the appendix, located in close proximity to the bladder, causes urination disorders. Loss of appetite, including anorexia, is noted in 90% of cases of inflammation of the process of the cecum. If the patient continues to eat normally, then, most likely, differential diagnosis of acute appendicitis is necessary, which will detect another disease with similar symptoms.
Local symptoms
Given that common symptoms are characteristic of a number of other diseases, it is very difficult to make an accurate diagnosis in the first hours. However, after 4 hours, local symptoms join the general symptoms, allowing to differentiate inflammation of the appendix and provide the necessary medical assistance to the patient. It:
- Aching dull pain. Moreover, the pain becomes noticeable until the development of symptoms of a general nature. It is localized either throughout the abdomen, or in the umbilical or right iliac region. With the pelvic location of the appendix, pain occurs above the womb, and in the prehepatic - in the hypochondrium. But more often, doctors are faced with the so-called Kocher symptom, when the pain in a few hours from the epigastric region moves to the right iliac region.
- Gradually, the pain progresses and from aching it becomes acute, sometimes giving to the genital area, lower back or right thigh. Patients feel especially discomfort during movement or coughing. Doctors often ask the patient to cough in order to accurately determine the nature and location of the pain.
- Did the pain recede abruptly? This is also one of the symptoms of the disease, reporting necrosis of nerve cells in the appendix. Moreover, the symptom is truly formidable, preceding the deterioration of the patient's condition and peritonitis.
- Muscle tension of the abdominal wall also indicates peritonitis (in the case of the retrocecal location of the appendix, the muscles of the lower back are tensed). By touching the stomach, the muscles contract reflexively, demonstrating that the inflammation has reached the visceral peritoneum.
- There is hypertension of the skin in the right iliac region.
- The muscles of the right half of the abdomen seem to lag behind when breathing, which indicates muscle tension.
- In thin patients, the navel is slightly shifted to the right side.
- Diagnosis of appendicitis at home includes palpation. It is enough to press on the ileal region and sharply tear off the hand - the pain will immediately intensify.
- A rectal examination for appendicitis reveals pain in the rectum. More precisely, its front wall.
Additional diagnostic methods at home
To identify pathological reflexes and differentiation of the disease, the following methods are also used:
- Symptom Dubois - pain when pressing on the occipital points of the vagus nerve.
- Symptom of Moscow - dilated right pupil.
- There are also points in the abdomen, clicking on which causes an attack of pain with appendicitis. But only the doctor knows their exact location, so you should wait for the ambulance crew to arrive.
Appendicitis in children
The difficulty in diagnosing appendicitis in children lies in the fact that, due to age, they cannot tell about their feelings. Moreover, the younger the child, the more rapidly the disease progresses. Almost all the symptoms of childhood appendicitis are common, which is why with any of them you need to contact a specialist. First, the child changes his usual behavior, stops moving actively, becomes lethargic and lethargic. Later, other symptoms appear that make it possible to differentiate the disease.
Newborn babies refuse a breast or a bottle, the fontanel sinks, the tongue becomes dry. There is always a strong tension in the iliac right region. Diagnosis of acute appendicitis in children consists in monitoring the position of the child. Usually babies lie on their right side with bent knees. Older children can sit leaning forward.
When a doctor palpates the right iliac region, the child instinctively pulls his right leg to his stomach and pushes the doctor's hand away from him. Diagnosis of appendicitis in children of preschool and school age always includes the question "where exactly does it hurt?" Traditionally, the child points to the navel. With the course of the disease, the pain can move to the location of the inflamed process. Lethargy, nausea, vomiting, constipation preceding the onset of pain, tachycardia and fever are also symptoms of inflammation of the appendix.
Acute appendicitis in expectant mothers
Pregnant women are not safe from such an unpleasant disease as appendicitis. Diagnosis is complicated by the fact that general symptoms, such as abdominal pain, nausea and vomiting, are characteristic of toxicosis in the initial stages of pregnancy. With the growth of the uterus, it becomes more difficult to determine the development of symptoms of the disease. Some methods for diagnosing acute appendicitis in the second and third trimesters may not give a result. For example, symptoms of peritoneal irritation are not detected, pains are not localized in the right iliac region, but higher, palpation is ineffective due to the growing uterus covering the appendix. Because of this, aching, dull or cramping pain can be mistaken for symptoms of an approaching miscarriage.
Given the difficulty in diagnosing appendicitis in pregnant women, you should immediately go to a stationary examination and pass all the necessary tests to accurately determine the nature of the problem, without harming either the expectant mother or her baby. Suspicion of appendicitis? Differential diagnosis will help to verify the correctness of the diagnosis or refute it. Modern medicine allows you to remove the appendix during pregnancy without harm to health. The main condition for success is timely diagnosis and prevention of the development of complications such as peritonitis. Unfortunately, in the case of phlegmonous or gangrenous appendicitis, a cesarean section is required. Only after this is it possible to remove the appendix, clean the abdominal cavity and save the woman.
Elderly appendicitis
Appendicitis that occurs in older people is the most dangerous. This is due to the attrition of almost all the symptoms of the disease. The pain syndrome is mild, dysuric and dyspeptic disorders are practically absent, the temperature remains normal. Tachycardia, an increase in ESR and leukocytosis, which are characteristic of acute appendicitis attacks, do not occur in older people. Due to age-related sagging of the abdominal wall, a protective reaction from the abdominal muscles does not appear. That is why older patients should respond as clearly as possible to any changes in their condition. At the slightest suspicion of inflammation of the appendix, it is necessary to call a doctor who can conduct a full examination of the patient.
Complications of Appendicitis
The acute form of the disease can lead to the destruction of the appendix or its spontaneous amputation. In this case, purulent masses go beyond the process, which leads to local or diffuse inflammation of the peritoneum. With the phlegm form, empyema, purulent lesion spreading to the peritoneum, rectum and adjacent tissues is possible. This forms purulent foci reaching the fatty tissue.
No less serious consequences are threatened by thrombophlebitis of the appendix, which provokes the development of septic thrombophlebitis of the portal vein and branches. This leads to blockage of the veins of the liver and the development of purulent specific inflammation. Given these complications, treatment of appendicitis should be started immediately, without delaying "for tomorrow" and not hoping for "maybe it will pass."
Chronic appendicitis
There is such a thing as chronic, not acute appendicitis. The clinic, diagnosis and treatment of the disease differ from the picture of acute inflammation of the appendix. In fact, the chronic form is a consequence of acute inflammation. Dystrophic and sclerotic processes occur in the appendix, accompanied by tissue destruction. Inflammation occurs and heals, forming scars and commissures; ulcers and infiltrates may appear. In some cases, chronic appendicitis leads to the fact that the process is transformed into a cyst, a breakthrough of which is no less dangerous than a breakthrough of the appendix itself. It is worth noting that the chronic form is an extremely rare phenomenon, observed only in 1 out of 100 cases. Do you suspect chronic appendicitis? Diagnosis, treatment and subsequent drug support occurs in a hospital setting.
Diagnostics
Diagnosis of appendicitis at home should be as accurate as possible, since an error and subsequent medication, for example, from poisoning, can lead to sad consequences. This will not only complicate the diagnosis, but also worsen the condition of the patient. Appendicitis, the differential diagnosis of which is to some extent possible at home, does not tolerate self-medication. Prior to the arrival of doctors, you should not take any medicine or apply a heating pad to a sore spot, trying to calm down unpleasant sensations. Such "care" for the patient can lead to premature peritonitis and other possible complications.
Were you taken to a hospital with a preliminary diagnosis of appendicitis? Ultrasound diagnosis of appendicitis will allow to differentiate the disease and take timely measures to get rid of the problem. Also, for diagnosis, use abdominal radiography , computed tomography, irrigoscopy. After surgery, the morphological form of the disease is specified and a histological examination is performed .
Appendicitis treatment
Traditionally, the appendage of the cecum is eliminated by surgery. The most commonly used method is laparotomy appendectomy, in which the inflamed process is removed through the dissected section of the abdominal wall. With this operation, due to small openings, there is practically no postoperative scar, and the use of a telescopic tube allows you to make surgery as accurate as possible. The duration of the postoperative period is reduced, the possibility of adhesions and the development of a chronic form of the disease is minimized.
After surgery, antibiotic therapy is prescribed if there is an inflammatory effusion in the pelvis. In the catarrhal form, antibiotics are not used. The peculiar scar remaining after the operation allows you to accurately determine that the appendix has been removed if you are admitted to the hospital with similar symptoms in the foreseeable future. That is why during other operations in the iliac region, the appendix is always removed, even if it is not inflamed, so as not to disorient another specialist. Appendicitis, the diagnosis and treatment of which should be carried out as soon as possible, is a “one-time” disease. That is why in the case of repeated symptoms, it is necessary to contact specialists who can determine the disease with similar symptoms.