Early signs of appendicitis. How does appendicitis begin: a description of the first signs and symptoms. Diagnostic signs of the disease

Appendicitis is an acute surgical pathology that requires emergency care. Inflammation appendix from time immemorial one of the most important problems of medicine. The causes of this condition are still not fully understood.

Despite the fact that the process is well known, has characteristic clinical symptoms, the occurrence of severe forms and mortality remain at high level.

According to statistics, young women are most susceptible to this disease, due to the structural features of the body.

Therefore, for them, the questions: what is appendicitis, symptoms in women where is the appendix, are especially relevant.

It is important that it is the most common surgical pathology in pregnant women. This poses a particular danger to the life of the mother and the unborn baby.

Therefore, signs of appendicitis in women, the symptoms that occur when carrying a child, should be seen on early stages development of the inflammatory process.

What is appendicitis

Appendicitis is an inflammation of the tissues of the appendix (appendix).
It is located near the valve that separates the large and small intestines.

In a typical location, the appendix departs from the caecum in the direction forward and down in the right iliac region.
But often the localization can be different. Therefore, if it occurs, appendicitis on which side the stomach hurts in women will be determined by its position in abdominal cavity.
Thus, the discharge of the appendix can be:

Retrocecal - behind the caecum;
Retroperitoneal (retroperitoneal) - behind the peritoneum (serous membrane covering the walls and organs of the abdominal cavity ();
Pelvic - in the pelvic region, with the prolapse of the intestine or a large length of the process;
Medial - closer to the middle of the abdomen;
Subhepatic - in close proximity to bottom surface liver;
Left-sided - with the left-sided position of all organs of the abdomen (rare congenital anomaly).

The appendix is a strand in the form of a cylinder, about 1 cm in diameter, about 10 centimeters long.

There are variations in length from 2 to 30 centimeters.
It consists of several layers: inner - mucous membrane, submucosal, muscular and serous - outer shell.

The spread of the inflammatory process relative to the layers determines how it hurts. Symptoms in women depending on the stage of the process will be different.

Vessels through which blood and lymph circulation occurs, as well as nerve fibers pass in the fold of the peritoneum (mesentery), which is attached to the appendix at the place of its discharge from the caecum.

The submucosal layer is rich in lymphatic cells, therefore, according to one of the theories of medicine, the appendix is an organ immune system providing local protection at the location.
It does not participate in digestion, although it belongs to the organs of the gastrointestinal intestinal tract.

The reasons

Inflammation in the appendix is infectious nature. But the specific causative agent of the disease could not be identified. Cause pathological process pyogenic bacteria that are in the intestines of all people (conditionally pathogenic flora). But in order for it to arise, provoking factors are needed.

Among them are the following possible reasons development of the inflammatory process:

Stagnation stool in the region of the caecum with constipation;
Blockage of the lumen with a "fecal" stone;
A foreign body that has fallen into the cavity of the appendix (fruit seeds, bone fragments, bristles from a toothbrush);
Excessive growth of lymphoid tissue of the submucosal layer;
Torsion and clamping of the process (with its long mesentery);
Infringement or blockage (thrombosis) of the supply vessels;
Worm infestation;
Abnormal structure of the appendix (doubling, consisting of several parts);
The predominance of protein products in the diet (provoke the processes of decay in the intestines);
Dysbiosis of the intestinal flora (predominance pathogenic flora over beneficial bacteria)
Inflammatory diseases of the large and small intestines;
Intestinal infections of various origins;
Adhesive process in the region of the caecum;
Infringement of the process in the inguinal or femoral hernia.

For any reason or a combination of them, the evacuation of the contents of the appendix is disturbed, it stagnates, and when the bacterial flora is attached, the putrefactive process begins. In this case, damage occurs in stages in all layers of the process.

Clinical manifestations

Due to the anatomical features of the location of the appendix, clinical picture inflammation can be very diverse. Only with typical localization, the symptoms will have characteristic features. The stages of the course of the disease correspond to the degree of tissue damage.

There are the following forms of appendicitis:

Spicy:

Catarrhal - damage only to the mucous layer;
Phlegmonous - the submucosal layer is involved, swelling of the serous membrane, around the imposition of fibrin, pus accumulates in the lumen;
Gangrenous - the walls of the appendix with areas of necrosis (necrosis);
Perforative - destruction of the walls (destruction) occurs with the release of pus into the peritoneal cavity.

Chronic:

Primary;
Recurrent (with periods of exacerbation).

Complicated:

Peritonitis - inflammation of the peritoneum (local or widespread);
Appendicular - a conglomerate of organs adjacent to the appendix soldered together;
Abscesses (collection of pus) in the abdomen different localization;
Phlegmon of cellular spaces behind the peritoneum;
Pylephlebitis - inflammation portal vein liver.

Its complications can be both a consequence of inflammation of the process, and occur in postoperative period.

If acute appendicitis occurs, symptoms in adult women appear, as a rule, against the background of full health.

The following clinical manifestations of the disease are distinguished:

Nonspecific first symptoms of appendicitis (lethargy, dry mouth, nausea, worsening general condition);
Vomiting is reflex in nature, occurs once;
The chair in most cases is not disturbed, with the localization of the appendix in the pelvis, it can be liquid;
The pain is constant, at the beginning it is noted in the epigastric region or "throughout the abdomen", then it moves to the right iliac region (Kocher's symptom);
Pain may increase with the development of the disease or decrease (with the death of nerve cells);
When coughing, walking, changing the position of the body, the pain intensifies;
Subfebrile fever (37 - 38 ° C).

For pain in a typical process, irradiation (spread beyond the lesion) to the lumbar, supraclavicular, inguinal region. This requires the exclusion of other diseases or an atypical location of the process.

Features of the clinic of inflammation of the appendix with an atypical location

With a retrocecal location, pain may be of low intensity.
The process is usually limited.

Irradiation to the lumbar region is noted. An increase in pain while lying down is determined, when trying to raise the right leg.

With retroperitoneal localization of the process characteristics erased from the abdomen.

Pain is localized in the lumbar region, aggravated by effleurage.
There are signs of urinary incontinence. rises above 39 °C.

When the appendix is in the pelvis, there is a slight soreness over the bosom. Arises liquid stool, urge to defecate, difficulty urinating.

With a median location, pain is localized around the navel. Observed high fever, flatulence. There is tension in the abdominal muscles in the umbilical region.

If the appendix located in the subhepatic space is damaged, the clinic is identical to acute cholecystitis (inflammation of the gallbladder). noted Blunt pain in the right hypochondrium.

With left-sided appendicitis, pain is localized on the left. on the right side indicates the reverse arrangement of organs.

Empyema of the appendix

This type of inflammation refers to the phlegmonous form.
When this occurs, as a result of blockage of the lumen, a cavity filled with pus.

The appendix expands in the form of a flask. It is characteristic of this form that the serous membrane is not damaged and the inflammation does not pass to the peritoneum.

In the clinical picture with empyema, there is a lack of Kocher properties.
If the appendix is clogged, the sensations will be somewhat different.

The pain is localized immediately in the right iliac region and increases over several days, becomes pulsating.
There may be single or double vomiting. The body temperature gradually rises.

Chronic inflammation of the appendix

Very rarely, chronic appendicitis occurs. Symptoms in women are expressed in intermittent moderate pain in the right iliac region.

Also, pain may increase with physical activity, during menstruation, or during sexual intercourse. There are no signs of peritoneal irritation.

Arises chronic process in the appendix as a result of the regression (regression) of inflammation in acute catarrhal appendicitis.
In this case, adhesions are formed between the appendix, the dome of the caecum and the peritoneum.

Diagnostics

Determining the lesion of the appendix in typical cases for an experienced surgeon is not difficult.

Diagnosis is carried out on the basis of an analysis of data on the development of the disease, as well as the identification of appendicular signs during direct examination:

Soreness and muscle tension, localized on the right;

With careful tapping, symmetrically on both sides, pain is detected in the right iliac region (Razdolsky's symptom);
When pulling on the patient's shirt and running a hand over it from the epigastric region (epigastrium) to the right iliac, on exhalation, it is determined sharp pain on the right (resurrection symptom);
Increased pain on the right side when turning to the left side (Sitkovsky's symptom);
The appearance of a sharp pain on the right when the hand is taken away from the site of inflammation after pressure (Shchetkin-Blumberg symptom);
Soreness with pressure in the right iliac region, when raising the right straightened leg (Obraztsov's symptom).

Instrumental and laboratory methods diagnostics:

Ultrasound is performed for all women admitted with an acute abdomen clinic. Fast and affordable, but not always informative method;
CT scan carried out subject to the technical possibilities and the availability of time. Is an accurate and non-invasive (not penetrating) study;
Diagnostic endoscopic laparoscopy is the "gold standard" in the detection of inflammation of the appendix. Three small punctures are made in the abdominal wall (for a gas blower, for a videoscope and a manipulator). The right iliac and other areas of the abdomen are objectively examined. Can be extended for appendectomy (removal of the appendix).
An extended blood test. Detects markers of acute inflammation (increased levels of leukocytes, a shift in the leukocyte formula, increased ESR).

Given atypical appendicitis, symptoms in women where the process is located may mask the pathology of other organs located nearby.

Therefore, it is necessary to conduct a differential diagnosis with the following diseases:

Ectopic pregnancy. At the same time, there are indications of the transferred gynecological diseases, cycle disorders, positive pregnancy test. The disease occurs acutely, possibly with loss of consciousness, pallor of the skin, a drop in pressure. Sharp pains radiating to the right shoulder. At vaginal examination defined overhanging painful posterior fornix.
Acute inflammation of the uterine appendages (adnexitis). Soreness is determined in the lower abdomen, lower back, gives in the leg to the knee. There is purulent discharge from the vagina. At gynecological examination a painful ovary is determined.
Torsion of an ovarian cyst. Soreness in the lower abdomen is accompanied by vomiting. No Kocher sign. During vaginal examination, a soft elastic formation above the womb is determined.
Food poisoning is characterized by uncertainty pain syndrome. The predominance of dyspeptic disorders (nausea, vomiting, diarrhea). There is an indication of the use of low-quality food.
Right-sided renal colic or pyelonephritis is accompanied by pain in the lower back with irradiation to the genitals. There is restless behavior, impaired urination. Blood, bacteria, leukocytes are found in the urine sediment.
Acute intestinal obstruction characterized by severe cramping pains, flatulence, vomiting, gas and stool retention. The diagnosis is confirmed radiographically (with obstruction, swollen bowel loops with fluid levels are determined).
Perforated. There is a sharp "dagger" pain in the epigastrium, vomiting with blood. There is a "board-like" tension of the abdominal muscles. The patient's face is pale, with a pained expression, covered with sticky cold sweat.
Acute cholecystitis. With it, pains are localized in the right hypochondrium, are cramping in nature, give to the region of the right shoulder blade and shoulder. Possible vomiting with an admixture of bile.
Acute pancreatitis characterized by diffuse girdle pain in the upper abdomen. Accompanied by indomitable, debilitating vomiting, discoloration of the skin.

Treatment

Treatment of appendicitis is surgical.
It is carried out immediately upon confirmation of the diagnosis.

Only if the patient has developed peritonitis, the operation is briefly postponed to stabilize vital signs and conduct preoperative preparation.

Surgery is performed under general endotracheal (insertion of a breathing tube into the trachea) anesthesia. Depending on the nature of the inflammation, the operation can be performed through incisions (laparotomy) or punctures (for the introduction of endoscopic instruments).

With catarrhal and phlegmonous appendicitis, laparoscopic surgery is possible.
And with gangrenous and the development of complications, only general access with the opening of all layers abdominal wall, with a possible expansion of access in the presence of a massive lesion of the abdominal organs.

In the postoperative period, antibacterial, restorative therapy is prescribed.
The dressings are regularly changed with the treatment of sutures, the change of drainage (means of outflow of fluid from the abdominal cavity).

The passage of gases is actively stimulated in order to prevent intestinal paresis due to the action of anesthetic drugs.
Complications may require therapy in the intensive care unit.

The recovery time in each case is individual and depends on age, presence of concomitant pathology, stages of inflammation and terms of rendering medical care.

With catarrhal and uncomplicated phlegmonous appendicitis, provided that the postoperative period is smooth, recovery occurs in 7-14 days.

Appendicitis in pregnancy

If appendicitis occurs in a pregnant woman, the symptoms of the disease can be masked by the usual manifestations of the period of bearing a child.

Nausea as a manifestation of toxicosis, pain as a reaction to a growing uterus, leukocytosis as a general reaction of the body to pregnancy.

This is due to untimely seeking help and, as a result, belated diagnosis. Therefore, the most common form of appendicitis in women in position is phlegmonous.

Inflammation of the appendix occurs in pregnant women more often than in other population groups, this is due to the fact that the growing uterus displaces the caecum with the process upward, provoking its infringement, torsion and reduced blood supply.

What leads to stagnation of feces and development pathogenic microflora. because of hormonal changes there is a decrease in immunity, one hundred contributes to inflammation with the development of destructive forms of the disease.

Clinical manifestations in the first half of pregnancy are no different from the sensations in non-pregnant women.
In the second half, there is some difference, as appendicitis hurts, symptoms in women are associated with displacement of organs by an enlarged uterus.

Pain in pregnant women is mild, localized above the iliac region, depending on the gestational age.
Muscle tension due to their stretching is also not detected.

Body temperature is moderately elevated. It is necessary to palpate the area of the appendix carefully, placing the woman on her left side.

Appendectomy is performed regardless of the month of pregnancy.
On the early dates The operation is performed, if possible, laparoscopically.

In the later stages, the incision is made higher, in accordance with the location of the displaced appendix.
At full-term, first, based on the patient's condition, emergency delivery is carried out through the natural birth canal or through caesarean section.

At natural childbirth shorten the period of attempts and expulsion of the fetus by applying vacuum extractor, obstetric forceps by making an incision in the perineum.

The treatment strategy must be coordinated with obstetrician-gynecologist. In the postoperative period, drugs are prescribed that reduce the tone of the uterus (tocolytics), hormonal drugs, to prevent the threat of interruption.

Currently, acute and chronic appendicitis is quite common. Symptoms in women may be typical, or may differ from the usual clinical picture due to structural features. female body.

The issue of inflammation of the appendix in pregnant women is especially relevant, which can be the cause of the death of the mother and child.

Therefore, the earliest possible application for medical assistance, in the initial stages of the disease, will determine the prognosis for life and the timing of recovery.

Appendix, lat. appendix vermiformis - appendix, 5-7 cm long (sometimes 20 cm), 1 cm in diameter, blindly ending, tubular shape.

Exacerbation of appendicitis can occur at any age. Risk groups are children over 5 years old, adults 20-30 years old, pregnant women. Pathology is equally characteristic of the female and male. Very rarely, appendicitis occurs in young children, which is explained by the age-related anatomical feature of the appendix, which has the shape of a funnel and is easily emptied, and the poor development of the lymphoid apparatus of the process.

Among all diseases of the abdominal organs that require urgent surgical intervention, appendicitis is the most common. If there is an attack of acute appendicitis, you need to as soon as possible call an ambulance. If appendicitis is left untreated, peritonitis can develop, a complication that is fatal.

How Appendicitis Manifests, Symptoms and Signs of It emergency every person should know. Main symptom appendicitis in adults and children - pain. It occurs in the upper abdomen or near the navel, sometimes it is not possible to pinpoint the exact location of the pain (“the whole stomach hurts”). Then the pain moves to right side belly. This migration of pain is considered highly specific feature diseases

Causes of appendicitis

Allocate the following reasons inflammation of the appendix:

The appendix is a small outgrowth of the caecum. In most people, it is located on the right side of the abdomen, below the navel. On which side of a person's appendicitis, the condition of the intestine can affect. If appendicular peritonitis has developed, then the symptoms are pronounced and acute, the localization of appendicitis pain is usually on the right side, this is typical for the development of an acute inflammatory process in the patient's body, which requires emergency medical care and surgery to remove the appendix.

Appendicitis can be located differently in the peritoneal region, which gives an ambiguous picture in the localization of symptoms, pain can be given as in right side and in the lumbar region, or in the pelvic region, the patient's genitals. The nature of pain has a different intensity, intensifying or subsiding, cramping, can last for a long time or for a short time.

Signs of appendicitis

There are many different signs of appendicitis in adults and children. The signal for the onset of the disease is strong pain. At the very beginning, it does not have a relatively clear location. It may seem to a person that he just has a stomach ache. However, after 4-5 hours, the pain is concentrated closer to the right iliac region.

It should be noted that the appendix different people can be located in different ways, it all depends on the structure of the body. If the process has a normal position, then pain will be observed in the right iliac region. If the process is located slightly higher, then the pain will be on the right under the ribs. Well, if the process is lowered down, it will hurt in the pelvic area. Among other things, the patient may be disturbed by vomiting, and in some cases diarrhea.

Among other popular signs of appendicitis, the following can be noted: dry tongue, dark urine, fever, which can reach 40 degrees, pregnant women may experience increased pain while turning from left to right.

Symptoms of appendicitis

In the case of acute appendicitis, the symptoms are pronounced. There is an attack of pain in the right iliac region, expressed locally and general reaction organism. Typically, pain acute appendicitis start suddenly.

At the beginning of an attack, they are often localized in epigastric region, in the navel or throughout the abdomen, and after a few hours (sometimes after 1-2 days) - in the right iliac region. More often, the pains are permanent, do not radiate anywhere, but are aggravated by coughing. does not allow the patient to fall asleep, but its intensity is usually small; characterized by a decrease in pain in the position on the right side.

In the first hours of the disease, nausea and vomiting may occur. The chair and gases are often late. Liquid stools are much less common (mainly with severe intoxication). Body temperature rises to 37.5-38 °, less often remains normal. The pulse on the first day from the onset of the disease increases to 90-100 beats per 1 min, blood pressure does not change, and only with severe intoxication decreases slightly. The tongue is at first slightly coated and moist, but soon becomes dry.

There are other symptoms of appendicitis as well. For example, when examining the abdomen, they often determine the lag in breathing. lower divisions abdominal wall. Palpation of the abdomen should be carried out carefully, starting from its left half. In this case, in the right iliac region, as a rule, there is a sharp pain, combined with a protective tension of the muscles of the abdominal wall in a limited area. Most sick lung tapping with fingers in different parts of the abdominal wall helps to quickly establish the place of greatest pain.

However, the symptoms and course of acute appendicitis are not always so characteristic. The clinical picture of the disease in children, the elderly and old age, as well as with an atypical location of the appendix. In any case, if you experience symptoms similar to appendicitis, you need to call an ambulance.

It proceeds with aching dull pains in the right iliac region, which can periodically intensify, especially with physical exertion.

Signs of appendicitis in women

Slopes to inflammation of appendicitis more woman than men, whose symptoms appear more often at the age of twenty, forty years. This is due to the physiological structure of the female body, the pelvis, so it can proceed differently. They are especially different during pregnancy. In view of the fact that the appendix is located close to the right uterine appendages, signs of inflammation are twice as common as in the male population.

On palpation, women experience pain which indicates inflammation of the abdominal cavity.
If you press a point below the navel in a woman, then pain may occur, which intensifies when standing up, which indicates involvement in inflammatory process reproductive organs.
When examining the vagina in a woman, pain is found, especially when examining the cervix, with appendicitis it indicates inflammation of the appendages.

When diagnosing and making a diagnosis, a woman checks not only the condition of the appendix, but the condition of the genital organs as a whole.

Diagnostics

Diagnosis is based on characteristic symptoms appendicitis. Confirm the diagnosis of "inflammatory signals" of a complete blood count. The most reliable method is laparoscopy.

Clarification morphological form appendicitis (catarrhal, gangrenous, phlegmonous) is possible during surgery: histological examination removed appendix. Of the instrumental methods, ultrasound, abdominal radiography, irrigoscopy, and computed tomography are used.

Treatment

The generally accepted tactic for acute appendicitis is the earliest possible surgical removal of the inflamed appendix. After 36 hours from the onset of the first symptoms, the probability of perforation (rupture) of the appendix is 16-36% and increases by 5% every subsequent 12 hours. Therefore, after confirming the diagnosis, the operation should be performed without undue delay.

At the stage prehospital care if acute appendicitis is suspected, bed rest, exclusion of fluid and food intake, application of cold to the right iliac region are indicated. It is strictly forbidden to take laxatives, use a heating pad, and administer analgesics until the final diagnosis is established.

Currently, with a simple form of appendicitis, laparoscopic operations are preferred that do not require an incision in the abdominal wall. In this case, an endoscopic instrument is inserted into the abdominal cavity through a small puncture in the tissues. Removal of appendicitis in this way avoids operating injury, and reduce recovery period factor of. Development risk postoperative complications when removing appendicitis by laparoscopic method is minimal.

When chronic appendicitis appendectomy 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, taking antispasmodic drugs, physiotherapy.

Appendicitis is an inflammation of the appendix called the appendix. It's a small blind appendage colon located on the border of the small and large intestines. because of anatomical features The appendix is quite often inflamed - acute appendicitis is the most common surgical disease.

This happens so often that in the thirties of the last century in Germany a proposal was put forward to remove the appendix to children at an early age, in the form of a preventive measure to combat appendicitis. In those years, it was believed that the appendix is an atavism, a completely useless anatomical formation, without which it is quite possible to do without. However, the results of the experiment were depressing: those children who had their appendix removed at an early age subsequently developed a severe form of immunodeficiency.

Acute appendicitis with no urgent curative measures dangerous because it leads to suppuration and rupture of the inflamed appendix, with the spillage of pus and the spread of inflammation to the peritoneum - peritonitis develops, a dangerous complication that can lead to death.

Causes of appendicitis

It is believed that the main cause of appendicitis is a blockage of the lumen of the appendix. This can happen due to the kink of the appendix, as well as as a result of mechanical obturation, when it enters the lumen fecal stones or foreign bodies. The ingress of foreign bodies into the appendix is one of the common causes of appendicitis in children, and in adults, appendicitis is more often caused by fecal stones. Another mechanism of inflammation of the appendix is the appearance of ulcers on its mucous membrane, as a rule, as a result of a viral infection.

The main symptom of appendicitis is sudden onset abdominal pain. Pain in acute appendicitis is characterized by the following:

Initially, the pain is localized in the epigastric region;
After 6-8 hours, the pain moves to the right iliac region (Kocher-Wolkovich symptom, or symptom of pain movement);
In the future, the pain takes on a diffuse character;
The pain is constant, there may be periods of increase and decrease in pain, but there are no pain-free periods;
The pain increases with movement, so patients with acute appendicitis often move around holding the right side of the abdomen with their hands, which is one of the characteristic symptoms of appendicitis;
Sharp pain indicates purulent inflammation of the appendix (appendix empyema);
The subsidence of pain in acute appendicitis is an unfavorable sign, since the cause of this may be the onset of the gangrenous process and the death of nerve endings.

In addition to the pain syndrome, the symptoms of appendicitis are loss of appetite, nausea, single vomiting, stool retention, and increased urination are possible.

Appendicitis in adults usually does not cause sharp deterioration general condition, at least until the development of peritonitis. A slight increase in temperature is possible, up to subfebrile figures (37-37.5 ° C). Appendicitis in adult patients can be simple and destructive. With a destructive course, all the symptoms are more pronounced, the pain is more significant and the general condition suffers.

Appendicitis in children is much more violent, inflammation progresses quickly, and peritonitis develops much faster. With appendicitis in children, severe abdominal pain can immediately be diffuse, general symptoms pronounced: severe nausea, repeated vomiting, fever. Appendicitis in children almost always proceeds according to the type of destructive appendicitis in adults.

Diagnosis of appendicitis

In the classical form, the disease does not cause difficulty in making a diagnosis, which is made on the basis of the characteristic symptoms of appendicitis. The following tests help clarify the diagnosis:

Soreness in the right iliac region on palpation of the abdomen;
Soreness in the right iliac region with slight tapping (Razdolsky's symptom);
Increased pain with a sharp withdrawal of the hand after pressing the anterior abdominal wall (Shchetkin-Blumberg imptom);

Increased pain when the patient is lying on the left side (Sitkovsky's symptom);
Palpation is much more painful when lying on the left side (Bartomier-Michelson symptom);
Increased pain when raising the straightened right leg in the supine position (Obraztsov's symptom);
Increased pain in the right iliac region when moving the hand from the upper abdomen to the right iliac region through a tight shirt (Voskresensky's symptom);
Soreness in the right iliac region when pushing with the fingers in the left iliac region (Rovsing's symptom).

These symptoms of appendicitis are important diagnostic value. However, in some cases, with an abnormal position of the appendix, the clinical picture may be blurred, and some of the described signs may be negative. Symptoms that are not typical for appendicitis, such as diarrhea, may also appear.

Any signs of an acute abdomen should alert you to an attack of appendicitis, therefore, as a rule, a clarifying diagnosis is carried out already during the operation (exploratory laparotomy), since delay can lead to serious life-threatening complications. Because of the difficulty in making a diagnosis, abnormal forms of acute appendicitis are much more likely to cause death.

Treatment of appendicitis

Treatment consists of surgical removal appendicitis.

If acute appendicitis is suspected, the patient should be laid down and kept calm until the ambulance arrives. Transportation to the hospital also takes place in the supine position. It is forbidden to put enemas and take laxatives, food, water, and taking painkillers is also undesirable, due to subsequent difficulties in diagnosing.

Removal of the appendix should be carried out as soon as possible to avoid rupture of the appendix and the development of peritonitis. In order to reduce the likelihood of infection during the removal of appendicitis, it is administered before the operation. antibacterial agents. Antibiotics are also prescribed in the postoperative period.

Removal of appendicitis is carried out under general anesthesia, in some cases, in lean patients, local anesthesia may be used.

Currently, with a simple form of appendicitis, laparoscopic operations are preferred that do not require an incision in the abdominal wall. In this case, an endoscopic instrument is inserted into the abdominal cavity through a small puncture in the tissues. Removal of appendicitis in this way allows you to avoid surgical trauma, and reduce the recovery period at times. The risk of developing postoperative complications during the removal of appendicitis by laparoscopic method is minimal.

Video from YouTube on the topic of the article:

Inflammation of the vermiform appendix of the caecum, known worldwide as appendicitis, is the main cause of all urgent surgical operations. Signs of acute appendicitis are known to almost every adult, but this pathology has several stages and varieties, each of which has its own special symptoms. How to recognize inflammation of the appendix in children and adults on time and prevent dangerous complications this seemingly simple disease?

Manifestations of appendicitis in adults

To understand how appendicitis manifests itself in adult patients, it is enough to know a few basic symptoms. However, in each person, inflammation of the appendix can proceed differently, depending on age, immunity, and the anatomical location of the appendix itself.

In most people, acute appendicitis begins with the following symptoms:

Pain is the first and main symptom of intestinal inflammation. It occurs unexpectedly and without visible reasons in the upper abdomen or in the navel, gradually moving to the right iliac region. Initially, pain is dulled, then intensifies.
Weakness and lethargy, loss of appetite, trouble sleeping due to abdominal discomfort.
The temperature can rise to 37-38°C, the patient's pulse quickens to 80-90 beats. In some cases - chills.
The patient suffers from nausea, which may be accompanied by one or two vomiting (in 20-40% of patients), yellow- white coating.
Lying on the left side discomfort in the stomach are amplified, so the sick person instinctively fits on the right side.

Manifestations of appendicitis in children

Signs of acute appendicitis in children after 7 years of age usually coincide with classic symptoms illness in adults. In young children, the disease begins abruptly and develops very rapidly.

The first signs of inflammation in babies are screaming, crying, refusing to eat, bad dream, instant temperature increase up to 38-40°С. In rare moments of calm, children try to lie in one position without moving.

In older children, inflammation of the appendix can be recognized by the following symptoms:

Pain in the abdomen of different localization (in the upper part, in the navel, on the right or throughout the abdomen).
Anxiety (weakness, moodiness, poor appetite, sleep problems).
The temperature instantly jumps to high numbers.
Syndrome of "toxic scissors" (when the temperature rises by 1 degree, the pulse quickens by 8-10 beats per minute).
Stool disorders (constipation or diarrhea), tummy swells.
Nausea, vomiting, white coating on the tongue.
In young children under 3 years of age, inflammation of the appendix can cause pain when urinating.

Manifestations of appendicitis at different stages

Inflammation of the appendix is progressive in nature: signs acute pathology largely due to the stage in which the disease is located.

The catarrhal stage lasts the first 6-12 hours from the onset of inflammation.

The main symptom of this form of appendicitis is discomfort and pain in the abdomen, which worsens at night, when coughing/sneezing and when lying on the left side. Patients suffer from nausea, there may be a single vomiting. The temperature rarely rises, usually not higher than 38 ° C.

Purulent phlegmonous form develops before the end of the first day of the disease

The pain is finally localized in the right lower abdomen, the patient is constantly sick, the pulse quickens, the temperature is stable at around 37-38°C.

The abdomen is very tense, with palpation it is easy to detect all the main diagnostic symptoms inflammation of the appendix.

The gangrenous stage continues for the second or third day.

The pain subsides due to the death of the nerve cells of the appendix, severe intoxication begins: nausea, vomiting, dry mouth, tachycardia. The abdomen is swollen, the stool is completely absent.

perforative stage

A breakthrough in the wall of the appendix is accompanied by severe pain, which is rapidly growing. Vomiting does not stop, the abdomen is swollen and tense, there is no stool, the temperature rises to 40 ° C and above.

Manifestations of atypical forms of appendicitis

Atypical forms of acute appendicitis are usually associated with a non-standard location of the appendix in the abdominal cavity and are quite rare. The diagnosis in such cases is difficult, therefore, the risk of developing purulent forms and severe complications is high.

The retrocecal variety occurs in 10-12% of patients. With this diagnosis, pain is felt in the right side of the abdomen, can move to the lower back and give to the right thigh when walking. There is practically no nausea and vomiting, the stool is semi-liquid, with an admixture of mucus. The temperature rises from the first hours of inflammation.

Pelvic appendicitis is diagnosed in 5-20% of patients, mostly adult women. The pain is concentrated in the lower abdomen, may give in the groin or navel. Urination is frequent and painful, loose stools with mucus occur several times, temperature and signs of intoxication of the body are almost not expressed.

With medial appendicitis (8-10% of cases), all symptoms are pronounced - excruciating pain on the right or in the navel area, fever, repeated vomiting, severe tension in the muscles of the peritoneum, intestinal obstruction.

The chronic form is characterized by periodic bouts of pain; at moments of exacerbation, all the classic signs of acute inflammation can appear.

Pain in acute appendicitis

Discomfort and soreness in the abdomen are considered the main symptoms of acute inflammation of the appendix. Pain with such a pathology is always there, but it can vary in intensity, location and character (dull, aching, paroxysmal).

Classical acute appendicitis usually begins with strong attack diffuse pain in the abdomen, which gradually passes into the right iliac region. Pain then decrease, then increase again, but do not completely disappear. If the pain begins to subside 2-3 days after the onset of the disease, this may indicate appendix gangrene. A sharp attack by the end of the third day of the disease can signal a perforation of the appendix and lead to peritonitis.

Where does pain usually occur with inflammation of the appendix:

In the navel - the onset of the disease, then pain covers the entire abdominal cavity;
In the lower abdomen, in the right iliac region - the usual catarrhal acute appendicitis;
In the right side or in the lower back - retrocecal inflammation of the appendix;
Above the pubis and in the pelvic area - pelvic appendicitis.

Temperature in acute appendicitis

Body temperature plays an important role in the diagnosis of appendicitis. The first 6-12 hours, at the catarrhal stage, the temperature usually stays at a normal level, in some cases it rises to 37.2-37.8 ° C.

As inflammation develops, the temperature rises to 38.3-38.5°C, with a gangrenous form, it may return to normal levels and even drop to 36°C. At the stage of perforated appendicitis, the temperature usually jumps to 40 ° C, this is one of the symptoms of incipient peritonitis.

The height, temperature and severity of the inflammatory process in appendicitis do not always correspond to each other. In most cases, the disease in the first hours proceeds with normal temperature body, only some patients (more often children) develop a fever. With severe purulent forms pathology, the temperature is also unstable, rising to high numbers or falling below normal.

Diagnosis of appendicitis

Since the signs of appendicitis are varied and manifest differently in all patients, only a doctor will be able to make an accurate diagnosis. The main tests to determine the nature of inflammation are the collection of anamnesis and examination, general analysis blood, urinalysis, ultrasound, in difficult cases - laparoscopic examination.

There are also home methods that will help identify appendicitis and speed up the patient's hospitalization. Please note that such self-diagnosis techniques must be used very carefully so as not to provoke a new attack of pain, and in the later stages - a breakthrough of the appendix.

Gently tap with the pad of your index finger in the right and left iliac regions - with appendicitis in the first case, pain will appear, in the second - no discomfort.
Lie on your right side and assume the fetal position. If in this position the pain subsides, and when turning to the left side it intensifies, this is probably appendicitis.
Try coughing and sneezing: acute inflammation appendix pain will increase dramatically.
Press lightly with the palm of your hand sore spot and hold for 10-15 seconds. When the pain subsides a little, remove your hand. If the pain gets worse, it's a sign of appendicitis.

Symptoms of acute appendicitis have been known to mankind for several centuries, but even today, with the most modern diagnostic methods, diagnosis can be difficult. Therefore, it is important for each person to know how appendicitis manifests itself in order to consult a doctor in time, complex diagnostics and prevent such life-threatening complications as abscess and purulent peritonitis.

Appendicitis often develops in men and women in their prime - at the age of 20-40 years. That is why it is important to be able to distinguish the first signs of a dangerous disease, often requiring rapid medical intervention. Symptoms of appendicitis in adults may be similar to other diseases, which is why only a specialist can establish an accurate diagnosis.

Cause of appendicitis in adults

The main cause of appendicitis in adults is the accumulation of food particles or large fecal stones in the appendix. This is fraught with blockage of the appendix, stagnation in it, reproduction pathogenic bacteria and development of inflammation.

Also, the appearance of appendicitis can contribute to:

Entering the appendix of Escherichia coli.
Typhoid fever and intestinal tuberculosis.
Helminths located in the lumen of the process of the caecum.
Abuse of meat products.
Disorders of the stool in the form of constipation.
Pathology of the vessels feeding the process.

The cause of the development of the disease can also be malfunctions of the digestive system, tumors in the intestines. The risk of appendicitis increases significantly against the background of any untreated inflammatory process in the body.

Appendicitis is less common in the elderly. This is due to the reverse changes occurring in the lymphoid tissue, and its lesser susceptibility to inflammation.

Appendicitis symptoms in adults

If an attack of appendicitis develops, the symptoms in adults often have an increasing character. The main features are:

moderately severe pain that appears in the epigastric region (pit of the stomach);
increased pain at the slightest tension;
dyspeptic disorders;
body intoxication.

Painful sensations often stop in the first hours of an attack after defecation, gradually moving to the right iliac region, becoming dull and constant. In acute appendicitis, pain may be localized around the navel.

For an attack of appendicitis is characterized by soreness that occurs when you change the position of the body, coughing, sneezing. This forces the patient to take a body position that provides minimum load to the iliac region.

Intoxication is manifested by chills, increased body temperature, weakness and lack of appetite. Dyspeptic disorders include nausea, single vomiting, stool disorders.

The disappearance of pain after a few hours from the moment of its appearance is not an indication that the inflammatory process has been suspended. Often this is caused negative factors- death of nerve endings, perforation of the appendix and initial stage peritonitis.

Where does appendicitis hurt in adults

Often, with the appearance of discomfort in the abdomen, the question arises - where does appendicitis hurt in adults? In most cases, the appendix is located in the middle between the navel and the right ilium. The most pronounced pain sensations are observed here.

If, due to the peculiarities of physiology, the appendix is raised to the right hypochondrium, the pain occurs closer to the liver. If the appendix is lowered to the lower part of the pelvis, the manifestation of the disease resembles the sensations that accompany inflammation. Bladder or female appendages.

Pain can manifest itself in the groin, pelvic region and give to the leg if the process is located behind the cecum, directed towards the kidney and ureter. In pregnant women, it often spreads throughout the abdomen or is localized in its upper, lower right, left side of the abdomen.

What is the pain of appendicitis?

In order to correctly assess your condition, it is important to know what pain is with appendicitis. Pain that occurs during an attack is usually sudden appearance and increasing intensity with each passing hour.

In acute appendicitis, there is a sharp dull pain resembling colic. At first, it is aching, paroxysmal, but at the same time tolerable. When lying on the right side, the pain may increase. Increased discomfort is caused by coughing, any movements, pressing on the area of development of an acute process.

After a few hours, the sensations acquire a constant pressing character, the patient feels bursting, burning pain. If it becomes unbearable, twitching, pulsating, this often indicates the presence of purulent masses in the appendix. A short relief may come after going to the toilet, but after a while the main symptoms of the pathology appear again.

Perforation of the appendix is accompanied by a sharp sudden increase in pain, gradually spreading to various departments belly. With gangrene of the appendix nerve endings organs die. At the same time, a period of “imaginary well-being” sets in, the patient feels improvement for some time.

Appendicitis chronic symptoms in adults

Appendicitis chronic form in adults it develops in 2 cases - in the presence of a sluggish process that does not take sharp shape, and after the transferred acute stage of the disease. In the first case, the pathology does not always manifest itself, therefore, it is possible to identify it only as a result of laboratory research. In the second, well-distinguishable symptoms are observed. Often this condition develops after the removal of the appendix, when the patient has a stump up to 2 cm long.

When appendicitis is chronic, symptoms in adults resemble the typical picture of the disease, but are milder. This state accompanied by:

recurring pains radiating to the groin, lower back, thigh;
a feeling of heaviness on the right (in the iliac region) or around the navel, aggravated after eating;
nausea and vomiting;
constipation or diarrhea;
discomfort.

Such symptoms can be supplemented by difficulties during urination and defecation, pain during intercourse in women.

The chronic form of the disease is not accompanied by an increase in body temperature and a deterioration in the general condition. However, during the period of exacerbation, the symptoms of appendicitis in adults often appear in the classical form.

The disease requires timely detection and treatment. Due to the constant presence of a focus of infection in the body, the likelihood of developing appendix perforation, peritonitis and critical conditions sick.

False appendicitis symptoms in adults

In some cases, signs of false appendicitis arise on the basis of dyskinetic pathologies (disturbances motor function digestive system). Development catalysts similar condition become malnutrition, physical overload and regular stress.

Pain syndrome occurs against the background of involuntary contractions of the muscular layer of the walls of the appendix. The reason for such movements is the sudden narrowing of the appendix, the reduction of one of its layers, anatomical changes in the organ. The inflammatory component is completely absent.

If false appendicitis develops, symptoms in adults appear as:

discomfort in the right lower abdomen;
tense abdominal muscles;
pain during tapping of the iliac region;
enlargement of the lymph nodes.

Completely absent such symptoms in appendicitis in adults as signs of intoxication and fever body.

Pathology does not require surgical intervention, as it does not pose a threat to the patient's life. Main danger false appendicitis lies in its ability to become chronic over time.

Knowledge of the flow various forms disease will become relevant when the first signs of pathology appear. It is important to be able to distinguish the first symptoms of appendicitis in adults. This will allow timely necessary measures and not expose the patient increased risk. You can read reviews on this topic or write your opinion on the forum.