Appendicitis (appendicitis) is the inflammatory process of a small appendix of the cecum called the appendix. The word "appendix" in Latin means "appendage", and the end of "itis" indicates inflammation.
According to statistics, among all surgical diseases, appendicitis in frequency of spread takes approximately 89% of cases and comes first. More often it occurs in people of young working age from 18 to 35 years. The prevalence of this disease in women is 2 times higher than in men.
Classification
Appendicitis can occur in acute and chronic form. The acute form is divided into the catarrhal course of the disease and the destructive, which, in turn, can take several forms:
- phlegmonous;
- phlegmonous ulcerative;
- apostematous;
- gangrenous.
Chronic appendicitis is also divided into several forms. He can be:
- residual;
- primary chronic;
- recurrent.
All these forms of chronic appendicitis are distinguished by sclerotic and atrophic processes occurring in the appendix. The growth of granulation tissue in the walls of the appendix and its lumen, the formation of adhesions between the surrounding serous membranes can occur. In the case of accumulation in the lumen of the vermiform appendix of serous fluid, cysts form.
Appendicitis in children and adults: causes, symptoms and treatment
Very often, the patient pays attention to abdominal pain not immediately, but after several hours or even days. This is due to the fact that the first signs of appendicitis in adults develop gradually and are uncertain. Difficulties arise in determining a specific area of pain localization. When taking pain medication, the pain can completely subside and be felt only with sudden movements and a deep breath or cough.
Appendicitis: signs in adults
- Constant pain, which in the first hours is localized in the navel, then goes down to the right.
- Nausea and single vomiting.
- An increase in body temperature to subfebrile.
If similar symptoms (signs) of appendicitis in adults have manifested, then you should not hope that everything will resolve by itself. You need to call an ambulance. An experienced team of doctors will easily identify such a dangerous disease that requires immediate hospitalization as appendicitis. Symptoms in adults, as already mentioned, may be blurred. To clarify the diagnosis before the arrival of doctors, you can conduct a self-diagnosis.
This is done as follows: in the lower abdomen on the right you need to strongly press with two fingers (middle and forefinger), while the pain should not be felt. Then the fingers are removed, and the pain increases sharply. If such a test is positive, i.e. everything turns out as described, in addition, nausea, and in some cases vomiting, can be present, then, most likely, these are the first signs of appendicitis in adults. Now we will describe them in more detail.
Symptomatology
With a diagnosis of appendicitis, the symptoms in adults may be somewhat blurred, but still they boil down to the following:
- First, there is abdominal pain, which is not clearly localized. It can manifest itself in the navel, epigastrium or have a blurred character (throughout the abdomen). The pain is constant, sometimes it can be cramping. After an hour or more, she concentrates on the lower abdomen on the right. This symptom of pain movement is called Kocher-Volchkov. Irradiation of pain is usually not observed. This is only possible with an atypical location of the appendix. In this case, the pain can be given to the groin or lumbar region.
- Patients, as a rule, lack appetite. This symptom is called anorexia.
- Following the pain, nausea develops, and there may be a single vomiting. These signs of appendicitis in adults are reflex in nature and develop due to irritation of the peritoneum.
- Subfebrile temperature may rise , but this is not always the case. Signs of acute appendicitis in adults, such as fever, vomiting, and anorexia, are called Murphy's symptom.
With the appearance of such signs in a patient, acute appendicitis can be suspected. Sometimes these main symptoms of appendicitis in adults are accompanied by frequent urination, diarrhea (diarrhea), frequent pulse and, in rare cases, increased pressure. Other uncharacteristic symptoms of this disease can be observed in elderly people, children and pregnant women, as well as in the atypical location of the appendix of the cecum. What signs of appendicitis in adults are most often observed, we examined. Now let's talk about the features of the development of this disease in women, and also consider what danger it carries during pregnancy.
Features of the diagnosis of appendicitis in women
Representatives of the beautiful half of humanity have a higher probability of error in diagnosing this disease than men. This is due to the fact that the sensations during the development of this disease can be confused with pain during menstruation or a pain reaction in the event of an inflammatory process in the gynecological area of the pelvic organs. This error can occur with an atypical location of the appendix.
To clarify the final diagnosis in a medical institution, a gynecologist must also examine a woman, in addition to the surgeon. A distinctive symptom of appendix inflammation from gynecological pathology is the fact that in the latter case, vomiting, nausea and upset stool are not characteristic.
Symptoms of appendicitis in pregnant women
Signs of appendicitis in adult women are the same as in men. The exception is pregnant women. According to statistics, the incidence of appendicitis during pregnancy is about 5%. A representative of the beautiful half of humanity who is preparing to become a mother, with this disease, an atypical form can be observed (in case of displacement of the vermiform appendix).
Diagnosis of appendicitis during pregnancy usually does not cause difficulties. Symptoms are the same as in other adults. Difficulties may arise in the last trimester of pregnancy if the nature of the pain is cramping in nature. Patients, as a rule, take a forced position of the body lying on their back with legs bent at the knees and legs tucked up to the stomach. The pain is localized most often on the right in the iliac region, but in later pregnancy can manifest itself higher. Surgical treatment of appendicitis and the postoperative rehabilitation period are also of concern in the last months of pregnancy. Therefore, it is extremely important to correctly diagnose.
Causes of appendicitis during pregnancy
This ailment arises due to the fact that during the period of bearing a baby, a greatly enlarged uterus can affect the cecum and change its position. Also, the appendix can be restrained by an enlarged uterus, as a result of which the blood supply is disturbed in it. This sometimes leads to an inflammatory and even gangrenous process. The cause of appendicitis in pregnant women is also a change in hormonal levels. During the bearing of a child, women often have stool disorders, namely constipation, which can also provoke this pathology.
What is the risk of appendicitis during pregnancy?
Obviously, any surgical intervention, especially when performed in the abdomen of a pregnant woman, can cause a miscarriage or premature birth. But besides this, it is dangerous with the following conditions:
- the development of fetal hypoxia;
- placental abruption and premature aging of the fetus;
- the occurrence of acute intestinal obstruction;
- postoperative infection;
- violation of the contractile activity of the uterus during childbirth;
- the development of bleeding in the postpartum period.
Thus, we examined all the possible symptoms of appendicitis and signs of the disease in adults. Now let's pay attention to the features of the development of this disease in children.
Symptoms of appendicitis in older children
Symptoms in older school children are similar to signs of this disease in adults. We can only add that such patients often occupy a forced position of the body, in which the intensity of pain decreases. They lie on your back or right side. In addition, the temperature rises to 38 degrees and even higher. The pulse does not correspond to the parameters of increasing body temperature and is greatly accelerated.
When examining the oral cavity, a moist tongue is noted, in which there is a white coating. A bad sign is a dry tongue. This may indicate the development of the gangrenous course of the disease and peritonitis. In children of this age, stool retention may occur with this disease.
Symptoms of appendicitis in young children
In babies, signs of the disease in question can be suspected in the following cases:
- The child cries and does not allow inspection.
- The baby pulls the right leg to the stomach and curls up.
- The temperature in young patients diagnosed with appendicitis often rises above 38 degrees, can reach 40.
- The pulse is frequent and corresponds to the increased temperature.
- The chair is liquid, frequent.
- Urination can be painful and rapid. When urinating, the baby cries.
- In young children, vomiting can be repeated.
- The child is restless, refuses to eat, cannot fall asleep, constantly asks for a drink.
What signs of appendicitis in adults and children exist, we now know. Consider the possible dangerous consequences of this ailment.
Complications
In some cases, the course of the disease is complicated by the following processes:
- an abscess of the abdominal cavity, which can be appendicular, subphrenic, interintestinal or douglas, depending on the location;
- thrombophlebitis of the pelvic or iliac veins, this can cause a very serious condition - pulmonary embolism;
- peritonitis, in case of rupture of the appendix;
- the formation of postoperative infiltrate;
- the development of adhesions in the postoperative period, which can provoke intestinal obstruction.
Treatment
If there are signs of appendicitis inflammation in adults or children, then an appendectomy is indicated as soon as possible, i.e. removal of the appendix, to avoid severe complications of this disease. This operation is carried out on an emergency basis - no later than an hour from the moment of making an accurate diagnosis.
At the stage of first aid, bed rest is recommended. It is strictly forbidden to take any food or drink. You can not take painkillers, laxatives and other drugs until the final diagnosis is clarified, apply cold or heat.
After the exact diagnosis of appendicitis is established (signs in adults and children are described above), the patient is placed in the surgical department and an appendectomy is performed. With an uncomplicated course, this operation is done by the laparoscopic method.
After which the patient is transferred to the intensive care unit for several hours, where he is under the constant supervision of medical personnel. After the patient finally departs from anesthesia, he is transferred to the surgical department. On the 5th day, sutures are usually removed and the patient is transferred to outpatient treatment.
With a complicated course of this disease, the patient remains in the clinic, and his discharge will be delayed until the unwanted consequences are eliminated and the general condition is stabilized.
Forecast
With an uncomplicated course of the disease and timely correctly performed operation, appendicitis does not pose a threat to life. The patient's full working capacity is restored after 4 weeks.
The reasons for the development of complications of appendicitis, as a rule, are untimely hospitalization and delayed surgery. In especially severe cases, this can even lead to death.