Signs and symptoms of appendicitis. Clinical picture, complications of acute and chronic appendicitis. Appendicitis - symptoms in adults, signs, causes Causes of appendicitis

This disease involves inflammation of the vermiform appendix of the caecum (appendix), and can have both acute and chronic course. From the point of view of diagnostic accessibility, appendicitis can be determined both easily and with difficulty.

Let's move on to the most characteristic symptoms of this pathology.

Acute appendicitis

The acute course of appendicitis is characterized by a gradual increase in symptoms that appear in strict sequence. Therefore, you should immediately consider the stages of acute appendicitis.

stages

catarrhal changes. At this stage of development of acute appendicitis, there is a predominant lesion of the mucous membrane of the appendix;
Superficial lesion characterized by rapid progression of inflammation and violation of the integrity of the mucous membrane. At this stage, there is a significant accumulation of blood and leukocytes in the lumen of the appendix;
Phlegmonous lesion. At this stage, all layers of the wall of the appendix are affected, taking into account the outer shell;
The next step is the appearance of phlegmonous-ulcerative changes in the mucous membrane of the appendix;
Gangrenous lesion. This stage is the last and most dangerous. Gangrenous appendicitis is characterized by necrosis (necrosis) of the wall of the appendix, and the ingress of purulent contents into the abdominal cavity. The most likely consequence of this condition is peritonitis, which can be fatal.

The transition from the first stage to the last takes no more than 2 days. Given such a rapid progression, acute appendicitis is an absolute indication for emergency surgery.

Timely hospitalization in the surgical department with subsequent surgical intervention can significantly reduce the likelihood of complications. In order to familiarize yourself with the main symptoms of acute appendicitis, their detailed description will be given below.

Symptoms

Pain syndrome

Increased pain in acute appendicitis occurs during exercise, walking, torso, sneezing, coughing and laughing. In old age, pain syndrome may not be observed at all.

If the inflamed appendix has an abnormal location, which is often observed in adult men, then the place of localization of pain may be the suprapubic region, the projection of the ureters and kidneys, the lumbar region, and the region of the right hypochondrium.

If a few hours after the onset of pain, they spontaneously disappear, then this sign indicates the death of nerve endings, and the development of a gangrenous form of acute appendicitis.

Nausea and vomiting

These two signs usually begin to bother in combination with pain, but never occur before it appears. Nausea in this case is permanent, but vomiting can occur once, as it is associated with a reflex effect.

As a rule, the initial stages of acute appendicitis are not accompanied by the appearance of dry mouth and feeling greedy. The surface of the tongue in acute appendicitis is covered with a white coating. Dry mouth may indicate a rupture of the wall of the appendix, and the development of inflammation of the peritoneum.

Increase in body temperature

The initial stages of acute appendicitis may not be accompanied by an increase in body temperature. In rare cases, temperature indicators can increase to 37-38 degrees. An increase in temperature to higher numbers may indicate the development of severe complications.

Minor symptoms of acute appendicitis include:

Chair. For the acute form of this disease, as a rule, a violation of the stool is not characteristic. Older people may experience constipation. If the appendix is located near the bends of the small intestine, then this may be the cause of the development of diarrhea.
Sleep disturbance. In the acute course of appendicitis, insomnia can be caused solely by pain and an increase in general discomfort;
Appetite in this case, it can be sharply reduced, or completely absent. This is due to an increase in the general intoxication of the body;
Observed muscle tension in the anterior abdominal wall.

Chronic appendicitis

According to statistics, chronic appendicitis is a rather rare pathology, and occurs in only 1% of all cases. This condition is characterized by the periodic appearance of pain in the right half of the abdomen from below (with a typical location). Only a qualified medical specialist using ultrasound diagnostics, computed tomography or diagnostic laparoscopy can establish the presence of chronic appendicitis.

The chronic form of appendicitis can be perceived as a number of other diseases, and this happens due to the presence of similar symptoms. The developing inflammatory process in the appendix has common symptoms with such diseases as: gastric ulcer, chronic cholecystitis, pyelonephritis.

The leading symptoms of chronic appendicitis include:

Paroxysmal pain, aggravated even with minor physical exertion. The pain is intermittent.
During an exacerbation, chronic appendicitis resembles the symptoms of an acute one, while the body temperature may remain within the normal range;

The most dangerous complication of chronic appendicitis is peritonitis. If you have at least one of the above symptoms, you should immediately contact a medical specialist.

False appendicitis

The clinical picture of this condition can be perceived as manifestations of acute appendicitis. At the heart of false appendicitis are the phenomena of increased contractile activity of muscle tissue. The resulting pain syndrome is associated with an involuntary contraction of the muscle layer of the wall of the appendix. In this case, the inflammatory component is completely absent.

Also, false appendicitis can proceed according to the atonic type. In this case, a sharp decrease in tone prevails, and pain is caused by excessive accumulation of fecal masses in the cavity of the appendix.

What to do?

First of all, it is important to consider that these variants of the course of acute and chronic appendicitis are generalized. It is impossible to exclude clinical cases when the disease had a fulminant or latent (latent) course.

Almost every person encounters during his life. What is this disease? What are its symptoms and treatments? Appendicitis is an inflammation of the appendix, a worm-like appendage of the rectum.

Expert opinion: The appendix is a appendix of the caecum.

The disease has a characteristic pronounced clinical picture and is treated only with the help of surgical intervention.

Doctors distinguish two types of appendicitis: acute and chronic. Chronic appendicitis, in turn, can have three morphological forms:

Superficial or catarrhal.
Simple.
Phlegmonous-ulcerative, gangrenous, apostematous.

Symptoms of appendicitis

One of the main symptoms of the disease - pain in the lower abdomen (usually on the right) appears in 90% of cases of appendicitis. The first sign of an acute form of the disease may be the patient's complaints about the periodic occurrence of discomfort and mild pain from the gastrointestinal tract: pain in the navel, bloating, colic. After going to the toilet, there may be a short relief, but after a while these symptoms usually return.

For 2-3 hours, rare colic turns into constant aching and arching pain. At this time, the pain sensations move to the right, to the lower abdomen. This process is called the Kocher-Wolkovich symptom. To save yourself from the oncoming pain and severe discomfort at this moment, it is recommended to lie on your right side and pull your legs bent at the knees to your stomach.

Increasing pain in the abdomen with the slightest movement, whether it is an attempt to cough or stand up, while shaking while walking or riding in transport, is a typical sign of appendicitis in an adult or child.

Expert opinion: These symptoms will be related to irritation of the peritoneum. Irritation of the peritoneum can be with peritonitis, perforation of a stomach ulcer, with acute and other diseases of the abdominal organs.

Usually appendicitis occurs in the right side, however, cases of left-sided appendicitis have been reported in medical practice. In this case, the appendage of the caecum is on the left.

Expert opinion: Such situations arise in the case of dextraposition of organs, that is, with their mirror arrangement. The heart will be on the right and the liver on the left, and so on.

In addition, the pain that occurs during an attack directly depends on how the appendix is located. Pain in the right lower abdomen, in the womb area indicates the pelvic position of the appendix. If it is located in close proximity to the medial line of the abdomen, the pain will make itself felt in the navel area. When the appendix is located behind the caecum, pain sensations appear in the lower back and "give" to the right leg and inguinal region.

Pain with appendicitis is not pronounced, strong. Basically, the patient tolerates it until the appendix begins to stretch from the accumulated pus in it, that is, until the empyema of the appendix begins. In this case, the pain becomes unbearable. The resulting gangrenous processes contribute to some relief of the patient. This is due to the death of nerve endings, which serve as a source of pain. When the appendix ruptures, the pain spreads throughout the abdominal cavity along with the purulent contents of the erupted appendage.

In 80% of patients, the main symptoms of appendicitis are nausea and vomiting in the first hours of inflammation. Therefore, appendicitis can often be confused with a disease or disorder of the gastrointestinal tract. The diagnosis of acute appendicitis is immediately called into question if nausea occurs before abdominal pain. Often a sign of appendicitis, and to a greater extent among adults, is refusal to eat. Loss of appetite is typical for 90% of patients with a similar diagnosis.

Also with appendicitis are possible:

Problems with stool (in a third of all cases). Defecation is delayed due to intestinal paresis, that is, restriction of the motor functions of the intestine due to the spread of inflammation in the abdominal cavity. In 15% of patients, on the contrary, excessively loose stools are observed.
False urge to go to the toilet (tenesmus).
Slight rise in temperature. Half of the patients during the first 24 hours have an increase in temperature up to 37.5 C. Doctors note that a strong increase in temperature is not typical for this disease if it is not associated with complications and extraneous infections.

Acute appendicitis is characterized by the development of some pathological changes that are observed on the first day after the onset of inflammation: lymph disorder and stagnation of blood in the capillaries, hemorrhages and edema, margination of leukocytes, the appearance of siderophages - specific phagocytes. These changes usually appear in the part of the appendix that is farthest from the medial line of the abdominal cavity.

Operation for appendicitis

Usually, a patient admitted to the hospital with suspected appendicitis should be under the supervision of a doctor for some time and pass a series of tests. After confirming the diagnosis, a surgical operation must necessarily take place. It can be carried out by one of two methods: endoscopic or traditional.

With the traditional method, at the location of the appendix, more often in the right side, an incision is made in the muscle tissue, reaching a length of 8 cm. Next, the surgeon examines the appendix, if the adjacent tissues are not inflamed, he removes it, and sews up the junction of the rectum and the inflamed appendage. A ruptured appendix can cause peritonitis. In this case, an operation is also performed to remove the inflamed appendage, after which the patient remains in the hospital for another week under the supervision of specialists and takes antibiotics.

Today, more and more often, an operation to remove the appendix is performed using a modern endoscopic method, in which a tube with a camera at the end is inserted into the abdominal cavity. The doctor monitors the condition of the appendix at this moment on the computer monitor. Through a special section, the inflamed appendage is cut out, the incision in this case will be much smaller than with the traditional method of surgery.

Rehabilitation with the successful implementation of such an operation takes place within two days. The postoperative period does not require any special diets or restrictions. Often, symptoms characteristic of appendicitis may occur due to dyskinetic pathologies. This condition is called false appendicitis. If, during the surgical intervention, the doctor finds that there is no inflammation of the appendix, he will still cut it out to prevent a possible disease.

Appendicitis is a disease of the gastrointestinal tract that can occur in a person at any age. Usually, you can get rid of appendicitis only by surgery, since the inflammatory process in the appendix does not go away on its own.

If there is a suspicion of appendicitis, then you should immediately seek medical help. Otherwise, the disease can go into an acute phase, which will lead to serious complications that pose a threat to human life.

Features of the disease

Experts call appendicitis inflammation of the appendix. This is a small process on the caecum, outwardly resembling a worm that does not have a through passage. Its length can vary from 5 cm to 15 cm, diameter - 0.7-1 cm.

For a long time, the appendix was considered rudimentary, inherited by humans from herbivorous ancestors. But recently its uselessness has been questioned by many researchers. There is reason to believe that this part of the intestine affects the functioning of the endocrine and immune systems.

However, the appendix is not a vital organ. After the operation to remove it, a person can live a full life for a long time.

Inflammation of the appendix (a purulent mass accumulates inside the process) can occur for various reasons.. After some time, the inflamed appendix increases significantly in size and becomes painful.

If no action is taken at this stage of the disease, the walls of the appendix may burst, and pus enters the abdominal cavity. This pathology is already called acute peritonitis, the most complex complication of which is pylephlebitis (severe liver damage).

Appendicitis develops very quickly. The disease is almost always acute, its duration rarely exceeds 2-4 days.

Do not hope that the disease will heal itself: such cases are extremely rare.

The inflammatory process can lead to the formation of an infiltrate, which is formed from the tissues surrounding the diseased organ. But such a neoplasm can also cause a new abscess.

Very rarely there are patients with chronic appendicitis, which does not require surgical intervention. It manifests itself with the same symptoms as acute appendicitis, but they occur periodically.

Where is appendicitis located?

Most people think about which side the appendix is on only at the moment when their stomach starts to hurt sharply. WITH there are several options for the placement of the process, and each of them is considered the norm:

"Classic" is considered to be the location of the appendix in the right lower abdomen. When examining a patient, doctors draw an imaginary line from the upper part of the ilium to the navel, then divide it into three parts. On the border of the lower and middle parts there will be a projection point for the location of the appendix. In medical language, this place is called McBurney's point.
Sometimes the appendix may have a pelvic position. This pattern is more common in women.
Some people have their appendix on the left, such cases are extremely rare.

Displacement of the appendix can be caused by deformation of the internal organs, pregnancy in women, or injuries. In such cases, the location of the process can only be determined with the help of ultrasound.

The first signs of appendicitis

Appendicitis is a very dangerous disease, the complications of which can lead to death. To prevent this, it is very important to start treatment in a timely manner, until the pathology has passed into an extreme stage.

The first symptom of appendicitis is a sharp, persistent pain in the abdomen. Most often it occurs at night or in the morning.

In the first stage of the disease, the entire abdomen will be painful, but after a while the pain is concentrated in the lower abdomen on the right side, which is where the appendix is located in most people. It is possible to distinguish appendicitis from other diseases precisely by this displacement of the focus of pain, this process is called Kocher's symptom.

Other symptoms of appendicitis include:

temperature increase. First, there is a slight increase, the thermometer rarely shows 37-38 ° C, and then the body temperature can return to normal. But when the disease passes into the final stage, there is a strong fever up to 39-40 ° C. This indicates the readiness of purulent masses to break through the wall of the appendix and escape into the abdominal cavity;
vomiting and stool disorders- symptoms characteristic of gastrointestinal disorders. To this is added a delay in stool and a feeling of dryness in the mouth. Diarrhea in adults is rare - this symptom is more common in children;
tachycardia. During appendicitis, the pulse quickens to 90-100 beats per minute.

Usually in adults, appendicitis symptoms of appendicitis are more pronounced than in children. But the older a person becomes, the more difficult this disease will be to diagnose.

In older people, the symptoms of appendicitis are often erased., signs of pathology may not appear until the development of the extreme stage of the disease. This does not mean that appendicitis is more easily tolerated in old age - on the contrary, older people are more likely to experience serious complications that require a special approach to treatment.

Symptoms of appendicitis in women and men

Appendicitis occurs in about 10% of people, while gender and age do not matter. But according to statistics, among patients under the age of 20, there are more men, while in the age group of 20-40 years there are twice as many women.

Experts note that in general, this pathology occurs more often in the fair sex.

Determine appendicitis in adult women, and start treatment in a timely manner by several characteristic symptoms:

Symptom Zhendrinsky. If you lie on your back and try to press on your stomach (about 2 cm below the navel), then the pain will increase. It can also be felt when trying to get up. If the pain was caused by urological pathologies, then at this moment the pain should subside a little.
Symptom Promptov used as an exclusive method. With constant pain, a gynecological examination of a woman is performed, during which the doctor compresses the cervix and moves it back and forth. If at the same time the woman received new pain sensations, then appendicitis is excluded.
Grube's symptom describes an increase in pain in the right side of the iliac region during vaginal examinations.

Symptoms of appendicitis in women after 40 years of age are somewhat blurred. The risk of this disease at this age is somewhat reduced, but this does not mean that the appendix will no longer be able to become inflamed.

The symptoms of appendicitis in adults, regardless of gender, are largely similar.. Both women and men will initially feel a sharp pain in the abdomen. But ladies often confuse it with the pain that occurs during menstruation.

Even some doctors may mistake the first symptoms of appendicitis for manifestations of gynecological diseases.

In order to prevent the development of complications, you must be attentive to your health, and if acute abdominal pain occurs, immediately consult a doctor.

If diagnosing an attack of appendicitis in a woman is not easy, then in men, this disease is manifested by a set of characteristic symptoms, which do not allow to confuse appendicitis with another pathology.

Men often have such signs of inflammation of appendicitis:

Britten's syndrome. If you click on the area where the appendix is located, then the man's right testicle will pull up a little;
symptom of Larock. Spontaneous pulling of the right testicle to the scrotum is noticed by the patient himself;
Horn sign. If you stretch the scrotum a little, then the man will feel pain in the right testicle.

Most often, inflammation of the appendix develops in boys and young men under the age of 20.. At this age, it is necessary to carefully monitor health. However, signs of appendicitis in men after 30-40 years old can also occur, while the symptoms will be pronounced, characteristic of this disease.

Pain with appendicitis in women and men occurs abruptly, then its focus shifts. After a while, the pain may disappear, but soon the pain will become even more severe. Displacement of the foci of pain and a change in their intensity is a clear indication of the presence of an inflammatory process in the appendix.

It is not always possible to independently determine at home where appendicitis is located: most people have a standard arrangement of internal organs, but sometimes there are exceptions.

You should be aware of the health risks and seek help immediately if you experience severe pain in the abdomen.

You may not be diagnosed with appendicitis, but the presence of pain indicates pathological processes in the body that require appropriate treatment.

Diagnosis of chronic appendicitis in women and men is very difficult., since the symptoms characteristic of inflammation of the appendix are usually absent or blurred. Laboratory studies of urine and blood do not reveal pathologies. The diagnosis can be made using hardware methods: ultrasound, fluoroscopy, colonoscopy and others. During the examination, great attention is also paid to the exclusion of other diseases that have similar symptoms.

Symptoms of appendicitis during pregnancy

During pregnancy, women often experience pain in the abdomen, so the first symptoms of appendicitis often go unnoticed.

But it is pregnancy that can provoke inflammation of the appendix, since the enlarged uterus can compress the process and disrupt its blood supply.

The first signs of appendicitis in pregnant women differ little from the manifestations of this disease and other categories of patients. The main symptom of inflammation of the appendix is severe abdominal pain, but its nature and location may be different:

at the first stage of the disease, all inflammatory processes take place inside the process. At this time, the woman feels pain in the upper abdomen, gradually the pain shifts and is localized in the right lower abdomen. In some cases, the pain may be minor, it occurs throughout the entire area of the abdominal cavity. A pregnant woman can feel pain only when she lies on her right side. In this position, the uterus presses on the inflamed appendix most strongly;
as the inflammatory process develops, the nature of pain sensations changes. It manifests itself in the right iliac region. Pain can occur in both the lower and upper abdomen. Often, pain is felt even in the hypochondrium. The level of soreness largely depends on the duration of pregnancy: the larger the uterus, the more it presses on the site of inflammation, which means that the pain will be sharper;
the location of pain in pregnant women may be different. This is due to the fact that at this time the internal organs of a woman are displaced under the influence of an enlarged uterus. If the appendix is located close to the liver, then the woman may experience symptoms that have much in common with the manifestation of gastritis. When the process is displaced to the urethra, the pain radiates to the legs and perineum.

Also, inflammatory processes in the appendix may indicate nausea, vomiting, diarrhea or constipation, as well as fever. But these symptoms often occur in pregnant women for other reasons.

A doctor should diagnose appendicitis in a pregnant woman h, often this can only be done using hardware research methods: ultrasound and laparoscopy.

If the expectant mother begins to experience acute pain, then it is necessary to inform the attending physician about this. Inflammation of the appendix can lead to the development of complications that can lead to abortion, placental abruption, etc.

Symptoms of appendicitis by authors

As noted above, the main symptom of appendicitis is abdominal pain. But it can manifest differently for each person. Many studies have studied the symptoms of this disease.

Thanks to them, some symptoms were identified, which later received the names of the researchers. In total, 43 "author's" symptoms are described, the most famous of them are:

Symptom of the Resurrection also called the shirt symptom. Its essence boils down to the fact that when examining a patient, the doctor pulls on his shirt with his left hand. The patient should take a deep breath, and the doctor with the fingertips of his right hand slides down the shirt from top to bottom. The movement of the hand should be directed to the iliac region, after its completion the patient will feel a sharp increase in pain. This symptom is manifested in acute appendicitis.
Kocher's symptom. As noted above, this symptom is one of the main ones in the diagnosis of acute appendicitis. Only for this disease is characterized by a shift of pain from the epigastric region to the iliac part of the abdomen. Usually, a change in localization is noted approximately 2-4 hours after the onset of pain.
Obraztsov's symptom also seen in acute appendicitis. To detect it, it is necessary to simultaneously raise the right leg and press on the abdomen, where the caecum should be located. This intensifies the pain. Accurate results can only be obtained if the leg is absolutely straight (straightened at the knee joint).
Shchetkin-Blumberg symptom manifested by slowly pressing on the abdominal wall with a hand and abruptly removing it. If during pressure the patient feels moderate pain, and when the hand is removed, the pain intensifies, then we can talk about the presence of a symptom.
Roswing's symptom also found in the acute form of the disease. A significant increase in pain is noted with simultaneous exposure to the sigmoid (squeezing) and descending colon (pushing pressure).
Symptom Sitkovsky appears when the patient lies on the left side. If the patient really has acute appendicitis, then in this position he should intensify in the right part of the iliac region.
Symptom of Razdolsky. To identify it, the doctor taps the abdominal wall. This diagnostic method in medicine is called percussion. When it is performed, a patient with acute appendicitis should feel increased pain in the right iliac region.
Widmer's symptom can be detected in the process of measuring body temperature. In acute appendicitis, its value in the right armpit will be slightly higher than in the left.
Symptom of Bartomier-Michelson manifested in increased pain when feeling the caecum. During palpation, the patient should lie on the left side.

The combination of these and other symptoms makes it highly likely to diagnose acute appendicitis in a patient, which requires surgery to remove the appendix.

Kinds

There are two main types of appendicitis. The first of them is called acute, the second - chronic.

Only a doctor in a hospital can identify the symptoms and treatment of acute appendicitis. As a rule, this requires a surgical operation.

Features of acute appendicitis is the rapid development and the presence of vivid symptoms. The disease lasts about 4 days. The first two days account for an early stage, then the inflammation passes into an acute phase, which can end with a rupture of the walls of the appendix.

If you do not perform a surgical operation to remove the inflamed process on time, then complications that are incompatible with life may develop.

Symptoms and treatment of chronic appendicitis are very different from the acute variety of the disease, it is even distinguished as a separate pathology. Chronic appendicitis is rare. It is difficult to diagnose this form, due to the distortion of the nature of pain. You can identify the disease by several signs:

pain response tests. When feeling the walls of the abdomen, pain occurs in its right side;
pain when raising the right leg, also patients note that she gets tired while walking faster than the left;
decreased muscle tone in the right side of the abdomen.

For the diagnosis of chronic appendicitis, radiation methods are used, while it is possible to identify indirect signs of inflammation.

Chronic appendicitis can also be treated surgically, but in some cases, patients may need to take antibiotics.

Forms of appendicitis

The most dangerous for humans is acute appendicitis.. This disease can proceed in different ways. Depending on the degree of development of the inflammatory process, there are several forms of appendicitis:

The initial stage is called catarrhal appendicitis.. At this stage, inflammation covers only the mucous membrane of the process. Since the pathological processes are still quite superficial, the symptoms are still weak. Appendicitis is rarely diagnosed at this stage. But if you perform an operation to remove the appendix at this very moment, it is almost painless and with the least complications.
Superficial appendicitis affects the tissues under the mucous membrane, as well as the blood vessels located in them. At this stage, the patient feels the main symptoms of intoxication, pain increases, body temperature may rise. Most often, acute appendicitis is detected at this stage of its development.
Phlegmous appendicitis is a severe form of the disease. Inflammation penetrates into all tissues of the appendix, and it itself begins to fill with purulent masses. Against this background, the main symptoms of the disease manifest themselves most clearly. Purulent appendicitis requires immediate surgery. Most often, the diagnosis is determined very quickly, and only in rare cases, the doctor can observe the patient for a couple of hours.
Gangrenous appendicitis represents an extreme degree of the disease, leading to the development of peritonitis. At this point, the pain may subside. This is due to the death of appendix cells. But the inflammation does not disappear, but, on the contrary, intensifies.

Sluggish appendicitis (chronic form of the disease) develops according to a different pattern, but it can lead to acute inflammatory processes in the appendix.

Hidden appendicitis characterized by recurrence of seizures. Usually, after the second episode, the patient is diagnosed with an acute form of the disease, followed by removal of the appendix.

Sometimes the appendix can remind of itself with characteristic pain sensations, but at the same time, inflammatory processes do not occur in it. This so-called wandering (false) appendicitis. It occurs as a result of involuntary movements of the process. After a while, the discomfort disappears. Other symptoms of acute appendicitis (diarrhea, vomiting, nausea, etc.) are absent altogether.

Causes of Appendicitis

Many surgeons find appendix surgery to be easy enough to do on a daily basis. But, despite this, they are not able to name the exact cause of appendicitis.

It is reliably known that for the development of an inflammatory process in this appendix of the intestine, two conditions are necessary: the presence of pathological microflora and blockage of the lumen of the appendix.

There are several theories explaining the occurrence of inflammatory processes in the appendix.:

Aschoff's theory is based on the fact that acute appendicitis develops as a result of exposure to local microflora, which at some point becomes pathogenic. As a result, foci of inflammation appear on the mucous membrane of the appendix, they spread over time and lead to the development of the disease. Specific acute appendicitis causes Escherichia coli, streptococcal and staphylococcal infections. Specific appendicitis arises from exposure to pathogens of typhoid fever, tuberculosis, dysentery, etc.
Riquerra theory among the main causes of the development of inflammatory processes in the appendix indicates vasospasm. The vascular theory gives a more complete answer to the question of why destructive forms of appendicitis develop.

Both theories are not refuting - they complement each other.

As a result, the researchers were able to identify factors that can serve as an impetus for the development of appendicitis. These include:

decreased immunity. Immunodeficiency can develop as a result of previous diseases, on the basis of smoking, the abuse of fatty foods, alcohol, as well as against the background of various stresses and experiences;
necrosis of the walls of the appendix frolicking as a result of vasospasm or thrombosis of the artery that feeds the process. This is typical for people with diseases of the cardiovascular system;
blockage of the lumen can occur due to helminthic invasions, fecal stones, foreign bodies entering the process, as well as its deformation;
eating large amounts of meat;
hereditary causes. People who have certain types of antigens are more likely to develop appendicitis;
transfer of inflammatory processes from other organs. This picture is typical for women. The appendix is located close to the uterine appendages, in which inflammatory processes very often occur.

Also, the causes of appendicitis may lie in the anatomical features of a person. The shape and size of the appendix can vary from person to person. The process may be too long or have bends that can provoke stagnation of its contents.

Treatment

For a long time it was believed that the treatment of appendicitis without surgery is impossible. This is partly true, because patients often go to the doctors already in a state where other types of care are ineffective.

But recently, more and more patients with inflammation of the appendix are being treated with antibiotics.. However, medication should be taken only in a hospital under the supervision of specialists, self-medication is unacceptable.

Antibacterial drugs are used in such cases:

The disease is in the initial (catarrhal) stage. In this case, it is still possible to stop the inflammatory process.
In the presence of serious contraindications to the surgical operation or in the categorical refusal of the patient from surgery.
If the diagnosis is in doubt. Quite often, appendicitis is disguised as other diseases, so the use of medications avoids unnecessary surgery.

Moreover, antibiotics may be prescribed during the preparation of the patient for surgery. The combination of these two methods allows several times to reduce the risk of complications.

Only a doctor after a thorough examination can recommend conservative treatment of appendicitis. If the experts came to the conclusion that an operation is necessary, then the patient is better off agreeing with their conclusions.

Complications and consequences after appendicitis

Thanks to the development of medicine, the operation to remove the appendix has ceased to be difficult. With timely treatment to doctors, recovery occurs within 7 days after the operation.

Ignoring warning signs can lead to complications.

The most dangerous is peritonitis with appendicitis. This disease is characterized by the development of inflammatory processes in the entire abdominal cavity. Rupture can lead to peritonitis appendicitis.

For treatment, a more serious operation will be required, which affects a large area. Recovery of the patient after that will be more difficult and long.

Despite the apparent simplicity of the operation, it can also lead to the development of complications. The risk of their occurrence largely depends on the severity of the patient's condition, the stage of development of the disease, as well as the qualifications of the surgeon.

Most often, such complications occur after the removal of appendicitis.:

adhesions often occur after surgery to remove the appendix. The patient feels discomfort, there are pulling pains. It is difficult to identify adhesions, since even ultra-sensitive ultrasound devices do not detect them. If such symptoms occur, the patient is recommended to take absorbable agents. In especially severe cases, laparoscopic surgery to remove adhesions can be performed;
hernia after appendicitis is also a fairly common complication. It occurs as a result of a separate fragment of the intestine falling into the hole between the muscle fibers. As a rule, such a complication occurs through the fault of the patient himself due to failure to comply with the requirements of the attending physician. It is possible to eliminate a hernia only surgically;
an abscess may occur after treatment of peritonitis. This complication is eliminated with the help of antibiotics;
pylephlibitis - the transition of inflammation to the portal vein. This postoperative complication is extremely rare;
intestinal fistulas appear due to poor sanitation of purulent appendicitis and other medical errors. The risk of such complications is quite small. Fistulas are not amenable to treatment; resection of damaged tissues is usually performed with the capture of part of the epithelium.

Sometimes there may be other complications due to the individual characteristics of the patient.. The reason for a second visit to the doctor may be a deterioration in well-being on the sixth day after the operation. This indicates the presence in the body of pathological processes that require special treatment.

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

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 call an ambulance as soon as possible. If appendicitis is left untreated, peritonitis can develop, a complication that is fatal.

As appendicitis manifests itself, each person should know the symptoms and signs of this emergency. The main symptom of appendicitis in adults and children is 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 the right side of the abdomen. This migration of pain is considered a very specific sign of the disease.

Causes of appendicitis

There are the following reasons for the development of 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 both to the right side and to the lumbar region, or to 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 of the onset of the disease is severe 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 is worth noting that the appendix in 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 when turning from the left side to the 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 by the local and general reaction of the body. As a rule, pain in acute appendicitis begins suddenly.

At the beginning of an attack, they are often localized in the 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, the lag in breathing of the lower sections of the abdominal wall is often determined. 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. In most patients, light tapping with fingers in various 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 can be especially peculiar in children, elderly and senile people, 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

Women are more prone to inflammation of appendicitis than men, the symptoms of which appear more often at the age of twenty or forty. 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 the involvement of the reproductive organs in the inflammatory process.
When examining the vagina in a woman, pain is found, especially when examining the cervix, with appendicitis 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

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

Clarification of the morphological form of appendicitis (catarrhal, gangrenous, phlegmonous) is possible during surgery: a histological examination of the removed appendix is performed. 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 of prehospital care, if acute appendicitis is suspected, bed rest, exclusion of liquid and food intake, application of cold to the right iliac region are shown. It is strictly forbidden to take laxatives, use a heating pad, and administer analgesics until the final diagnosis is made.

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.

In the case of 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, the use of antispasmodic drugs, and physiotherapy.

Doctors say that not every problem with the appendix can be called appendicitis, as many people are used to doing. After all, pain in the right hypochondrium from the side of the process of the caecum may well be caused not by any inflammation, but, for example, by convulsions. In this case, doctors talk about such a phenomenon as false appendicitis. What it is, and what symptoms this pathology has, not many people know.

Symptoms of appendicitis familiar to everyone can appear not only against the background of the so-called catarrhal (inflammatory) phenomena. They can also appear in response to the appearance of involuntary convulsive movements of the process.

Such convulsions are due to a number of reasons:

a sharp contraction of the muscle layer;
instant narrowing of the lumen;
an increase in follicles.

Also, after a detailed examination (especially when it comes to chronic appendicitis), it can be found that with a loss of muscle tone, the lumen of the appendix is excessively expanded and filled with feces. The walls of the process are significantly thinned.

How to identify appendicitis itself to distinguish other conditions

Symptoms of appendicitis, especially acute (in chronic appendicitis are somewhat different), are quite characteristic. After you have had sharp pain on the right side of the peritoneum, you should think about it. And if you are experiencing:

nausea;
vomit;
problems with a chair of a different nature;
weakness;

- an increase in temperature after the onset of inflammation to high numbers and much more, you can confidently say that you have an acute phase. At hr. appendicitis pain will be less pronounced, problems with stools are not permanent, etc. Symptoms are generally milder.

What to pay attention to

Since the manifestations of false appendicitis are not an acute phase and not xp. option, the pain may well pass. But, as is the case with the usual course of the disease, then it is imperative to visit a doctor to figure it out. Characteristic symptoms are not found out of the blue, so you can decide that some things went wrong, and in the future, without proper examination and treatment, it can lead to the development of a chronic variant of the disease.

Sometimes the disappearance of pain, especially if the appendix is filled with feces, may indicate that gangrene of the process begins and its death. After making an appropriate diagnosis, it will need to be removed immediately.

How to Diagnose a Problem

Physicians have a number of options for studying the patient's condition. To begin with, they ask about the symptoms, then they clarify the presence of various xp. forms of diseases. After that, proceed to palpation. So, the presence of appendicitis, including false, will be indicated by:

tense stomach (this is due to muscle spasm);
pain when tapping the iliac region;
study of aortic pulsation, etc.

All this helps them to correctly determine whether there is a pathology or not, and also what plan it is - chronic appendicitis or acute. True, unfortunately, appendicitis is often easily diagnosed when the disease has already developed to peritonitis. And at that moment, the clock starts counting. After this, the patient should be taken to the hospital as quickly as possible.