Hidden signs of appendicitis. Blind but dangerous. What is dangerous appendicitis during pregnancy

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 features 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 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 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 abdominal cavity which causes 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 dangerous disease without 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 first mentioned. 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 in the right iliac region.

Strengthening of unpleasant sensations occurs when a person walks, bends over. Chased sharp discomfort when coughing and laughing. It hurts a lot to sneeze. But older people tend to lack pain syndrome.

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 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 accompanying 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. AT rare cases fixed rise above 38 degrees. But if the body temperature rose even higher, we can say with confidence that inflammatory process progresses in earnest.

What else to pay attention to?

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

because of serious condition 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 full complex 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, common manifestations 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, you can best case"reward" yourself unpleasant moments severe pain, at worst, death awaits.

That also happens!

One of the most famous in modern medicine cases of treatment of appendicitis occurred at the 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 treatment: 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, the stories about incidents at the Arctic stations are curious to everyone and 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 it in a timely manner. medical care. Who to contact if you suspect appendicitis?

First call " ambulance". 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.

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 in such early age that the baby is not even able to speak yet. How to suspect the disease in this case?

Usually with the development of the appendix 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 complicating 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.

The appendix never complains: it either screams piercingly or remains silent.

W. Lawrence

The first symptom of inflammation of appendicitis for you is pain. On which side does appendicitis hurt? Often, the pain of appendicitis seems to radiate throughout the abdomen. However, after six hours it hurts with appendicitis in the iliac region. But at the same time, one should remember such a nuance that each person's appendix has its own location, so the question "which side appendicitis hurts from" is very individual. sore spot everyone will have their own.

How does acute appendicitis manifest in adults?

Appendicitis is an inflammation of the appendix of the caecum. It is the most common in the group of acute diseases of the abdominal organs and accounts for up to 70% of cases. acute abdomen. On average, every year, out of every 250 people, one shows symptoms of acute appendicitis. Mortality from acute appendicitis is 0.1% with non-perforated appendix and up to 3% with its perforation, and mortality among those hospitalized on the first day is 5-10 times lower than among patients admitted to the hospital at a later date. These figures emphasize the need for early diagnosis of appendicitis: in most cases, death could be prevented by timely recognition of the signs and symptoms of appendicitis and promptly undertaken surgery.

In the pathogenesis of acute appendicitis, the leading role belongs to the blockage of the lumen of the appendix (the cause may be the formation of fecal stones in its lumen, getting into the appendix foreign bodies, inflection of the process) or ulceration of its mucous membrane (possibly of viral origin).

Why does my stomach hurt with appendicitis?

The main reason that prompts a patient with acute appendicitis to seek medical help is a sudden onset prolonged pain in the abdomen, lasting 4-6 hours. On which side does appendicitis hurt? It has a diffuse character, but in the first hours, patients especially often localize it in epigastric region(so-called epigastric phase). In the following hours, independent pain in appendicitis in adults begins to be localized in the right iliac region (a symptom of Kocher-Volkovich pain displacement). They are usually permanent and usually mild. Pain with appendicitis can be either stronger or weaker, sometimes patient patients call it insignificant, but it does not stop for a minute.

Sudden and sharp increase in pain, as a rule, is extremely warning sign and indicates perforation of the appendix. Sharp pains, accompanied by anxiety of patients, occur in forms of acute appendicitis, characterized by the formation of a closed purulent cavity in the appendix (the so-called empyema of the appendix). As with any, even local, peritonitis, pain in acute appendicitis intensifies when walking, moving, and also in the position on the left side. Patients step carefully, usually holding the right iliac region with their hands. The characteristic sparing of the abdomen immediately attracts attention.

The subsidence of pain in acute appendicitis does not always indicate the onset of well-being. The lull may be due to progressive gangrene of the appendix and necrosis of the sensitive nerve endings of the serous cover of the appendix and its mesentery. The pain symptom in acute appendicitis has its own characteristics in the second half of pregnancy: it is less pronounced and localized higher than usual (due to displacement upwards and backwards by the enlarged uterus).

Typical signs of acute appendicitis in adults are:

loss of appetite (anorexia),

in about half of the cases there is nausea and a single vomiting in the first hours of the disease. Repeated vomiting of gastric contents or bile in acute appendicitis indicates the progression of peritonitis. Often there is a delay in stool.

Constipation is a consequence of intestinal paresis, characteristic of any peritonitis. Stool retention, sometimes taken as the cause of the disease, misleads the patient, his relatives, and often medical workers, which entails the use of unnecessary and harmful measures aimed at removing the contents of the intestine (enemas and laxatives).

With the retrocecal location of the appendix, dysuric disorders may be noted.

Diagnosis of acute appendicitis in adults

Examination of the abdomen reveals a picture of local peritonitis in the right iliac region. This sign of appendicitis consists of muscle resistance and local pain on palpation in the right iliac region (these symptoms are absent only when the appendix is located behind the caecum or in the pelvic cavity). Symptoms of local irritation of the peritoneum are also expressed (Shchetkin-Blumberg symptom and percussion tenderness of the anterior abdominal wall in the iliac region on the right). When tapping, even cautious, patients note pain in the right iliac region due to shaking of the inflamed peritoneum (Razdolsky's symptom). There are no pathognomonic, i.e. characteristic only for acute appendicitis, objective symptoms. In most cases, the symptoms of locally expressed peritonitis in the right iliac region serve as a manifestation of acute appendicitis, this extremely frequent pathology.

The degree of muscle resistance of the anterior abdominal wall in acute appendicitis can vary significantly. This sign of appendicitis may be very mild in old men with flabby muscles, as well as in women who have recently undergone childbirth, but careful examination almost always reveals some degree of local muscle protection.

Additional signs of acute appendicitis:

Rovsing's symptom - soreness in the right iliac region with jerky pressure with fingers in the left iliac region (due to the movement of gases through the large intestine);

Sitkovsky's syndrome - increased pain in the position on the left side (due to displacement of the caecum and appendix and tension of the inflamed peritoneum);

symptom of Bartomier - Michelson - an increase in pain on palpation in the position on the left side;

Voskresensky's syndrome as a sign of appendicitis - pain in the right iliac region when moving the hand from the epigastrium to the right iliac region through a tight shirt;

Obraztsov's symptom - increased pain when lifting a straightened right foot in the supine position.

With the exception of the rare and very rapidly progressing so-called hypertoxic forms of acute appendicitis, the general condition of patients in the first hours is relatively little disturbed and almost always remains satisfactory. The temperature as a sign of appendicitis is usually slightly increased, rarely reaches and even more rarely exceeds 38 ° C and higher figures, sometimes remains within the normal range. In the blood, there is a moderate increase in the number of leukocytes up to 10,000-12,000, less often up to 15,000 in 1 μl with a shift in the formula to the left (the appearance of an increased number of stab leukocytes).

Symptoms of atypical appendicitis of acute form

However, not always acute appendicitis proceeds with typical symptoms and signs. The main cause of the atypical course is the atypical location of the appendix, mainly pelvic (in the pelvic cavity) or retrocecal (behind the caecum). Pelvic and retrocecal appendicitis differ most severe course, gangrenous and perforated forms are much more often observed, they are characterized by a significantly higher lethality. This is not because the abnormal location of the appendix contributes to a more severe course of the inflammatory process, but only because pelvic and retrocecal appendicitis are often recognized late - already with the appearance of severe complications (retroperitoneal phlegmon).

characteristic features appendicitis of pelvic forms are dysuric disorders (frequent, with pain urination), frequent liquid stool sometimes with tenesmus. These symptoms are due to the transition of the inflammatory process from the appendix hanging into the small pelvis to the wall of the bladder or rectum. They are the cause of frequent diagnostic errors when, instead of acute appendicitis, they suggest gynecological pathology, cystitis, and most often food poisoning. Difficulties in diagnosis are aggravated by much less pronounced, and sometimes completely absent, muscular protection of the anterior abdominal wall in pelvic appendicitis. In these cases, a rectal examination often plays a decisive role, and in women, a vaginal examination, which makes it possible to note a sharp pain pelvic peritoneum, uncharacteristic for the noted diseases, and in more late stages identify and infiltrate around the inflamed appendix.

It is even more difficult to recognize the symptoms of retrocecal appendicitis in adults, in which phenomena often prevail at first. general order(fever, headache, vomiting), and local phenomena are slightly expressed. In these cases, pain is often noted much lateral to the right iliac region and is detected during a bimanual (two-handed) abdominal-lumbar examination with the patient in the left lateral position. A special responsibility for recognizing these forms of acute appendicitis lies with the doctor to whom the patient turns in the first hours of the disease, when, as a rule, careful history taking and a thorough objective examination make it possible to recognize the signs and symptoms of acute appendicitis with atypical localization of the appendix or, in any case, suspect him. At further development diseases, when the pain often subsides, general phenomena prevail and complications arise, its recognition becomes more and more difficult.

Thus, the diagnosis of appendicitis symptoms is based on a characteristic clinical picture, which in typical cases includes pain, first localized in the epigastric region, moving after the onset of nausea and vomiting to the right iliac region, and local signs of peritoneal irritation in the right iliac region.

Complications of acute appendicitis in adults

Complications of acute appendicitis in adults:

mesenteryolitis (inflammation of the mesentery of the appendix),
infiltrate (may develop on the 3-4th day of the disease when the inflammatory process is delimited),
abscess (manifested by an increase in infiltration in size and the appearance of hectic fever),
peritonitis (develops immediately after pain attack or on the 3-4th day due to gangrene or perforation of the process),
sepsis.

Differential Diagnosis acute appendicitis

The differential diagnosis of symptoms of acute appendicitis is carried out with right-sided renal colic (it is characterized by irradiation of pain in the genitals, urethra, as well as a symptom of dysuria); in women - with adnexitis and ectopic pregnancy; With acute cholecystitis(it is characterized by irradiation of pain in right shoulder or shoulder blade, phrenicus syndrome); With acute pancreatitis, intestinal obstruction. Since with appendicitis, vomiting occurs simultaneously with pain in the epigastrium, and patients indicate a possibly poor-quality character food taken, in adults with symptoms of appendicitis, it is often suspected acute gastritis, food poisoning, wash the stomach, give a laxative, put an enema, i.e. use useless measures, and sometimes contraindicated. Meanwhile, a careful examination of the patient allows in the first hours to reveal limited muscle tension and local pain on palpation in the right iliac region.

Treatment of all forms of acute appendicitis is only surgical. Patients diagnosed with acute appendicitis (or suspected of having this disease) require immediate hospitalization in surgery department with maximum rest when transported in the supine position. Categorically contraindicated are enemas and laxatives that enhance peristalsis, treatment for prehospital stage is reduced to the appointment of bed rest and the prohibition of the intake of water and food.

If your stomach hurts, then it is quite possible that you have inflammation of the appendix. Doctors say that in no case should you try to eliminate the symptoms chronic appendicitis on one's own. After all, self-medication can end quite tragically.

How does chronic appendicitis manifest in adults?

Apart from pain in the case of chronic appendicitis, vomiting is also possible, less often it can be diarrhea. It occurs only if an accumulation of fluid begins to appear in the intestine. Also, with inflammation of the appendicitis, a white coating appears on the tongue. If you lie on your right side or on your back, then the pain partially fades away. Also, pain sensations appear with spontaneous muscle tension. With a certain knowledge of anatomy, you can slightly feel the stomach. If muscle tension is felt in its right part, then this is it - inflammation of appendicitis. In this case, you should call for medical help every minute.

Forms of chronic appendicitis in adults

It is customary to distinguish 3 forms of this disease:

chronic relapsing,
residual
and primary chronic.

Chronic residual (or residual) appendicitis occurs after acute attack ending in recovery without surgical intervention. In these cases, as a rule, all the conditions for the occurrence of a repeated attack of the disease remain (such signs of appendicitis as kinks of the process, adhesions, adhesions and other reasons that make it difficult to empty the process). If the patient has a history of attacks of acute appendicitis, in such cases it is customary to talk about chronic recurrent appendicitis.

Most doctors question the existence of primary chronic appendicitis (i.e., without a previous acute one). Most often, mild pain and tenderness on palpation in the right iliac region are due to other causes. Therefore, the diagnosis is made by excluding diseases of other organs located in the abdomen and chest. Indirect symptoms of chronic appendicitis are the lack of filling of the appendix, slowing down its emptying, deformation, narrowing of its lumen, filling defects in its shadow (according to irrigography) or detection of fecal stones, changes in the shape of the appendix and unevenness of its lumen (ultrasound).

Diagnosis of chronic appendicitis in adults

Inflammation of appendicitis is very difficult to reliably determine, since a change in symptoms and signs occurs when the location of the appendix changes. Also, the doctor cannot see with his own eyes what is going on inside you. Often, diagnosis for the detection of appendicitis is carried out by passing urine and blood tests. You should know that in the blood the amount blood cells white color increases significantly, and urine becomes protein-rich. However, everything is not limited to this. Sometimes X-rays are used. However, it only allows you to identify a fecal stone that will burn to clog the opening of the process. For accurate identification acute appendicitis, computer diagnostic ultrasound is used. It should be noted that if the process is not visible, then the pain is not caused by appendicitis at all. You can also resort to computed tomography. With its help, you can see both an increase in the process, and changes in the tissues of the intestine and peritoneum. In addition to the above methods, laparoscopy can determine whether there is inflammation of appendicitis. To do this, a small incision is made in the abdominal wall, into which a tube containing a camera is inserted for viewing.

In remission clinical symptoms chronic appendicitis are minimal. Patients complain of episodic dull, aching, non-progressive pain in the right iliac region, which may occur spontaneously, during exercise, or after an error in diet. When examining during palpation of the abdomen, mild pain in the right iliac region can be detected. There are no symptoms of acute appendicitis. When signs of another acute attack appear, it is necessary to make a diagnosis of acute appendicitis, and not "exacerbation of chronic", therefore, diagnosis and treatment in this case are carried out, as in acute appendicitis.

It should be remembered about the possibility of recurrence of an attack of appendicitis in patients who have erroneously performed a subtotal appendectomy (laparoscopic or open method). If a stump of a process 2 cm long or more is left, acute inflammation may re-develop in it.

Appendicitis (appendicitis) is an inflammatory process of a small appendix of the caecum, called the appendix. The word "appendix" translated from Latin means "appendage", and the ending "itis" indicates inflammation.

According to statistics, among all surgical diseases, appendicitis occupies approximately 89% of cases in terms of prevalence and ranks first. It is more common in people of young working age from 18 to 35 years. The prevalence of this disease in women is 2 times higher than in men.

Classification

Appendicitis can occur in acute and chronic form. The acute form is divided into the catarrhal course of the disease and destructive, which, in turn, can have several forms:

phlegmonous;
phlegmonous-ulcerative;
apostematic;
gangrenous.

Chronic appendicitis is also divided into several forms. He can be:

residual;
primary chronic;
recurrent.

All these forms of chronic appendicitis are distinguished by sclerotic and atrophic processes occurring in the appendix. There may be proliferation of granulation tissue in the walls of the appendix and its lumen, the formation of adhesions between the surrounding serous membranes. In case of accumulation in the lumen of the appendix serous fluid cyst formation occurs.

Appendicitis in children and adults: causes, symptoms and treatment

Very often, the patient pays attention to abdominal pain not immediately, but after several hours or even days. This is due to the fact that the first signs of appendicitis in adults develop gradually and are uncertain. Difficulties arise with the definition of a specific area of localization of pain. When taking painkillers, the pain may completely subside and be felt only when sudden movements and deep breath or cough.

Constant pain, which in the first hours is localized in the navel, then goes down to the right.
Nausea and occasional vomiting.
Increase in body temperature to subfebrile.

If similar appendicitis in adults manifested itself, then you should not hope that everything will resolve itself. You need to call an ambulance. An experienced team of doctors can easily identify such a dangerous disease that requires immediate hospitalization, such as appendicitis. Signs in adults, as already mentioned, can be blurred. To clarify the diagnosis before the arrival of doctors, you can conduct a self-diagnosis.

This is done as follows: in the lower abdomen on the right, you need to press hard with two fingers (middle and index), while pain should not be felt. Then the fingers are removed, and the pain increases dramatically. If such a test turned out to be positive, i.e. everything turns out as described, in addition, there may be nausea, and in some cases vomiting, then most likely these are the first signs of appendicitis in adults. Now we will describe them in more detail.

Symptoms

With the diagnosis of "appendicitis", the signs in adults may be somewhat blurred, but nevertheless they come down to the following:

First, there is pain in the abdomen, which is not clearly localized. It can manifest itself in the navel, epigastrium, or be blurred (throughout the abdomen). The pain is constant, sometimes it can be cramping. After an hour or a little more, it concentrates in the lower abdomen on the right. This symptom of the movement of pain is called Kocher-Volchkov. Irradiation of pain is usually not observed. This is possible only with an atypical location of the appendix. In this case, the pain may radiate to the groin or lumbar region.
Patients usually have no appetite. This symptom is called anorexia.
Nausea develops following the pain, and there may be a single vomiting. These signs of appendicitis in adults are reflex in nature and develop as a result of irritation of the peritoneum.
It can go up but it doesn't always happen. Signs of acute appendicitis in adults such as fever, vomiting, and anorexia are called Murphy's sign.

When similar signs The patient may be suspected of having acute appendicitis. Sometimes these main symptoms of appendicitis in adults are accompanied by frequent urination, stool disorders (diarrhea), and in rare cases, increased pressure. Other uncharacteristic symptoms of this disease can be observed in the elderly, children and pregnant women, as well as in the atypical location of the appendix of the caecum. What signs of appendicitis in adults are observed most often, we examined. Now let's talk about the features of the development of this disease in women, and also consider what danger it carries during pregnancy.

Features of the diagnosis of appendicitis in women

The representatives of the beautiful half of humanity are more likely to make an error in diagnosing this disease than men. This is due to the fact that the sensations during the development of this disease can be confused with pain during menstruation or a pain reaction when an inflammatory process occurs in the gynecological region of the pelvic organs. This error can occur with an atypical location of the appendix.

To clarify the final diagnosis in medical institution a woman, in addition to a surgeon, should also be examined by a gynecologist. hallmark symptom inflammation of the appendix from gynecological pathology is the fact that in the latter case, vomiting, nausea and stool disorder are not typical.

Symptoms of appendicitis in pregnant women

Signs of appendicitis in adult women are the same as in men. The exception is pregnant women. According to statistics, the incidence of appendicitis during pregnancy is about 5%. A representative of the beautiful half of humanity who is preparing to become a mother, with this disease, may experience atypical form(in case of displacement of the appendix).

Diagnosis of appendicitis during pregnancy is usually not difficult. The symptoms are the same as in other adults. Difficulties may arise in the last trimester of pregnancy if the nature of the pain is cramping. Patients usually take forced position body lying on the back with knees bent and legs pulled up to the stomach. The pain is localized most often on the right in but on later dates pregnancy may be higher. also in recent months pregnancy raises concerns surgery appendicitis and rehabilitation. Therefore, it is extremely important to make a correct diagnosis.

Causes of appendicitis during pregnancy

This ailment arises due to the fact that during the period of bearing a baby, a greatly enlarged uterus can affect the caecum and change its position. Also, the appendix can be infringed by an enlarged uterus, as a result of which the blood supply is disturbed in it. This sometimes leads to an inflammatory and even gangrenous process. The cause of appendicitis in pregnant women is also a change hormonal background. During the bearing of a child, women often experience stool disorders, namely constipation, which can also provoke this pathology.

Why is appendicitis dangerous during pregnancy?

Obviously, any surgical intervention, especially when carried in the abdomen of a pregnant woman, may cause miscarriage or premature birth. But besides this, it is dangerous in the following conditions:

the development of fetal hypoxia;
placental abruption and premature aging fetus;
the occurrence of acute intestinal obstruction;
postoperative infection;
violation contractile activity uterus during childbirth;
development of bleeding in the postpartum period.

Thus, we have considered all possible symptoms appendicitis and signs of disease in adults. Let us now turn our attention to the development this disease in children.

Symptoms of appendicitis in older children

Symptoms in older children school age similar to the symptoms of this disease in adults. We can only add that such patients often occupy a forced position of the body, in which the intensity of pain decreases. They lie on the back or right side. In addition, the temperature rises to 38 degrees and even higher. The pulse does not correspond to the parameters of the increase in body temperature and is greatly accelerated.

When examining the oral cavity, a wet tongue is noted, on which there is a white coating. bad sign serves as a dry tongue. This may indicate the development of a gangrenous course of the disease and peritonitis. In children of this age with this disease, stool retention may be observed.

Symptoms of appendicitis in young children

In children, signs of the disease in question can be suspected in the following cases:

The child cries and does not allow examination.
The baby pulls the right leg to the stomach and curls up.
The temperature in young patients diagnosed with appendicitis often rises above 38 degrees, can reach up to 40.
The pulse is frequent and corresponds to the rising temperature.
The chair is liquid, frequent.
Urination may be painful and frequent. When urinating, the baby cries.
In young children, vomiting may be repeated.
The child is restless, refuses to eat, cannot sleep, constantly asks for water.

What are the signs of appendicitis in adults and children, we now know. Consider possible dangerous consequences this ailment.

Complications

In some cases, the course of the disease is complicated following processes:

which can be appendicular, subdiaphragmatic, interintestinal or Douglas depending on the location;
thrombophlebitis of the pelvic or iliac veins, this can cause a very serious condition - PE;
peritonitis, in case of rupture of the appendix;
the formation of postoperative infiltrate;
development adhesive process in the postoperative period, which can provoke intestinal obstruction.

Treatment

If there are signs of inflammation of appendicitis in adults or children, then it is shown to do an appendectomy as soon as possible, i.e. removal of the appendix to avoid severe complications of this disease. This operation spend in urgent order- no later than an hour from the moment of making an accurate diagnosis.

At the stage first aid recommended bed rest. It is strictly forbidden to take any food and drink. Do not take painkillers, laxatives, etc. medicines until the final diagnosis is clarified, apply cold or heat.

After the exact diagnosis of appendicitis is established (signs in adults and children are described above), the patient is placed in the surgical department and an appendectomy is performed. This operation with an uncomplicated course is done laparoscopically.

After that, the patient is transferred to the intensive care unit for several hours, where he is under the constant supervision of medical personnel. After the patient finally recovers from anesthesia, he is transferred to the surgical department. On the 5th day, stitches are usually removed and the patient is transferred to outpatient treatment.

In case of a complicated course of this disease, the patient remains in the clinic, and his discharge will be delayed until it is eliminated. undesirable consequences and stabilization general condition.

Forecast

With an uncomplicated course of the disease and a timely competently performed operation, appendicitis does not pose a threat to life. Full working capacity of the patient is restored after 4 weeks.

The reasons for the development of complications in appendicitis, as a rule, are untimely hospitalization and late surgery. In particular severe cases it can even lead to death.

Mortality due to it seems to be low: only 0.2-0.3%, but such insignificant numbers hide about 3,000 human lives that doctors cannot save. And in summer period When many people are in their country houses and far from doctors, it is especially important to be able to distinguish appendicitis from ordinary abdominal pain in order to see a doctor in time.

Blind but dangerous

The appendix is a short and thin blind appendix 7-10 cm long, located at the end of the caecum ( initial department large intestine). Like any part of the intestine, the appendix produces intestinal juice, but so little that it does not play a special role in digestion. Therefore it for a long time considered a "mistake of nature" and removed from the sick at the first opportunity. But recently, scientists have discovered lymphoid cells in the blind process, the same as in the human tonsils. And since these cells have the ability to protect the body from infections, the assumption was born that the appendix is part of the immune system.

However, the number of protective cells in it, as it turned out, is very small and cannot have a strong effect on immunity. So most experts are still sure that there is no benefit from the appendix, but the harm in case of its inflammation can be significant: acute appendicitis not diagnosed in time can cost not only health, but also life.

Blame your teeth?

Experts do not agree on exact reasons development of appendicitis. However, risk groups are identified.

For example, people suffering from diseases such as chronic tonsillitis, pneumonia, prolonged colds, diseases gastrointestinal tract, caries. As a result of these diseases, infections penetrate the bloodstream into the appendix and provoke an inflammatory process there. So that healthy teeth- pledge of health for appendicitis.

There is also a stress theory. It is based on the fact that as a result of excitement, a person experiences sharp narrowing blood vessels and this leads to a sudden bleeding of the appendix and the development of its inflammation.

But most often, the occurrence of appendicitis is explained by clogging of the junction of the large intestine and the appendix, which often happens with constipation and chronic colitis.

How to recognize him?

For most people, the appendix is about halfway between the navel and the right ilium. In this place, with appendicitis, the maximum pain is felt. But if the appendix is raised to the right hypochondrium, closer to the liver, pain will appear in this area. And if the appendix is lowered into lower part pelvis, then in women appendicitis is easily confused with inflammation of the appendages, in men - the bladder.

When the process is located behind the caecum, when it is wrapped to the kidney and ureter, there is pain in the lower back, it radiates to the groin, to the leg, to the pelvic region. If the process is directed inside the abdomen, then pains appear closer to the navel, in the middle section of the abdomen and even under the spoon.

Pains arise suddenly, for no apparent reason. At first they are not too strong - they can still be tolerated. And sometimes, from the first minutes of an attack of acute appendicitis, they become unbearable and proceed like colic.

Pain will torment a person as long as they are alive nerve endings process. When will it die, nerve cells die and the pain subsides. But this is no reason for reassurance. Appendicitis Won't "Resolve". On the contrary, the retreat of pain is a reason for immediate hospitalization. Acute appendicitis is accompanied by other symptoms. At the onset of the disease, general malaise weakness, loss of appetite. Nausea may soon occur, and sometimes vomiting, but only once. Typical temperature in the range of 37.2-37.7 degrees, sometimes accompanied by chills. A white or yellowish coating appears on the tongue.

Recognize appendicitis will help simple tricks. But, keep in mind, self-diagnosis must be carried out very carefully.

1 . Lightly tap with the pad of a bent index finger in the area of \u200b\u200bthe right iliac bone - with appendicitis, it always hurts there.

2 . For comparison, also tap on the left iliac region, which in case of inflammation of the appendix will not cause pain. Attention: you cannot palpate (palpation of the abdomen with your hands) yourself, there is a danger of tearing the appendix, which usually leads to peritonitis.

3. Try to cough loudly: increased pain in the right iliac region will tell you that you have appendicitis.

4 . Press lightly with the palm of your hand in the area of the abdomen where it hurts the most. Hold your hand here for 5-10 seconds. This will ease the pain a bit. Now take your hand away. If pain appears at this point, this is a sign of acute appendicitis.

5 . Take the fetal position, that is, lie on your right side and pull your legs towards your torso. Appendicitis relieves abdominal pain. If you turn on your left side and straighten your legs, it will intensify. This is also a sign of acute appendicitis.

But this self-diagnosis should be limited. Do not hesitate to see a doctor, because appendicitis itself, and all the diseases that it can disguise as ( renal colic exacerbation of pancreatitis or cholecystitis, peptic ulcer stomach and duodenum, acute inflammation bladder, kidneys, female organs) require hospitalization.

How to treat

If the diagnosis is "acute appendicitis", the primary treatment is one - emergency operation. Currently, there is a sparing laparoscopic method in which the appendix can be removed without a large incision. Unfortunately, in our country, this type of operation is not yet widespread due to the poor technical equipment of hospitals.

the main task postoperative period- avoid complications, such as suppuration postoperative wound. In their occurrence most often there is no fault of the surgeon. And to be this complication or not to be, depends on the state of the appendix at the time of the operation - the greater the degree of inflammation, the higher the risk of suppuration.

If the operation was successful, the sutures are removed for young patients on the 6-7th day and discharged from the hospital. But for the elderly, as well as with chronic diseases(diabetes mellitus, hypertension, cardiac ischemia, etc.) the sutures are removed 2-3 days later. After that, it is desirable to fasten the wound with adhesive tape.

Do not take a bath for about a month and do not go to the bathhouse: water and temperature loads on a fragile scar tissue make the seam coarser, wider and uglier. At least three months, and the elderly should not lift weights for six months. Avoid sports activities that cause tension in the abdominal muscles. Try not to catch a cold: it is dangerous for you to cough.

Hard case

If you try to "tolerate" appendicitis, you may experience peritonitis - inflammation of the abdominal cavity. Its symptoms:

increasing pain throughout the abdomen, nausea, vomiting, in severe cases - drowsiness, lethargy, bluish tint of the face;

pulse up to 120-140 beats per minute, temperature up to 39-40 C;

tongue coated with white, then becomes dry as a crust, lips dry and cracked;

the abdomen is swollen, it hurts in all its parts, but especially on the right side.

Treat only peritonitis. operational way. Moreover, the operation is very complex and lengthy. Unfortunately, it is not always possible to save the patient. That is why, with the appearance of any pain in the abdomen, in no case should you delay a visit to the doctor. As they say, we do not want to scare anyone, but everyone should remember how dangerous appendicitis is.

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. childhood, as preventive measure in the fight against 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, dangerous complication, which 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 fecal stones or foreign bodies enter the lumen. 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;
Pain is aggravated by movement, so patients with acute appendicitis often walk by holding right side abdomen with hands, which is one of the characteristic symptoms of appendicitis;
Sharp pain indicates purulent inflammation 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 pain, symptoms of appendicitis are loss of appetite, nausea, single vomiting, stool retention, and increased urination are possible.

Appendicitis in adults usually does not cause a sharp deterioration in the 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. For appendicitis in children strong pain in the stomach can immediately be spilled, 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 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, clinical picture may be blurred, and some of the features described 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 severe complications, life threatening. 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, antibacterial agents are administered before the operation. 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 avoids operating injury, and reduce recovery period factor of. Development risk postoperative complications when removing appendicitis by laparoscopic method is minimal.

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