Appendicitis - inflammation of the appendix, called the appendix. It is a small appendage of the blind colon, located on the border of the small and large intestines. Because of the anatomical features of the appendix often inflamed - Acute appendicitis is the most frequent surgical disease.
This happens so often that in the thirties of the last century in Germany, it was proposed to remove the appendix for children in early childhood, as a preventive measure to combat appendicitis. In those years it was believed that the appendix is a throwback, a completely useless anatomical education, without which it is possible to do. However, the experimental results have been disappointing: in those children at an early age that the appendix was removed, subsequently developed a severe form of immunodeficiency.
Acute appendicitis in the non-acceptance of urgent therapeutic measures is dangerous because it leads to fester and break inflammation of the appendix, with diffuse spread of inflammation and pus in 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 the obstruction of the lumen of the appendix. This can happen because of the inflection of the appendix, as well as a result of mechanical obstruction, when released into the lumen of fecal stones or foreign bodies. Entry of foreign bodies in the appendix - one of the frequent causes of appendicitis in children and adults caused by appendicitis often fecal stones. Another mechanism of inflammation of the appendix, is the emergence of ulcers on the intestinal mucosa, usually as a result of a viral infection.
The symptoms of appendicitis
The main symptom of appendicitis is suddenly appeared pain in the abdomen. For 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 (symptom Kocher-Volkovich, pain or symptom displacement);
- In the future, the pain takes spilled character;
- The pain is constant, there may be periods of strengthening and pain relief, but there are no painless periods;
- Pain increases with movement, so patients with acute appendicitis often move, holding the right side of the abdomen arms, which is one of the characteristic symptom of appendicitis;
- A sharp pain indicates purulent inflammation of the appendix (appendix empyema);
- Calming down the pain of acute appendicitis - an unfavorable sign, as the reason for this could be the beginning of gangrene and death of nerve endings.
In addition to pain, symptoms of appendicitis are loss of appetite, nausea, possible single vomiting, constipation, frequent urination.
Appendicitis in adults usually causes rapid deterioration of general condition, in any case, before the development of peritonitis. Possibly a slight increase in temperature to subfebrile (37-37, 5 ° C). Appendicitis adult patients can be simpler and destructive. When destructive course of the symptoms more pronounced, greater pain and suffering overall.
Appendicitis in children occurs much more rapidly, inflammation progresses quickly and peritonitis develops much faster. When appendicitis in children severe abdominal pain may soon wear spilled character, pronounced general symptoms: severe nausea, repeated vomiting, fever. Appendicitis in children almost always occurs on the type of destructive appendicitis in adults.
In the classic form of the disease does not cause problems with the diagnosis, which is set based on the characteristic symptoms of appendicitis. Help clarify the diagnosis following tests:
- Soreness in the right iliac region on palpation of the abdomen;
- Soreness in the right iliac region with gentle effleurage (symptom Razdolsky);
- Increased pain with a sharp withdrawal of the hand after pressing the anterior abdominal wall (MPPI Shchetkina-Blumberg);
- Increased pain with the patient lying on his left side (a symptom Sitkovskiy);
- Palpation much more painful when lying on the left side (a symptom-Bartome Michelson);
- Increased pain when picked up straight in his right leg in the supine position (psoas sign);
- Increased pain in the right iliac region when moving the hand from the upper abdomen to the right iliac region spanned by the shirt (a symptom of the Resurrection);
- Soreness in the right iliac region when pushing his fingers in the left iliac region (symptom Rovzinga).
These symptoms of appendicitis are important diagnostic value. However, in some cases, in the anomalous position of the appendix, the clinical picture may be blurry, and some of the features described herein may be negative. You may also receive uncharacteristic for appendicitis symptoms such as diarrhea.
Any signs of acute abdomen should guard against an attack of appendicitis, therefore, as a rule, the more specific diagnosis has been held at the time of surgery (laparotomy), as delay may lead to serious complications, life-threatening. Because of difficulties in diagnosis of abnormal forms of acute appendicitis is much more likely to become a cause of death.
Treatment for appendicitis
Treatment consists of surgical removal of appendicitis.
For suspected acute appendicitis patient must be put and keep at rest until the arrival of the ambulance. Transport to the hospital is also happening in the supine position. Do not place the enema and laxatives, food, water, and taking pain medications is undesirable, because of the subsequent difficulties in conducting diagnosis.
Appendectomy should be carried out as quickly as possible to avoid a rupture of the appendix and peritonitis. To reduce the chance of infection at the time of appendectomy, is administered before surgery antibacterials. Antibiotics are prescribed in the postoperative period.
Appendectomy is performed under general anesthesia, in some cases, lean patients may use local anesthesia.
At present, the simplest form of appendicitis prefer laparoscopic surgery that does not require an abdominal incision. In this case, the endoscopic instrument is introduced into the abdomen through a small incision in the tissue. Appendectomy this method avoids surgical trauma and reduce the recovery period at times. The risk of post-operative complications of laparoscopic appendectomy is minimal.