What accumulates in the appendix. How can appendicitis be caused and should it be done? Classification and stages of development of appendicitis

The main symptom of appendicitis is pain, which is of a varied nature. It can occur suddenly, be observed in the lower back, in the right lower abdomen and epigastric region. The pain in most cases appears sharp, less often pulling and cramping. It also increases with tension of the anterior abdominal wall during walking and lifting. There are discomfort mainly in the morning and late in the evening.

Common Symptoms of Appendicitis

Lack of appetite, loose stools, nausea, vomiting - all of these are among the most common causes of appendicitis. Often they can be accompanied by painful and frequent urination. This is due to the fact that the disease progresses. Inflammation began to cross the bladder and ureter.

In order to reduce pain, you can take an antispasmodic drug. However, you can not drink more than 2 tablets. Only one-time use is allowed. It is impossible to reduce pain with cold compresses on the abdomen and use heating pads. All this will only lead to increased inflammation.

The increase in weakness and malaise is also appendicitis. They are noted by patients when strong inflammatory processes are observed in the appendix. Along with these symptoms, high fever with chills may be present. As a rule, it is not possible to bring it down with conventional medicines.

Wrong gait is also a symptom of appendicitis. When walking, patients bend to the right side, and hold their stomach with their hands, thereby protecting it from concussions and reducing pain. With a deep breath, they note sharp pains in the suprapubic region, which are of a short duration.

Discoloration of the skin is another main symptom of appendicitis. Along with this, the patient may have a weak pulse and low blood pressure. When pressing on the abdomen with a finger, localized soreness occurs, and the muscles tense up strongly.

What to do when you find yourself experiencing symptoms?

If you have one or more of the symptoms of appendicitis, see your doctor as soon as possible. It is necessary to undergo a thorough examination in order to confirm the presence of such a disease. Based on its results, it will be clear whether surgery is required, or the reason lies not in the presence of appendicitis, but in something else.

- this is an acute, less often chronic form of inflammation of the appendage of the caecum - the appendix (vermiform appendix). Depending on the form, it can occur with pain in the right iliac region of varying severity, indigestion (nausea, vomiting, stool and gas retention), and elevated body temperature. When recognizing appendicitis, they rely on positive diagnostic symptoms (Sitkovsky, Bartomier - Michelson, Blumberg - Shchetkin), data from a digital examination of the rectum and vaginal examination, and a detailed clinical blood test. Surgery (appendectomy) is indicated.

General information

Appendicitis is one of the most common pathologies of the abdominal cavity, which accounts for 89.1% of the total number of hospitalizations in a surgical hospital. Appendicitis occurs in men and women and can develop at any age; The peak incidence is between 10 and 30 years of age. Inflammation of the appendix is ​​detected in about 5 out of 1000 people a year. Appendicitis is treated by specialists in the field of abdominal surgery.

Causes of appendicitis

In the occurrence of the disease, as a rule, the polymicrobial flora, represented by E. coli, staphylococci, enterococci, streptococci, anaerobes, takes part. Pathogens enter the wall of the appendix by the enterogenous route, i.e. from its lumen.

Conditions for the development of appendicitis occur when intestinal contents stagnate in the appendix due to its kink, the presence of foreign bodies in the lumen, fecal stones, hyperplasia of lymphoid tissue. Mechanical blockade of the lumen of the process leads to an increase in intraluminal pressure, circulatory disorders in the wall of the appendix, which is accompanied by a decrease in local immunity, activation of pyogenic bacteria and their penetration into the mucous membrane.

A higher risk of developing appendicitis exists in pregnant women, which is associated with an increase in the uterus and displacement of the caecum and appendix. In addition, constipation, restructuring of the immune system, and changes in the blood supply to the pelvic organs can serve as predisposing factors for the development of appendicitis in pregnant women.

Pathoanatomy

The appendix is ​​a rudimentary appendage of the caecum, having the shape of a narrow elongated tube, the distal end of which ends blindly, the proximal end communicates with the cavity of the caecum through a funnel-shaped opening. The wall of the appendix is ​​represented by four layers: mucous, submucosal, muscular and serous. The length of the process is from 5 to 15 cm, the thickness is 7-10 mm. The appendix has its own mesentery, which holds it and provides relative mobility of the appendix.

The functional purpose of the appendix is ​​not completely clear, however, it has been proven that the appendix performs secretory, endocrine, barrier functions, and also takes part in maintaining the intestinal microflora and the formation of immune responses.

Classification

There are two main forms of appendicitis - acute and chronic, each of which has several clinical and morphological variants. During acute appendicitis, simple (catarrhal) and destructive forms (phlegmonous, phlegmonous-ulcerative, apostematous, gangrenous appendicitis) are distinguished. Catarrhal appendicitis is characterized by signs of circulatory and lymphatic disorders in the process, the development of foci of exudative-purulent inflammation in the mucous layer. The appendix swells, its serous membrane becomes full-blooded.

Progression of catarrh leads to acute purulent appendicitis. 24 hours after the onset of inflammation, leukocyte infiltration extends to the entire thickness of the appendix wall, which is regarded as phlegmonous appendicitis. With this form, the wall of the process is thickened, the mesentery is hyperemic and edematous, a purulent secret is released from the lumen of the appendix.

If multiple microabscesses form during diffuse inflammation, apostematous appendicitis develops; with ulceration of the mucosa - phlegmonous-ulcerative appendicitis. Further progression of destructive processes leads to the development of gangrenous appendicitis. Involvement in the purulent process of the tissues surrounding the appendix is ​​accompanied by the development of periappendicitis; and his own mesentery - the development of mesenterolitis. The complications of acute (usually phlegmonous-ulcerative) appendicitis include perforation of the process, leading to diffuse or delimited peritonitis (appendicular abscess).

The clinic of appendicitis in children, the elderly, pregnant women, in patients with atypical localization of the appendix has its own originality. In young children with acute appendicitis, the general symptoms inherent in many childhood infections predominate: febrile temperature, diarrhea, repeated vomiting. The child becomes inactive, capricious, lethargic; with an increase in pain, restless behavior can be observed.

In elderly patients, the clinic of appendicitis is usually erased. The disease quite often proceeds areactively, even at destructive forms of appendicitis. Body temperature may not rise, pain in hypogastrium is slightly expressed, pulse is within normal limits, symptoms of peritoneal irritation are weak, leukocytosis is small. In older people, especially in the presence of a palpable infiltrate in the iliac region, differential diagnosis of appendicitis with a tumor of the caecum is necessary, which requires colonoscopy or barium enema.

Chronic appendicitis occurs with aching dull pains in the right iliac region, which can periodically intensify, especially with physical exertion. The clinic of appendicitis is characterized by symptoms of indigestion (stubborn constipation or diarrhea), discomfort and heaviness in the epigastric region. Body temperature is normal, clinical analyzes of urine and blood without pronounced changes. With deep palpation, pain is felt in the right abdomen.

Diagnostics

When examining a patient with acute appendicitis, the patient's desire to take a forced position draws attention; increased pain with any spontaneous muscle tension - laughter, coughing, and also in the supine position on the left side due to the displacement of the caecum and its process to the left, tension of the peritoneum and mesentery (Sitkovsky's symptom). The tongue is wet in the first hours, covered with a white coating, then it becomes dry. When examining the abdomen, the lower sections of the abdominal wall lag behind when breathing.

Abdominal palpation for suspected appendicitis should be done with caution. An important diagnostic value for appendicitis is Rovsing's symptom (characterized by increased pain on the right after jerky pressure on the abdomen in the left iliac region) and Shchetkin-Blumberg (increased pain after light pressure and rapid removal of the arm from the abdominal wall).

During the examination of the surgeon, a digital rectal examination is performed, which allows to determine the soreness and overhang of the anterior wall of the rectum with the accumulation of exudate. In a gynecological examination in women, soreness and protrusion of the right vaginal fornix are determined. In the blood in acute appendicitis, a moderately pronounced leukocytosis of 9-12x10 * 9 / l is detected with a shift of the leukocyte formula to the left and a tendency to increase changes within 3-4 hours. Ultrasound of the abdominal organs in acute appendicitis reveals the accumulation of a small amount of free fluid around the enlarged appendix.

Acute appendicitis should be differentiated from right-sided renal colic, acute cholecystitis and pancreatitis, examination on a chair, ultrasound of the pelvic organs. In children, appendicitis is differentiated from SARS, childhood infections, coprostasis, diseases of the urinary system and gastrointestinal tract.

In the diagnosis of chronic appendicitis, contrasting x-ray studies are used - radiography of the passage of barium through the large intestine, irrigoscopy. Colonoscopy may be required to rule out neoplasms of the caecum.

Treatment of appendicitis

The generally accepted tactic in an acute inflammatory process is the earliest possible surgical removal of the appendix. At the stage of prehospital care, if acute appendicitis is suspected, bed rest, exclusion of liquid and food intake, application of cold to the right iliac region are shown. It is strictly forbidden to take laxatives, use a heating pad, and administer analgesics until the final diagnosis is established.

In acute appendicitis, an appendectomy is performed - removal of the appendix through an open incision in the right iliac region or by laparoscopy. With appendicitis complicated by diffuse peritonitis, a median laparotomy is performed to ensure a thorough revision, debridement, and drainage of the abdominal cavity. In the postoperative period, antibiotic therapy is carried out.

According to surgeons, appendectomy in chronic appendicitis is indicated if there is a persistent pain syndrome that deprives the patient of normal activity. With relatively mild symptoms, conservative tactics can be applied, including the elimination of constipation, the use of antispasmodic drugs, and physiotherapy.

Forecast and prevention

With a timely and technically well-performed operation for appendicitis, the prognosis is favorable. Ability to work is usually restored after 3-4 weeks. Complications of appendectomy may be the formation of postoperative inflammatory infiltrate, inter-intestinal abscess, abscess of the Douglas space, the development of adhesive intestinal obstruction. All of these conditions require emergency readmission to the hospital. The causes of complications and death in appendicitis are late hospitalization and late surgical intervention.

Appendicitis is the most common surgical disease of the digestive system, and one of the most dangerous. The danger of the disease lies, first of all, in its transience and the inevitability of the appearance of serious, life-threatening complications. The probability of encountering acute appendicitis during life is quite high. It is diagnosed in 5-10% of people.

Appendicitis can occur at any age and in people of any gender. However, statistics show that most often it becomes inflamed in people aged 5-40 years. Among patients aged 20-40 years, there are twice as many women as men, while among patients under the age of 20, men predominate. Women are generally affected slightly more often than men. After the age of 40, the probability of developing the disease decreases significantly, but does not become zero. Therefore, appendicitis can also occur in older people. Appendicitis is also rarely diagnosed in children under 5 years of age.

Description of the disease

Appendicitis is an inflammation of the appendix, located in the lower part of the intestine. In the normal state, the appendix is ​​a small tube with a diameter of 7-10 mm and a length of 50-150 mm. It branches off from the caecum, while gradually narrowing, and does not have a through passage.

The function of the appendix is ​​not exactly clear. Previously, the appendix was considered as a simple rudiment, borrowed by man from his distant animal ancestors with a herbivorous diet and now functionally useless. Now there is good reason to believe that it plays an important role in endocrine and immune processes, as well as in the formation of intestinal microflora. It has been proven that people with an appendix removed have problems getting enough beneficial microorganisms in their intestines. However, the appendix is ​​not one of the vital organs, without which the body cannot exist.

As a rule, inflammation of the appendix is ​​acute. As a result of the disease, pus accumulates in the process, which cannot freely come out due to the narrowness of the process. The appendix enlarges and becomes painful. Ultimately, this leads to a rupture of the wall of the appendix and the release of pus to the outside. This, in turn, leads to acute peritonitis (inflammation of the peritoneum), sepsis, or abdominal abscesses, which are highly likely to be fatal. The most severe complication is pylephlebitis, inflammation of the portal vein leading to severe liver damage, the lethality of which is especially high.

The disease proceeds very quickly and usually lasts no more than 2-4 days, rarely more than a week. Cases of spontaneous healing of acute appendicitis are infrequent. Sometimes a protective infiltrate from the surrounding tissues can form around the affected appendix, but this formation can also lead to an abscess. Therefore, the disease requires medical intervention and surgical treatment. With timely treatment of the disease, the prognosis is favorable.

Occasionally, chronic appendicitis also occurs, characterized by either appearing or receding symptoms, which are common for acute appendicitis. The incidence of this condition is about 100 times less than that of an acute one. As a rule, it does not require surgical treatment.

Acute appendicitis is divided into simple (catarrhal) and destructive, fraught with complications. Without appropriate treatment, simple appendicitis almost always becomes destructive.

The main stages of development of appendicitis:

• catarrhal
• Phlegmonous
• Gangrenous
• Perforated

Causes

The causes of appendicitis in adults are still not exactly established. However, scientists agree that there is no single cause of appendicitis that is common to all patients. Each patient may have their own cause. In most cases, appendicitis is caused by a blockage in the entrance of the appendix to the rectum. The causes of blockage can be different - for example, the ingress of fecal stones or foreign bodies into the process. It can also be caused by squeezing the upper part of the process due to adhesions resulting from cholecystitis or enteritis.

Bacteria - enterococci, streptococci, staphylococci and Escherichia coli - also play an important role in the occurrence of appendicitis. Most often there is a combination of both of these factors. Stagnation of the contents of the process leads to a weakening of its internal immunity and the introduction of pathogenic bacteria into the mucous membrane. There is also a theory that the main cause of appendicitis is a spasm of blood vessels that supply the appendix with blood. Another possible cause is trauma to the abdominal area, which resulted in damage or displacement of the process.

An increased incidence of appendicitis in pregnant women has also been noted due to displacement of the process caused by an increase in the size of the uterus. In the case of some diseases of the uterus, it is possible to transfer the focus of inflammation from it to the appendix.

Symptoms

For early diagnosis of appendicitis, symptoms are essential. Their knowledge allows you to cut off other diseases of the gastrointestinal tract that are not related to inflammation of the appendix.

The main signs of appendicitis in adults include:

• Acute pain in the abdomen, including pressure
• Temperature increase
• Nausea
• vomit

The first symptoms and signs of acute appendicitis do not always make it possible to unambiguously identify this disease. Initially, the disease may be disguised as another, not so dangerous, and a person may take an attack of appendicitis for renal colic or gastritis.

The main symptom of appendicitis is constant sharp pain in the abdomen. As a rule, a sharp pain appears unexpectedly, most often at night or in the morning. In the catarrhal stage, the pain is first diffused throughout the abdomen or appears in its upper part (in the epigastric region). But then the pain is concentrated in the right lower abdomen, below the navel and just above the thigh (in the iliac region).

The process of moving the focus of pain is called Kocher's symptom and is one of the main defining signs of the disease. In most cases, it indicates just about appendicitis, and not about any other disease of the gastrointestinal tract. This process occurs within a few hours after the onset of the disease. The nature of the pain also changes over time, they intensify, become throbbing and aching. The pain intensifies with laughter and coughing, deep breathing, subsides a little when turning to the right side or in a position where the legs are bent to the stomach. The pain may also radiate to the right leg and be felt when walking. When pressing on the iliac region, pain is usually almost not felt, however, if you suddenly release the stomach, then severe pain appears. There is tension in the abdominal wall.

With the development of the disease, the pain may subside for a while. But this does not indicate a cure, but only a necrosis of the tissue of the wall of the process, including its nerve endings. However, pressure on the iliac region is still extremely painful. After this stage, perforation of the wall usually occurs, pus spreads over the peritoneum and the pain returns, intensified many times over.

It should be borne in mind that sometimes the appendix can be located on the left, so in this case the left side of the abdomen will hurt. In some cases, pain can be felt in the right hypochondrium, in the pubic area, pelvis, lower back.

Symptoms of appendicitis in adults also include disorders of the gastrointestinal tract. First of all, it's nausea. Sometimes there may be vomiting and diarrhea that do not bring relief. However, diarrhea with appendicitis is characteristic, first of all, for children, in adults it is less common. There is also a delay in stool, a feeling of dryness in the mouth. With a non-standard position of the appendix, urinary retention (dysuria) may occur. Tachycardia is often noted - up to 90-100 beats per minute.

In the initial phase of the disease, the temperature rises slightly - up to + 37-38 ºС. Subsequently, the temperature may even drop to normal, but in the final stage, preceding the breakthrough of pus, it again rises to high levels - + 39-40 ºС. In this case, the pain increases significantly.

In the case of appendicitis in the elderly, its symptoms may be erased and invisible until the transition of the disease to a destructive stage. Pain may be dull in nature, nausea may be minor, and a feature such as fever may be absent altogether. However, this does not mean that appendicitis is easier in older people. On the contrary, at advanced age complications of appendicitis are much more often observed.

Diagnosis of appendicitis is also difficult in young children (up to 5 years). This is due to the fact that the signs of appendicitis in adults are usually more pronounced than in children. Sometimes appendicitis in a child is disguised as a simple indigestion. Pain is often not localized in the iliac region, and sometimes the child cannot explain exactly where his stomach hurts. In this case, one should focus on such signs as fever up to +38 ºС, tongue fur, diarrhea. However, all these symptoms can appear with other diseases, so the child must be shown to a specialist.

Atypical forms of appendicitis

There are also several forms of atypical appendicitis, in which the symptoms may differ from the standard ones.

• emipyema. A form of appendicitis with slow development, in which Kocher's symptom is absent, and pain immediately appears in the iliac region.
• Retrocecal appendicitis. It is characterized by weak signs of inflammation of the peritoneum, loose stools. Pain is often felt in the lumbar region and radiates to the thigh region.
• Left sided appendicitis. It has a classic clinical picture, but pain is felt in the left iliac region.
• Pelvic appendicitis. More typical for women. There is a slight increase in temperature, dysuria, pain radiates to the navel.

What should be done if appendicitis is suspected?

At the slightest suspicion of appendicitis, a doctor should be called. The reason for going to the doctor is any persistent pain in the abdomen that does not go away within 6 hours. Laxatives, antibiotics, or other gastrointestinal medications, and especially analgesics, should not be taken before a doctor's examination, as all these drugs can blur the clinical picture and make it difficult to make a diagnosis. It is also forbidden to install a heating pad on the right side of the abdomen, since an external heat source can accelerate the development of the disease. Bed rest is indicated. You should refrain from eating. When the doctor arrives, you need to tell him about all the symptoms, about how the stomach hurts, and allow him to conduct an examination.

Diagnostics

Diagnosis is primarily by visual inspection and palpation. The main symptoms are tense abdomen, pain in the right lower part of it. However, these methods are not always reliable. Diagnostic methods such as ultrasound, MRI and computed tomography, blood and urine tests are also used. When viewing a blood test, the main attention is paid to an increased level of white blood cells in the blood (leukocytosis). A diagnostic laparoscopic examination can also be performed through an opening in the abdominal wall.

It should be noted that the recognition of the disease can be difficult, since the symptoms of acute appendicitis are in many ways similar to other diseases of the gastrointestinal tract. These include acute gastroenteritis, pancreatitis, an ulcer (especially if it is perforated), intestinal or renal colic, inflammation of the uterus, stretching or tearing of the abdominal muscles. Therefore, it is important to differentiate appendicitis from other diseases, which in most cases do not require urgent surgical intervention.

Treatment

Appendicitis is usually treated with surgery. It consists in removing the appendix (appendectomy operation). In some cases, it may be preceded by antibiotic therapy. Sometimes conservative treatment is also possible, without removing the process - in this case, antibiotics are prescribed. As a rule, it is resorted to if there are any contraindications to the operation.

The operation to remove the process is performed either in the traditional way, using an open incision, or by laparoscopic method. For the first 12 hours after surgery, bed rest and food should be avoided. In the recovery period, it is also possible to treat the consequences of the disease with antibiotics. The duration of the recovery period depends on the stage of the disease at which the operation was performed and is usually 1-2 weeks.

Inflammation of appendicitis is a process that affects the appendix. This element belongs to the caecum and is referred to in medicine as the "appendix". vary somewhat, this is determined by the form and individual characteristics of the patient. Allocate chronic and acute inflammation of appendicitis in children and adults. The first option in the last few years is much less common than before. As a rule, the reason is that acute inflammation proceeded with complications, due to which removal was impossible.

acute form

With this type of disease, several stages are distinguished. One stage eventually passes into another, if there was no intervention from the doctors. They talk about:

• Catarrhal appendicitis at this stage usually affects only the mucosa of the appendix.
• surface form. In this case, progress is observed relative to catarrhal, which leads to damage to the mucous membrane of the organ. By examining the lumen of the process, you can see leukocytes and blood.
• Phlegmonous stage. It is characterized by inflammation that affects all layers of the tissues of the body. Destructive processes are affected, including the outer shell of the appendix.
• Phlegmonous-ulcerative. This form is characterized by ulceration of the mucosal surface that protects the organ from the outside.
• Gangrenous. This stage is characterized by necrosis of the process wall. Often there is a breakthrough of tissues, causing the contents of the appendix to pour into the abdominal cavity, which provokes peritonitis. With the development of appendicitis to this stage, the probability of death is high.

Time does not endure

As a rule, inflammation of the appendix goes through all the steps described earlier in just 48 hours. Acute inflammation of appendicitis is a dangerous disease that does not tolerate delay.

At the first sign, it is urgent to visit a surgeon. If the disease has reached the phlegmonous stage, the risk of complications increases.

Pain as the first signal

Highlighting the signs of inflammation of appendicitis, pain is mentioned first of all. It appears in the area near the navel. Feels dull, does not go away with time, constant. Sometimes around the middle. Less often, painful sensations cover the abdomen completely. Sometimes the pain is felt on the right in the iliac region.

Strengthening of unpleasant sensations occurs when a person walks, bends over. Pursued by sharp discomfort when coughing and laughing. It hurts a lot to sneeze. But the elderly are characterized by the absence of pain.

Please note that with an atypical location of the appendix, pain may be felt in an unpredictable place. Sometimes it hurts on the right under the ribs, near the pubis or in the region of the kidneys, ureters. Pain may radiate to the hips or lower back. In some cases, it is noted that pain is felt in the external genitalia. An undefined area on the left side of the body may hurt.

A few hours after the initial appearance of the pain syndrome, sensations shift towards the appendix. These signs of inflammation of appendicitis in women are very important: if you suddenly stop feeling pain, there is a high probability that the disease will go into a gangrenous form, which is associated with the death of nerve endings in the affected area. You can’t pull: you need to urgently call a doctor!

Nausea and vomiting is also appendicitis

Particular signs of inflammation of appendicitis in adult men and women are vomiting and nausea that accompany the pain syndrome. Please note: before the onset of pain, such sensations are not observed. If nausea first appeared, and only then the pain came, it is likely that the matter is not in the inflamed appendix, but in another pathology, which the doctor will definitely be able to diagnose.

You should also know that in most cases, vomiting occurs only once. Why is this characteristic inflammation of appendicitis? Symptoms in adults suggest that this is a reflex rejection of toxins by the body.

Language and temperature

The characteristic symptoms of inflammation of appendicitis in women and men include changes in the tongue. At the beginning of the disease, it is usually moist and covered with a thin white coating. As appendicitis progresses, the tongue becomes dry. This shows that inflammation of the peritoneum has begun.

The temperature usually rises insignificantly. How to determine the inflammation of appendicitis, focusing on it? Remember that patients usually have a temperature of 37 to 38 degrees. It remains unchanged for a long time. In rare cases, a rise above 38 degrees is recorded. But if the body temperature has risen even higher, it is safe to say that the inflammatory process is progressing in earnest.

What else to pay attention to?

Characteristic signs of inflammation of appendicitis, suggesting the disease, include stools, although this is more typical for older people. Constipation noted. If the appendix is ​​near loops of the small intestine, diarrhea is more likely. For this reason, cases of erroneous hospitalization of the patient in the infectious diseases departments are not uncommon.

Due to the severe condition of the body, sleep is disturbed. General discomfort greatly affects a person's feeling of his body, pursues a state of fatigue, lethargy, indifference.

Appetite in acute appendicitis usually disappears completely.

Chronic form

Statistics show that this form develops very rarely, no more than one percent of all cases of inflammation of the appendix. Inflammation after appendicitis is manifested by pain on the right in the iliac region. Feelings are dull. Localization of pain is valid for a typically located organ.

How to determine the inflammation of appendicitis if the disease has become chronic? There is only one option: visit a doctor who will conduct a full range of diagnostics. The study usually includes:

• laparoscopy;
• tomography.

easy to confuse

Chronic appendicitis in its manifestations is close to a number of diseases, including:

• pyelonephritis;
• ulcer;
• chronic form of cholecystitis.

Chronic inflammation of appendicitis can be suspected if you regularly suffer from soreness that increases when a person moves the body (bends, turns). When the disease worsens, the temperature rises slightly, the general manifestations are similar to the acute form.

What is dangerous?

Chronic appendicitis is dangerous primarily because it can cause peritonitis. If a disease is suspected, it is necessary to urgently visit a doctor in order to assess exactly how serious the patient's condition is.

In general, practice shows that it is the timely visit to the doctor that saves people's lives. Having tightened up with an ambulance call, at best, you can “reward” yourself with very unpleasant moments of sharp pain, at worst, a fatal outcome awaits.

That also happens!

One of the most famous cases of treatment of appendicitis in modern medicine occurred at a Soviet station in Antarctica, where a doctor was among the permanent staff. During his stay at the station, due to obvious symptoms, the specialist diagnosed himself with inflammation of appendicitis in an acute form.

At first there were attempts to apply conservative methods of treatment: they resorted to ice, antibiotics and fasting. But this practice did not show results. There were no other doctors at the station at the time. The doctor decided to independently perform the operation on himself and immediately began to do so.

During the operation, the mechanical engineer of the research station held the mirror, a meteorologist was involved - he gave the tools. The doctor operated on himself for almost two hours. The result was successful. Just a week later, the physician was able to perform his regular functions again. The example of this operation is one of the most famous in our world, demonstrating human courage and readiness to fight any difficulties.

And if in ordinary life?

Of course, stories about incidents at the Arctic stations are curious for everyone, but in ordinary life, in everyday life, everything is much simpler. With signs of appendicitis, there is no need to show miracles of courage and become a hero, you just need to use medical help in a timely manner. Who to contact if you suspect appendicitis?

Call an ambulance first. As a rule, by the time a person realizes that he needs the help of a doctor, it is already too late to go to the clinic himself - the pain that accompanies every movement is too strong, and even a slight cough. Turning to the services of emergency medical care, the patient quickly, already in his bed at home, receives a primary diagnosis.

The next stage is the examination of the patient by a therapist in a hospital setting. Here, under the supervision of an anesthesiologist, an accurate diagnosis will be made and it will be determined what the stage of the disease is and what measures need to be taken. In some cases, inflammation of the appendix is ​​accompanied by severe pathologies that develop against the background of the disease of the appendix. Then you will have to involve specialized doctors in the treatment. The most difficult cases of inflammation of the appendix, accompanied by:

• recent myocardial infarction;
• decompensated diabetes mellitus.

Children are a special case

As a rule, diagnosing inflammation of the appendix in young children is characterized by increased complexity. The child cannot explain clearly and distinctly what exactly hurts him and where. In some cases, inflammation develops at such an early age that the baby does not even know how to speak. How to suspect the disease in this case?

Usually, with the development of the appendix, a small child cries a lot, worries, as if showing his stomach to others. But if adults try to touch, he protests and only cries and screams even louder. The disease develops gradually, the symptoms increase over time.

During the day, a sick child squats down and bursts into crying without any prerequisites. At night, children often wake up from pain. The development of the disease manifests itself as vomiting and nausea. If in adults this is a one-time phenomenon, then in young children it is repeated many times. Doctors say that this is a reflex reaction of the body to toxins, the release of which accompanies the inflammatory process.

Elderly people have their own characteristics

As for older people, their inflammation of appendicitis occurs with a number of characteristic features that complicate the diagnosis of the disease. First of all, it is a weak pain syndrome, which is often absent altogether. Because of this, the definition of appendicitis occurs with a significant delay.

You can suspect something was wrong by the missing appetite and the tension inherent in the muscles on the right, in the iliac region. You can feel it by palpation of a part of the body. However, it is not recommended to examine the body on your own, as you can harm yourself. Also, in the elderly, various atypical manifestations of appendicitis are observed, which science has not yet been able to systematize. Therefore, it is recommended to visit a doctor for any doubtful signs, to undergo an examination and a full range of studies. This will determine whether the appendix has become inflamed, as well as identify comorbidities.

Acute inflammation of the appendix can be called the most common pathology among adults, and it is she who is a fairly common reason for surgical intervention. An attack of appendicitis in adults occurs due to inflammation of the process of the caecum, called the appendix.

The problem of appendicitis in women aged 20 to 40 occurs twice as often as in men. Although risk groups have been known for a long time, nevertheless, no one is immune from such a health problem as appendicitis. It is quite fair to note that this pathology is heard by almost everyone and almost everyone is able to recognize its main symptoms. Such vigilance is not excessive, since a delay in the operation for appendicitis can cause not only complications, but can lead to death.

The causes of inflammation of the appendix often come down to the development of infectious diseases such as:

According to other data, based on direct observations, the appendix can become inflamed due to blockage with fecal stone or helminths, due to the growth of lymphoid tissue, the formation of a neoplasm, or due to clogging of the appendix with food debris: seed husks, grape seeds, small bones. It is also possible to bend the appendix, caused by scars formed due to the development of chronic colitis, cholecystitis, enteritis, perityphlitis, adnexitis, or due to adhesions in the peritoneum.

However, there are other causes of inflammation of appendicitis, for example, those associated with the vascular and endocrine systems. Nevertheless, the most common provocateurs of appendicitis are coprolites. Stones form in patients suffering from constipation, which is often a sign of a lack of fiber in the diet. In addition, permanent problems with emptying often become the impetus for the occurrence of colon cancer.

Whatever the cause of appendicitis in women and men, in the end, it leads to the accumulation of mucus. Deprived of an outlet, it provokes a stretching of the appendix and causes inflammation. Increasing pressure creates an obstacle to the flow of blood and lymph, which only aggravates the inflammatory process, entails the appearance of pus and tissue necrosis. If no action is taken at this time, the pus will reach the peritoneum and provoke peritonitis or pylephlebitis. Their main danger is the possibility of death. It is probable if the duration of such processes is more than two days.

Symptoms and signs of the disease

The stages of development of appendicitis in adults were divided in accordance with the classification of V. Kolesov:

• appendicular colic (moderate pain in the lower abdomen on the right, which subsides after 4 hours);
• catarrhal stage;
• destructive stage (includes phlegmonous, gangrenous, perforative);
• complicated stage (characterized by serious consequences, for example, peritonitis).

catarrhal stage

It covers the initial 12 hours of appendicitis in women and men. Often the process begins with discomfort and pain in the stomach area, usually in the evening or at night. Often these symptoms are confused with manifestations of gastritis, and since they are not so intense, because the pain most often has a dull nature, the patients do not pay due attention to it.

At the same time, there are attacks of nausea and a single vomiting is possible. It is generally accepted that nausea in appendicitis has a reflex nature and often in aged patients this symptom is not expressed, and this complicates the diagnosis and leads to late detection of the disease.

After a couple of hours, the pain migrates to the right iliac region (if the appendix is ​​located on the right). Then the nature of the pain syndrome changes - the pain becomes pressing, pulsating, and also increases. It is likely that diarrhea will appear and urination becomes noticeably more frequent, and there is an increase in temperature.

Within 6–12 hours from the onset of the process, the usual symptoms of general intoxication appear:

• lethargy;
• bad feeling;
• heartbeat quickens;
• there is a feeling of dryness in the mouth.

Against this background, pain intolerance is noted, as it becomes even more intense. This stage is also characterized by the fact that the abdomen still remains soft, but there is pain when pressed on the right. This stage is considered ideal for the operation, but the majority of people seek medical help much later.

Phlegmonous stage

This stage ends with the end of the first day from the onset of the pathology of appendicitis in women and men. The pains are clearly identified in the iliac zone on the right, they are pulsating and very strong. There is a permanent feeling of nausea and tachycardia (up to 90 beats per minute). Temperature indicators are kept within 38 degrees.

If you examine the abdomen, then the obvious delay of the right side during breathing is noticeable. Further, other symptoms of inflammation in the peritoneum appear: abdominal tension in the lower region on the right, all diagnostic signs become more and more pronounced and the diagnosis is no longer in doubt. It is at this stage that most patients undergo surgery.

gangrenous stage

This stage is characterized by a deceptive relief of pain, as there is a process of necrosis of the nerve endings of the appendix wall, and this reduces sensitivity. At the same time, the symptoms of general intoxication increase, tachycardia is observed, and vomiting is likely. Often at this stage of appendicitis in adults, there is a drop in temperature (sometimes below 36 degrees). At the same time, there is bloating and lack of peristalsis. An attempt to feel the area of ​​dislocation of the appendix is ​​associated with unbearable pain.

perforative stage

The process of perforation of the wall of the appendix is ​​accompanied by unbearable pain of increasing intensity, which is located in the right lower abdomen. There are simply no moments of relief - the pain becomes permanent. In addition, there is repeated vomiting. The person complains of excessive tachycardia, his abdomen shows signs of swelling and tension, and in addition there is no peristalsis. The white coating on the tongue is replaced by brown.

The temperature reaches dangerous levels. The result of the perforation of the appendix is ​​purulent peritonitis or local abscess. A similar stage is often characteristic of the third day of the disease, however, in fact, all stages and terms are rather unstable, since it is likely that a fulminant or latent course of appendicitis in women and men is likely.

Signs of a chronic process

Appendicitis, which has a chronic form, is a very infrequent occurrence. As a rule, the indicator of such a pathology does not exceed 1% among all cases. The symptoms of appendicitis are characterized only by occasional regular pain, the intensity of which increases with walking and coughing. In the case of a recurrence of a chronic process, its symptoms are similar to those of acute appendicitis, however, the temperature can be both subfebrile and may be within the normal range. The clinical picture of appendicitis is extremely similar to the course of pyelonephritis, cholecystitis, peptic ulcer, chronic gynecological and other pathologies of the peritoneal organs.

Diagnosis of appendicitis

An accurate diagnosis of "acute appendicitis" is made on the basis of:

• a blood test that shows signs of inflammation (increased white blood cell count)
• information obtained during the interview of the patient;
• measurements of temperature indicators;
• physical examination results;
• indications of ultrasound or CT.

It is necessary to clearly check the diagnosis, making sure that the patient does not suffer from diseases such as pancreatitis, acute gastroenteritis, covered perforation of a gastric or duodenal ulcer, renal colic, intestinal dyskinesia or pleuropneumonia. If the appendix has an atypical localization, then it should also be distinguished from cholecystitis, urological or gynecological pathology.

When there are fluctuations in determining the diagnosis of "acute appendicitis", then specialists can use the method of laparoscopic examination. Such a diagnostic method helps to obtain a verified diagnosis, and also provides the opportunity, if necessary, to immediately resort to laparoscopic appendectomy.

Treatment of the disease

Removal of this inflamed process is an accepted medical practice. Removal of the appendix in the early stages of the development of the disease is carried out using a minimally invasive laparoscopic operation. If symptoms of peritonitis are observed, then cavity surgery is inevitable. There are cases when the intervention begins with the method of laparoscopy, and ends with a cavity operation. This is possible when detecting the spread of inflammation outside the walls of the appendix.

The average postoperative period includes up to 10 days, and its duration is directly determined by the volume of surgical intervention, the stage of appendicitis pathology, as well as possible postoperative complications. The sooner they resort to surgery to remove appendicitis (optimally at the catarrhal stage), the shorter the recovery period will be, and the person will be able to plunge into their usual life faster. That is why even with slight suspicions of an attack of acute appendicitis, you should seek emergency medical care.

Methods of conservative therapy are used very infrequently and only with mild symptoms of appendicitis and general intoxication of the patient's body, as well as if there are contraindications to the surgical operation.

When the process develops, then appendectomy is performed in any case. In the West, one may encounter the practice of intravenous antibiotic therapy, which is prescribed in the very early stages of appendicitis. Domestic medicine does not support such methods and can use antibiotic treatment only in the postoperative period.