Whether it is possible to define or determine an inflammation of appendicitis on uzi. Ultrasound of the appendix: is the diagnostic method informative? Diagnosis of appendicitis in pregnant women

Appendicitis is an inflammation of a branch of the caecum called the appendix. With this disease, a person experiences severe pain in the abdomen on the lower right, surgical treatment is required. Consider how appendicitis manifests itself, what is the diagnosis, its symptoms.

At the very beginning of the development of appendicitis, a person often cannot indicate the exact localization of pain. Experiencing pain near the navel on the right, then closer to the stomach at the top. When moving, the pain either intensifies and becomes cutting, then subsides and becomes dull, aching.

After a few hours, usually no more than four, a digestive upset sets in. The pain becomes so severe that the person cannot move. It is characteristic that the sick person, trying to reduce pain, takes the position of the embryo. During this period, the pain already has an exact localization in the lower abdomen on the right, if the development of appendicitis proceeds as standard.

How to Diagnose Appendicitis at Home

• If the pain subsides in the position - lying on the right god with legs bent at the knees, and intensifies in the position - lying on the left side with outstretched legs, this indicates appendicitis.
• With appendicitis, it hurts even to cough a little.
• With appendicitis, it hurts to tap on the abdomen on the lower right.
• If the pain increases on releasing after pressing on the area where it hurts, this also indicates appendicitis.

Still, you should not put pressure on your stomach yourself and make a diagnosis for yourself. It is better to call an ambulance if the pain is severe.

Reasons for the development of appendicitis

1. Frequent constipation, squeezing of the appendix during pregnancy, tumors.
2. Sometimes hereditary factors matter.
3. A diet low in fiber.
4. Untreated infections.

Methods for diagnosing appendicitis

• Examination of a patient by a doctor. The doctor will ask clarifying questions. Using the method of palpation, examine the abdomen. Often this is already enough to make a diagnosis and hospitalize the patient.
• Blood analysis. Any inflammatory process can be detected by a blood test, and since appendicitis is an inflammation, it can be determined by this method. With inflammation in the blood, an increase in the number of leukocytes is noted, but it should be borne in mind that their level can increase not only due to inflammation of the appendix, but also in the presence of other inflammatory processes in the body. Therefore, this diagnostic method is not the main one, but confirmatory.
• Ultrasound is a study using ultrasound. Performed to rule out other causes of pain. The same is true for pregnant women.
• X-ray - will show inflammation in dark areas.
• Computed tomography is a very accurate type of diagnosis.

In acute appendicitis, there is a need for differential diagnosis with diseases of the peritoneum, chest, blood vessels, and infectious diseases. A differential diagnosis is a diagnosis by which a doctor can separate one disease from another. In diagnosing appendicitis, it is very important to accurately establish the presence of this particular disease, and not nearby organs.

What is an ultrasound?

Ultrasound is an ultrasound examination that is often performed on the internal organs of the abdominal cavity. This method is very common and provides enough information about the organ under study to make a diagnosis.

Is it possible to determine appendicitis on ultrasound

Many diseases of the gastrointestinal tract and the entire abdominal cavity have similar symptoms, therefore, accurate diagnostic methods are indispensable. Treatment of appendicitis requires immediate action and accurate data on the amount of inflammation.

Ultrasound examination has a number of advantages, namely:

• accurate results, up to 90% or more.
• safety for the body.
• procedure availability.
• research is inexpensive.
• the speed of the method.
• there is no need to prepare for the study, do enemas and so on.
• in the differential diagnosis, this is one of the best methods that gives a definitive picture of inflammation.

The cons are much less than the pros.

• Sometimes individual parts of the organ to be examined are not visible. This happens when the patient is overweight, with a large accumulation of gases.
• A qualified medical professional is needed for the study, who understands the diagnostic method and is able to explain the results.

How is an ultrasound performed?

In order to perform an ultrasound procedure to detect appendicitis, a sensor is applied to the patient's stomach, in order to obtain a clearer picture and completeness of data about the organ under study, the sensor is moved, slightly pressing movements are made. Such movements improve visibility, freeing the area of ​​study from gases. The doctor sees the organ and its tissues on the screen. First, the location of the caecum is determined, since it may have a non-standard location. Usually the sensor is located on the person's abdomen, but sometimes women may be offered a transvaginal examination, so the doctor can see the appendix in all details.

What exactly can be determined by ultrasound?

The doctor can see exactly with the help of ultrasound:

• appendix size.
• its location.
• his condition.
• pathology of nearby organs, if any.

What can hinder research?

Diagnosis can be difficult:

• in pregnant women.
• in an obese person.
• in a person with gas accumulation. Therefore, if the examination is planned, the day before it is not recommended to consume foods that cause increased gas production.

When does the disease manifest itself in a non-standard way?

The differential diagnosis is difficult to make when the disease proceeds differently from the usual cases, in such patients:

• in a sick person in old age.
• in persons with weak immunity.
• in pregnant women.
• in small children.

Diagnosis of appendicitis in women

The difficulty in determining appendicitis in women is that the symptoms are similar not only to intestinal diseases, but also to pathologies of the reproductive system. Therefore, it is difficult to establish a diagnosis only by a blood test and an external examination. It is more likely to be confused with an ectopic pregnancy or pelvic inflammatory disease. Ultrasound is the most reliable diagnostic method and allows you to find inflammation in a few minutes.

In women, appendicitis is diagnosed more often than in men, due to the different internal structure. The female body is arranged in such a way that the organs of the reproductive system are close to the organs of other systems. Inflammation can move from the appendages to the intestines, bladder.

Another feature of the structure of the female body is the presence of the uterus, which increases during menstruation. During pregnancy, the growing fetus puts pressure on nearby organs, which impairs their blood supply and increases the risk of inflammation.

Diagnosis in pregnant women

Pregnant women justify all their pain in the abdomen by position. Most often, unpleasant symptoms are really associated with the pressure of the enlarged uterus on neighboring organs. But nevertheless, if appendicitis has developed, it is difficult to recognize it in such a situation. Therefore, pregnant women are shown ultrasound.

Diagnosis in children

The difficulty of diagnosing appendicitis in children is that small patients cannot explain exactly where and how their stomach hurts, show. The disease is more severe than in adults.

When is an ultrasound not performed?

1. If there is no doubt that the patient definitely has appendicitis, the differential diagnosis is established.
2. If appendicitis has caused complications such as sepsis, peritonitis and an emergency operation is performed.
3. With urgent surgical intervention for perforation of the appendix.

Prevention

The development of many diseases can be prevented by taking care of your health.

A common pathology of the abdominal cavity - inflammation of appendicitis requires mandatory surgical intervention. Correct diagnosis is of great importance in the successful treatment of appendicitis.

For this, various instrumental techniques, laboratory tests and, of course, a personal examination of the patient are used. How an attack is diagnosed in children and adults, our article will tell you.

Diagnosis of appendicitis in adults and children

First of all, an analysis of the patient's history is carried out, that is, an initial survey of complaints, when and where pain appeared, under what circumstances. Was there vomiting, fever from 38 degrees and above, a violation of the stool (frustration or constipation) in the patient.

It is also necessary to conduct a survey about possible hereditary diseases of the gastrointestinal tract, liver, kidneys, and genitourinary system in order to exclude possible options for establishing the correct diagnosis.

How you can determine appendicitis on your own, as well as what examinations are used in the hospital, the information provided will tell.

The video will tell you how to identify appendicitis at home by symptoms:

Diagnostic ultrasound of appendicitis allows you to resolve complex clinical cases in surgical practice. The study reflects the intestinal structure of the tubular structure, which starts from the end of the caecum. With its inflammation, the appendix forms common symptoms of an acute abdomen, which increasingly have a latent or latent course. The strong inclusion of a diagnostic procedure using an ultrasound wave into the patient examination plan allows you to see the true pathological process.

The need for diagnostics

During surgical examination of patients with severe abdominal pain, approximately half of them show classic reliable and indirect symptoms of appendicitis. Another part of emergency patients has fundamentally different manifestations of the inflammatory process, which masquerades as a disease of other organs. There are other cases in the practice of doctors when the diagnosis of appendicitis makes it possible to establish diseases of adjacent anatomical regions.

A lot of controversy has been going on for a long time about whether it is necessary to perform an ultrasound of the appendicular process if inflammation is suspected in each patient. Some experts point to the obligatory examination, others point to the need for ultrasound, when appendicitis cannot be detected by the clinical picture, which only indirectly indicates inflammation of the intestinal appendage.

It is diagnostically important to determine appendicitis by ultrasound in individuals with an abnormally located organ. Most often, this is established already during the examination, when the patient has already overtaken the painful symptoms. The uncharacteristic location of the organ, detected on ultrasound, changes the symptoms of the inflammatory disease and complicates the diagnostic search.

Usually, a non-standard picture of appendicitis is detected in the following categories of patients:

1. In children of different age groups. Chronic diseases of the digestive tract in infants and toddlers increase the risk of an abnormally located appendix and possible appendix volvulus.
2. Ultrasound of appendicitis is detected in abnormal places in pregnant women, in whom a physiologically enlarged uterus creates additional pressure on the immune organ.
3. It is also difficult to diagnose appendicitis in the elderly, when irreversible changes in organs and their systems occur due to aging.

If the acute abdomen is not life-threatening in these patients, they are indicated for prompt diagnostic ultrasound. The threat of dangerous complications of appendicitis dictates the cancellation of the examination using an ultrasound wave.

Benefits of Ultrasound

The accuracy of the study based on the capabilities of ultrasound reaches 90% in relation to the abdominal organs. The high information content of the method is also accompanied by other advantages:

1. Ultrasound can show the condition of the appendix without an additional dose of radiation. Each specific organ was previously examined in x-rays after the use of a barium contrast mixture, which created a radiation load.
2. A clear advantage of ultrasound is the speed of the diagnostic method. Appendicitis can be recognized in a few minutes after the sensor is placed on the corresponding anatomical region.
3. It is possible to explore a fairly large area, where sometimes the pathology of adjacent organs is also visible. This is of the most pronounced diagnostic importance for women during and outside pregnancy.

Against the background of the positive aspects of the ultrasound method of examination, a high dependence of the study on the experience of the doctor can be detected. The echogenicity of various structures can be the same, as well as the organs affected by the pathological process. Very often, the question of whether it is possible to determine appendicitis by ultrasound depends on the knowledge of the clinical specialist.

The course of the diagnostic procedure

Ultrasound of the appendix in adults and children does not require long preparatory steps. The equipment during the examination is also used standard and includes computerized equipment with special sensors. When a patient enters the ultrasound diagnostics room, the following happens to the patient:

1. The patient is asked to release the anterior abdominal wall from clothing. Next, he is invited to lie down on a horizontal couch with a raised head end.
2. The corresponding area of ​​the skin in the projection of the area of ​​interest of the abdominal cavity is covered with a gel-like agent that promotes optimal contact between the skin and the sensor.
3. A device that transmits a signal to the screen is placed on the surface of the abdomen. For better visualization, the doctor may apply light pressure to the abdomen, which may cause some discomfort or pain, especially if inflammation is present.
4. If a transperitoneal examination does not reliably show appendicular signs, in women it is possible to examine the appendix in another way. Transvaginal sensors are reduced in size and have other physiological features, which allows you to consider abnormal forms of the location of the appendix, and here you need to take it with you.

Over the years of existence of ultrasound, the optimal parameters of the immune organ have been determined, which correspond to its optimal activity. So, the wall of the organ is in the usual mode, if the thickness does not exceed 3 millimeters. The diameter of the appendix should not exceed 7 millimeters, which corresponds to its optimal functionality.

The inflamed appendix involves the surrounding tissues in the pathological process, in particular fatty tissue, which is compacted. The vessels feeding the organ are also able to expand and form a dense network in the organ wall, which is clearly visible on ultrasound.

Features of the patient's constitution directly determine the quality of information obtained during ultrasound. However, even if a pronounced layer of subcutaneous tissue does not allow the appendix to be detected, indirect signs may indicate its inflammation. In general, ultrasound allows you to give an unambiguous answer to the question of whether a particular patient has appendicitis or not. The diagnostic conclusion is made on the basis of the method only by the surgeon, who relies on the description of the ultrasound picture of the endoscopist.

The appendix is ​​a tubular structure that grows from the end of the caecum. The appendix also ends blindly. The occurrence of appendicitis is provoked by inflammation of the appendix, which is one of the most common causes of an acute abdomen. This article will address issues related to ultrasound of the appendix.

Approximately half of the patients can identify the classic symptoms of appendicitis. In other patients, the symptoms may be radically different and be disguised as other diseases. There are also opposite cases when, with symptoms of appendicitis, diseases of a completely different organ are detected.

To date, there is controversy over whether it is necessary to perform an ultrasound examination of the appendix in all patients who have clinical signs, or only in those who have an atypical presentation of the disease. The whole point is that there are several options for how appendicitis can be located, which have a serious impact on the symptoms. In addition, there are several groups of patients in whom the disease can proceed non-standard. Such patients are children, debilitated patients, pregnant women, as well as people of advanced age.

There are also special cases in which appendicitis can cause complications. In this situation, surgery is almost always immediately necessary without any additional research. The use of ultrasound to a large extent helps to determine appendicitis in situations where the symptoms are not severe, while the consequences of delay can be quite dangerous.

Benefits of Ultrasound Appendicitis

Ultrasound diagnosis of appendicitis shows an accuracy of 90 percent. In addition, there are some advantages of this type of research. First of all, this is the absence of irradiation of the body, because earlier X-ray examination with barium was used in the diagnosis. Also, ultrasound is performed without surgical intervention, quickly enough, affordable, cheap, while providing an opportunity to identify other abnormalities in the area under study. The last point is of the greatest importance for children, as well as for women of childbearing age.

With an ultrasound of the appendix, only the area that worries the patient is examined. This is extremely important in cases where the appendicitis itself is located non-standard, as well as in identifying other pathologies that give symptoms similar to appendicitis. The presented method has one minor drawback - dependence on the doctor. But, taking into account all the advantages, it is ultrasound that is the most attractive method for examining appendicitis.

Stages of the study

Ultrasound diagnosis of appendicitis does not require additional patient preparation. For the study, a conventional abdominal sensor is used. Ultrasound is performed through the anterior abdominal wall. The exception is women with a non-standard position of the appendix. To obtain the most accurate results, it is recommended to conduct the study transvaginally, because this way you can see appendicitis in more detail.

After the study, appendicitis is determined by some signs: the walls of the appendix are enlarged by more than 3 millimeters, and its diameter is increased by more than 7 millimeters. Also one of the signs is increased echogenicity of the surrounding adipose tissue. When using the duplex scanning method, it is possible to determine additional signs of the disease. One of the signs that distinguish appendicitis is an increased density of blood vessels in the wall of the appendix.

It should be noted that the accuracy of the diagnostics is more dependent on the patient's physique. In some cases, visualization of the appendix will show nothing. However, this disadvantage provides an opportunity to obtain additional information about the state of nearby organs, which can cause pain.

Ultrasound diagnosis provides fairly unambiguous signs of appendicitis. But it should be borne in mind that the obstacles to obtaining the correct results include excess weight and bloating. It is worth noting that the signs of appendicitis are not yet the final diagnosis. In some cases, additional clinical studies are needed, as well as alternative imaging modalities. The final diagnosis is made by the attending surgeon.

Appendicitis can be detected by various examination methods. Sometimes there are situations when the inflammation is secretive, or the main symptoms are mild. In these cases, an ultrasound of the appendix is ​​performed to exclude other diseases with similar symptoms. The accuracy of ultrasound examination reaches 90%!

Benefits of ultrasound diagnosis of the appendix

With dangerous complications of appendicitis, such as sepsis, perforation, gangrenization, urgent surgical intervention is necessary. With pronounced symptoms, doctors rely on the overall clinical picture. But if the symptoms are not so pronounced, or the appendicitis itself proceeds atypically, then delay in surgical intervention can cost the patient's life. In these cases, resort to ultrasound examination of the appendix.

The procedure allows you to determine the current state of the patient. Moreover, almost half of abdominal diseases have symptoms similar to acute appendicitis. Interestingly, the very location of the appendix is ​​often completely different, which significantly affects the nature of pain and the course of inflammation. Ultrasound helps to make an accurate diagnosis and prescribe the correct and timely treatment.

Even before the 1980s, barium X-ray radiation was used to examine the appendix. Ultrasound is much safer, especially for pregnant women and children. Many experts single out computed tomography as the most accurate research method. Ultrasound examination is in no way inferior to it, but it is much cheaper and more accessible. In emergency situations, they resort to ultrasound, due to the faster obtaining of data on the patient's condition.

Especially convenient is the use of ultrasound in diagnosing inflammation of the appendix in children and pregnant women. Due to the anatomical features, diagnosing appendicitis with classical research methods is quite difficult. In addition, children themselves often cannot explain in a coherent and accessible way exactly where it hurts them. This makes it difficult to diagnose and prescribe appropriate treatment.

However, there are also disadvantages to this survey method. For example, due to bloating, due to improper preparation for ultrasound, or overweight of the patient, the examination may not show some parts of the abdominal cavity on the monitor screen. In any case, the surgeon makes the final diagnosis and prescribes treatment, while ultrasound is just a way to collect data.

What does the study show?

This procedure does not require special preparation. The study is carried out through the abdominal wall with a special abdominal sensor. In rare cases, women have a retrocecal position of the appendix or pathology of the appendages, in these cases, the study is carried out with another sensor - vaginally.

Regardless of the anomalies in the structure and location, the appendix always begins with the caecum, i.e. grows from its end, so finding the appendix is ​​carried out as follows: find the end of the caecum and the psoas major muscle with the external iliac artery.

During the study, the specialist presses the sensor on the area of ​​\u200b\u200bthe appendix. This leads to some displacement of the intestinal loops and the removal of gas from them. This method improves the visualization of the organ and is called dosed compression. And the echogenicity of the adipose tissue of the appendix can be determined using the duplex scanning method.

Inflammation in the appendix is ​​indicated by:

• thickening of the walls of the process by more than 3 mm, their unevenness;
• its increase in diameter by more than 7 mm;
• the presence of fluid in the organ itself;
• layered and intermittent structure of the appendix;
• increased vascular density and echogenicity of fatty tissue;
• inflammation of the omentum;
• abdominal abscesses.

Most often, ultrasound is prescribed for prolonged pain, without pronounced symptoms of appendicitis. The fact is that other diseases have similar symptoms, especially in gynecology, and this study allows not only to examine the appendix, but also nearby organs. Ultrasound studies have shown themselves especially well in diagnosing chronic appendicitis and its subsequent treatment.

How is the diagnosis carried out?

If the pain is mild, there is difficulty in its localization, then an ultrasound examination of the abdomen is carried out according to the following scheme:

• examination of the tops of the caecum;
• finding the iliac vessels located above;
• examination of the iliac muscle;
• examination of the area behind the terminal ileum and the space behind the caecum;
• general examination and ultrasound of the small pelvis;
• in women, the Douglass space and the region of the right ovary are additionally examined.

It should be noted that ultrasound is not a final study. If the signs of appendicitis are "suspicious", additional laboratory tests are prescribed, for example, a complete blood count, magnetic resonance imaging (MRI), laparoscopy, computed tomography (CT).

The final diagnosis is made by the attending physician based on the data of all examinations. Ultrasound of the appendix is ​​also performed after the operation, especially if the patient's condition has deteriorated sharply, pain has appeared. In this case, antibiotics are prescribed.

Features of diagnosis in women

Due to the peculiarities of the physiological structure in women, the pain characteristic of appendicitis can be caused by an ectopic pregnancy, inflammation of the appendages or the right ovary. As a result, it is very difficult to make a correct diagnosis and prescribe an effective treatment regimen based only on laboratory tests and palpation data. This is where ultrasound of the abdominal cavity and small pelvis comes to the rescue. The specialist is able to reliably determine whether the source of pain is inflammation of the appendix or a gynecological disease. In addition, radiography and other studies may be prescribed.

It is statistically revealed that women are more prone to inflammation of the appendix than men. This is due to the physiological structure.

Firstly, the female organs of the genitourinary system are almost in contact with the organs of the gastrointestinal tract. So inflammation in the genitals is transmitted to the bladder, urethra and even the intestines.

Secondly, during menstruation, blood circulation increases, the uterus "swells", shifts other organs and puts pressure on the appendix. Therefore, complex therapy is possible. Expectant mothers are especially at risk. The growing uterus compresses other internal organs, disrupting normal blood circulation.

Features of diagnosis in pregnant women

Most of the pain that occurs in the abdomen, pregnant women attribute to their "interesting position". This is usually the case, so the symptoms of appendicitis are not immediately recognized. Moreover, in late pregnancy, the appendix itself shifts upward, i.e. its location changes, just affecting the general symptoms of appendicitis and the nature of pain. At the same time, an “acute abdomen” is also associated with other diseases that can also be dangerous for the fetus and the life of a woman. In this case, the diagnosis of appendicitis is necessarily carried out using ultrasound.

The causes of inflammation of the appendix in pregnant women are not fully understood. According to one version, the growing uterus presses on other organs, shifting them. As a result, there is a blockage of the lumen between the appendix and the intestine, which disrupts blood circulation, leading to inflammation. It turns out that pregnancy itself, often, provokes appendicitis. According to statistics among women, acute appendicitis is diagnosed more often in pregnant women.

The main signs of appendicitis in pregnant women:

• pain in the upper abdomen or navel, gradually moving to the lower right region;
• diarrhea, nausea, vomiting;
• heat;
• lack of appetite;
• pallor of the skin;
• sweating.

Sometimes pregnant women notice pain not only above the uterus, but also throughout the abdomen, as well as increased pain in the supine position on the right side. With a low location of the process, the pain radiates to the legs, while the nature of such pains varies greatly, therefore an ultrasound examination is necessarily indicated.

Appendicitis is dangerous not only for a woman's health. Of the threats, one can single out: termination of pregnancy at a later date, infection of the fetus, inflammation of the pelvic organs, intestinal obstruction, premature detachment of the placenta.

At the same time, the threat remains in the postoperative period. Antibiotics are indicated, expectant mothers are prescribed general tonic and sedatives, tk. all experiences are transferred to the baby.

Features of diagnosis in children

Young children often cannot describe the nature and intensity of pain. They cry, act up, pull their legs up to their stomachs. All this complicates the diagnosis. Most often, children of school age are affected by this disease.

As a result, there is swelling of the mucosa of the process, increased tension of its walls, reproduction of pathogenic flora, venous congestion, and impaired arterial circulation. The inflammation itself in children is much more acute and faster than in adults. Appendicitis in children is provoked even by SARS, tonsillitis, otitis, measles, sinusitis, dysbacteriosis, gastritis, constipation and overeating. This is due to the special intestinal microflora and the untimely start of therapy. Some serious illnesses, such as typhoid fever, can cause inflammation of the appendix on their own. Treatment of appendicitis in children occurs only in an operable way.

Sometimes resection of the appendix is ​​contraindicated for various clinical indications. Such cases are less common, but they do occur. As a result, appendicitis is treated with antibiotics, without surgery. It will not be possible to completely cure the appendix, and appendicitis becomes chronic. In the period of exacerbation, treatment in a hospital under the watchful supervision of doctors is indicated. In this case, the ultrasound of the appendix allows you to see the entire clinic of inflammation, track changes. As a consequence, people with chronic appendicitis must undergo examinations 2-3 times a year, incl. ultrasonic, because inflammation can proceed secretly without pronounced pain.