If the patient already has a mention in the medical history of acute catarrhal appendicitis, there can be no doubt - the person knows how dangerous abdominal pain is and how it can end. However, if an operation to remove an organ has already been experienced, over time, a person sighs with relief: the second time you will not succeed in getting sick, which means that everything is for the better. Everyone has heard about the possibility of inflammation of the appendix (gastrointestinal tract) from early childhood, but what is it and what are the features of the pathology? Let's consider it in more detail.
general information
Appendicitis is a disease whose history in surgery is perhaps the simplest and most straightforward. As soon as people understood what exactly provokes soreness in the abdomen, when it became clear that inflammation sooner or later overtook an impressive percentage of the population, it was decided to practice preventive measures. Perhaps it is impossible to find another organ of the human body that is removed with the same high frequency, both due to the presence of a pathological process and in its absence. As they say, "out of sight, out of mind", only in our case - not from the heart, but from the digestive tract. By removing the appendix, doctors thus exclude the possibility of appendicitis in humans for the rest of their lives. True, as it turned out, such a measure leads to certain undesirable results.
The acute variant of inflammation called appendicitis is a disease that is very, very common in the history of a surgical patient. Today, among clients of surgeons, patients with such disorders are the most typical case. The main percentage of diseases requires urgent intervention.
How it all began
Officially, the history of the appendicitis disease in patients begins in the sixteenth century. It was at that time that the first case of an inflammatory process in the vermiform section of the intestinal tract was completely described. True, medicine was rather poorly developed, so doctors did not have the tools and techniques for differentiating inflammatory processes localized in the intestinal tissues and occurring in the appendix. Well-known to modern man, the term characterizing the disease was proposed in 1886. It was during that period that the leading physicians of our world, evaluating and analyzing the clinical manifestations of pathologies, came to the conclusion that in an impressive percentage of cases the most effective and effective therapeutic method is a radical removal of the intestinal region, namely the worm-shaped element.
Statistical studies on the history of the appendicitis disease, chronic and acute, show that the risk group is the age group under 33 years of age. There was no unambiguous connection with gender, but certain nuances of lifestyle influence were found. Doctors pay attention: despite the specified risk group, the danger of an acute form haunts any person throughout life. In progressive countries, an average of about 12% of the population suffered from appendicitis surgery. And in Asian and African countries, such cases are rare.
Men and women: sick and healthy
Studies of various forms (catarrhal, phlegmonous, gangrenous) of appendicitis, medical histories and features of its appearance made it possible to establish: among patients of clinics, women are more common than men. Statistics show that representatives of the stronger sex are less susceptible to inflammatory processes. If pathology develops, then it proceeds similarly in all sufferers, regardless of age, but there are some specific syndromes: some appear only in women, while others are more characteristic of men.
Features of manifestation
If the patient still has no catarrhal appendicitis (and other forms of pathology) in the medical history, additional specific measures are prescribed for the man to clarify the diagnosis. A classic test involves determining the Horn symptom: appendicitis leads to sharp and strong pain with weak pressure on the scrotum. Another classic manifestation is the symptom of Larok, which consists in the involuntary raising of the testicle on the right. The phenomenon is observed both on palpation, and in a calm, not disturbed state. Another specific fact is a symptom named after Britten. On the right, the testicle is pulled up if you press on the ileum, at the same time there is muscle tension. A person notes soreness. If you stop the pressure, the testicle returns to its original position.
Studying information about different patients, their surgical history of the disease, in which appendicitis is mentioned extremely often, it can be noted that many had a positive reaction when checking the pubis. It has been established that this is primarily inherent in the male: a person notes soreness in this part, sometimes covering completely the genitals. This indicates a displacement of the inflamed intestinal region into the pelvic region.
Women are sick: manifestations
In the female history of the disease with acute appendicitis, other specific manifestations of the pathological condition are usually mentioned. Studies show that the danger of the inflammatory process for women is significantly higher due to the nuances of the anatomical features. Every month, cyclic menstruation is associated with active blood flow in the pelvic region, which leads to irritation of the intestinal mucosa, affecting the area of the appendix.
Manifestations of the pathological condition are close to many other diseases - however, this is typical of both sexes. Quite often, instead of acute appendicitis, cholecystitis or pyelonephritis, colic or obstruction of the intestinal tract are first added to the history of the disease, and only after additional analyzes do they identify an inflammatory focus in the appendix. However, such an error will not occur if the doctor carefully examines the patient. It must be remembered that the manifestations of appendicitis are somewhat close to the signs of conception with the attachment of a fetal egg outside the uterine cavity.
Child bearing and inflammatory processes
The period of pregnancy is difficult for many women to transfer, a huge number of new entries appear on their cards that replenish their individual medical history. Appendicitis will not be an exception - in pregnant women it is diagnosed quite often. Dangers are associated with any periods and periods of gestation. Symptoms are often blurry, and it is rather difficult to determine where the inflammatory focus is located: in the appendix or other areas of the intestinal tract.
In the medical history of surgery, acute phlegmonous appendicitis can occur if the patient consulted a specialist because of severe pain in the abdomen, accompanied by nausea, vomiting. Since during the period of bearing a child such symptoms at first seem natural and non-disturbing to women, the process progresses to a severe degree earlier than the patient receives the qualified help she needs. Additional difficulties are associated with the study of the body: by the fourth month, palpation of the abdomen is complicated, which means that identifying the causes of pain becomes a difficult task.
Concerned pregnant appendicitis manifests itself in pain, but the picture as a whole can differ significantly from the classic, which is especially evident in a retrospective study of the history of the disease with phlegmonous appendicitis or another stage. This is due to the growth of the uterus, due to which the organs nearby are displaced, which affects the cecum and its process. As in other cases, the therapeutic course for appendicitis involves urgent operation of the patient. Pregnancy will not be a contraindication to intervention.
Tender age
Often there is appendicitis in the child’s medical history, and in recent decades the frequency of such cases has increased significantly. The appendix is formed by lymphoid nodules, the first of which appear already in the second week after birth, which means that already in this period the inflammatory process can begin. It can be provoked by factors completely unusual for adults.
In the old days, it was believed that the appendix was a rudiment, which must be removed immediately after birth, so that later the person would not be bothered by the disease. A relatively recent study on various stages and forms (including phlegmonous) of appendicitis, medical history, showed that the appendix is important for the normal functioning of the immune system. If this section of the cecum is removed, the strength of the immune response to various dangerous factors decreases, and the earlier the operation is performed, the more significant it will affect a person’s life.
Infants and minors: the intricacies of the case
If acute appendicitis appeared in the child’s medical history even before the baby reaches the age of three, it is likely that both parents and doctors had to deal with considerable difficulties in diagnosing and treating the disease. As is known from specialized studies, in children the problem of clarifying the diagnosis is due to the patient's inability to explain to others where painful sensations are localized and what character they are. Additional problems are associated with the structure of the child's body: the vermiform intestinal process is located differently than in an adult, fully developed person.
In children younger than three years of age, pain caused by appendicitis often appears in the umbilical zone. To suggest that you need to show the child to the doctor before acute phlegmonous appendicitis appears in the medical history of surgery, you can, if the child is worried, cries, behaves listlessly and naughty. Due to appendicitis, the sick child unconsciously seeks to take the position of the embryo, pulling his knees to his stomach, and usually lies on his right side. If parents notice the wrong thing on time and show the child to a specialist, serious consequences can be avoided. Procrastination increases the risk of progression to a severe stage, which is associated with a risk of death.
Childhood illnesses: for 3 years and older
In a child older than three years of age, appendicitis can appear more than easily in the history of the disease: it is known that many suffer from pathology. Manifestations are largely close to those characteristic of adult patients. The patient is sick and vomits, the child feels soreness in the abdomen. Observation of the sufferer makes it possible to notice that, unknowingly, the child bends the right leg in the knee and presses it to the stomach. Having noticed such symptoms, you should not pull: the sooner you can determine the inflammatory process and take measures to eliminate it, the lower the risks. A protracted pathology can provoke the death of the patient, which is especially likely due to the weakening of the juvenile organism.
What triggered?
If a certain form (including gangrenous) of appendicitis is detected , the doctor writes in the medical history of the surgery not only the features and manifestations of the case, but also the reasons that provoked the pathology in a particular patient. Several factors are known that can start the inflammatory process. The appendix walls, as scientists have established, are formed by lymphoid structures, and the dimensions of the danger zone are up to 10 cm long, up to a centimeter in diameter. The appendix is sometimes filled with various substances and is normally emptied. Violation of this process provokes stagnant phenomena, as a rule, this is due to blockage of a small clearance. In children, it is often explained by the proliferation of follicles of lymphoid tissue, and in adults, too dense feces can become the cause.
Obstruction of the lumen forms conditions that are comfortable for pathogenic microflora, which are associated with impaired circulation of substances and increased local pressure. If acute appendicitis is indicated in the history of the disease, a person knows how the problem gradually progresses, inflammatory processes cover other parts of the intestinal mucosa, which sooner or later initiates vascular thrombosis. The walls of the process lose their integrity, the tissues are transformed into necrotic masses.
Anatomical subtleties
It is likely that if the patient has a mention in the history of the disease of acute gangrenous appendicitis, the person knows first hand the features of the anatomical location of the area prone to inflammatory processes. However, many people who have encountered pathology only sigh with relief after the operation, realizing that there will be no relapse, therefore they are not interested in the structural features of the human body. But doctors are obliged to know how the appendix is arranged, and where it is located, what specificity this gives to the diseases of the site.
The cecum is localized in the fossa on the right, and it cannot be said in advance and exactly what the position of the worm-shaped area is. For some, this is a top-down option, for others it is a lateral option (this is found in about one in four). Up to 20% of people live with a medially located appendix, and the rarest variant is retrocecal, when the process is either localized in the peritoneal cavity or extends beyond it. The point of connection with the cecum is always constant - the nuances of the position do not play a role. Soreness associated with inflammatory processes is most pronounced in the place where the navel connects to the ileal spine. The point was named after McBourney, who created the first official description of the clinical progress of pathology.
What triggered?
It is not always possible to understand in a particular case, because of which a person has an acute appendicitis in the history of the disease (gangrenous stage or any other). Doctors know several factors that initiate the focus of inflammation. Statistical studies have shown that the risk of this condition is reduced for people eating plant foods.
The mechanism of development of appendicitis is associated with the structural features of the site. First, an obstruction of the area occurs, associated with certain features of life or other pathologies. This creates a comfortable environment for pathogenic microflora, normally living in the intestinal tract in a minimal concentration, which harms the mucosa. So the inflammatory process begins, forcing the person to go to the clinic, where he is urgently referred to the surgeon to remove the worm-shaped area.
About the causes and consequences
With appendicitis in the medical history, the doctor will try to list all the possible phenomena that affected the appearance of blockage in a particular case. It has been established that the quality of blood flow in the intestinal zone plays a role. In case of violation of the circulation of the main fluid of our body and the appearance of blood clots, the arteries are blocked, the appendix does not receive normal nutrition, the wall suffers from hypoxia, loses its ability to defend itself from pathological microflora, which means that the risk of an inflammatory process increases.
There is a higher probability of developing pathology with a lack of dietary plant fibers that stimulate contractility of the intestinal walls. Such batteries provide the ability of the tract to be cleared of feces. If in the medical history of surgery for phlegmonous appendicitis, the doctor notes that the patient adheres to an unjustifiably unhealthy diet in everyday life and does not receive a normal amount of dietary fiber with the products, the disease can be explained by stagnation of feces and the formation of stones from this substance. Such elements overlap the lumen of the appendix. A less unpleasant symptom indicating malnutrition is frequent constipation. Doctors pay attention: this phenomenon in itself can provoke a blockage of the appendix.
It has been established that in some cases pathological processes are associated with the allergic response of the body. The reason is the excessive activity of the cellular structures responsible for natural defense. Appendix is an element of the gastrointestinal tract, whose functionality is close to the work of the tonsils in the respiratory system, and for this reason it is formed by an impressive percentage of lymphoid tissue. The blockage is accompanied by the accumulation of mucous secretions, while the outflow into the intestinal tract is disturbed, and this harms the mucosa and initiates the inflammatory process.
Chronic form
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About types
Suspicion of appendicitis is a sufficient reason for urgent hospitalization. Already in the clinic, doctors during the examination determine what stage of the process and how the disease proceeds. At first they talk about a catarrhal variant. This diagnosis is made if the inflammatory process indicates itself for no more than six hours. The focus is localized in the mucosa, which swells under the influence of prostaglandins.
The next step is phlegmonous. The focus of inflammation covers the entire wall of the vermiform section of the intestinal tract. This period begins at the end of the sixth hour of symptoms and lasts until the end of the first day. Studies show swelling of the mucous appendix, the appearance of areas of discharge of pus.
The third stage is gangrenous. It is characterized by necrotic processes in organic tissues that form the appendix. The inflammatory process extends to nearby tissues and organs. The duration of the stage is up to three days.
Perforated is the most dangerous stage of development for the patient. The walls of the affected area lose their integrity, the contents penetrate the peritoneal cavity. This gives rise to the inflammatory process, initiates peritonitis. If the patient is almost always curable at the first steps of the disease, the perforated stage is associated with significant risks of death.
The situation
It so happened that the first manifestations of appendicitis rarely become the basis for seeking qualified help. A person does not understand why the stomach hurts, and hopes that the symptom will pass on its own over time. Diagnosis, even in a clinical setting, can be difficult. Complaints and fixation of the basic manifestations suggest appendicitis, but the disease can be clarified only by the results of instrumental, laboratory studies, for which there is not always time - much depends on the severity of the patient's condition. In total, about 120 typical manifestations of appendicitis were revealed, the presence of which helps to make a diagnosis, but even checking them all does not always allow you to immediately determine exactly in which part of the gastrointestinal tract the inflammation is localized. The most reliable way to identify the focus of inflammation is laparoscopy.
In modern clinics, there are cases when the patient is admitted in serious condition, and the symptoms almost unambiguously indicate appendicitis. The patient is sent for urgent surgery, during which it is established that the worm-shaped area is healthy, and the typical clinical manifestations are due to some other factor.
Assigned Operation
Removing an inflamed element of the intestinal tract is a classic treatment option for appendicitis. After admission to the clinic, the patient is sent for research to confirm the diagnosis, then the time of the operation is prescribed. If in doubt about the causes of pain, a person is left under observation for a while.
Removal is usually done by appendectomy. There are two options for holding the event. More often they do an open operation requiring local or general anesthesia. Standard intervention is performed through a small incision in the peritoneal wall. In the presence of complications, this approach is the only acceptable one. Sanitation of the site is carried out by the method of lower middle laparotomy. During and after the intervention, the patient needs antibiotics to prevent infectious complications.
An alternative is laparoscopy. This is such a unique method of removing the worm-shaped area, which begins with the clarification of the diagnosis, after its confirmation, the surgeon conducting the research immediately removes the affected area. For the event, a puncture is made in the peritoneal wall, equipment is inserted into the abdomen. To monitor the actions, the doctor has a video camera, which makes it possible to examine the diseased areas, determine the diagnosis and immediately cut out the necessary zones.