Clinical manifestations
The vast majority (95%) of patients with appendicitis have the following symptoms:
• pain - first widespread, then localized;
• loss of appetite.
Nevertheless, in about half of patients, "typical" signs of appendicitis can mimic other acute diseases of the abdominal cavity. In young children and the elderly, there is often a complex of nonspecific symptoms that develop at later stages of the pathological process, which increases the risk of complications. The appendix is normally located in the lower right quadrant of the abdomen, which determines the localization of pain in appendicitis. When the appendix is located behind the cecum or in the pelvic cavity, pain can only appear when the rectum is examined. On the contrary, during pregnancy, the displacement of the appendix of the appendix by a pregnant uterus to the top responds to a higher localization of pain.
Classic Appendicitis Symptoms
• Appearance of pain in the upper abdomen or in the navel, accompanied by nausea, vomiting and loss of appetite.
• Gradual migration of pains to the right lower quadrant of the abdomen (to the point of McBurney), increased pain with pressure on the peritoneum and a sharp weakening
pressure (a symptom of Shchetkin-Blumberg).
• Durative strain of the abdominal muscles of the patient during palpation or coughing.
• Low fever: body temperature in the range of 37.7-38.3 ° C.
• Unclear increase in the number of leukocytes in the blood (leukocytosis).
The diagnosis is usually made based on the history and clinical signs of the disease. A typical picture of acute appendicitis develops very quickly, usually in less than 24 hours. His symptoms last more than 48 hours, the diagnosis of appendicitis is unlikely. Specific tests to confirm appendicitis do not exist, additional tests are resorted to in doubt in the diagnosis.
Methods of research
• Laboratory tests and imaging technologies are used to exclude other causes of acute pain than to confirm appendicitis.
• Laparoscopy - examination of the abdominal cavity using an endoscopic instrument with a video camera.
• Ultrasonography is often useful in differential diagnosis of appendicitis and gynecological pathology (eg, inflammation of the pelvic organs).
An experienced physician is able to diagnose appendicitis solely on the basis of the history and clinic of the disease, but during 15% of operations for acute appendicitis it is found that the cause of the "acute abdomen" was another disease, or no organic pathology is found at all. Failure to provide appropriate care for acute appendicitis is fraught with serious complications, so in doubtful cases, surgeons are inclined to surgery. Obstruction (blockage) of the appendix lumen leads to an increase in pressure in it and damage to the mucous membrane. Under these conditions, bacteria living in the intestine easily penetrate into the wall of the appendix and cause inflammation. Because of the accumulation in the lumen of the appendectomy of mucus, the pressure inside it increases with the gradual clamping of the blood vessels. With the development of gangrene, a rupture of the shoot wall is possible.
Common causes
It is believed that the primary cause of appendicitis is ulceration of the mucosa, probably due to infection with the Yersinia microbe. Obstruction of the appendix is most often caused by coprolitis (congestion of feces around plant fibers). Other reasons include:
• intestinal parasites;
• Tumors;
• edema of lymphatic tissue in the intestinal wall in viral infections.
Clinical signs in acute appendicitis progress very quickly. With late diagnosis, the process can rupture the wall of the process with the outflow of its contents into the abdominal cavity (perforation).
Effects
• With a rapid rupture of the appendix, the picture of a generalized inflammatory process in the abdominal cavity (peritonitis) develops, which can have fatal consequences.
• With a slower progression, it is possible to cover the site of the perforation with a large gland site with the formation of an abscess.
Morbidity
• Acute appendicitis refers to the most common diseases in childhood and young age; the incidence among men is higher than that of women (ratio 3: 2).
• Significantly less appendicitis occurs in early childhood and old age, with an increased risk of various complications.
• Overall, the incidence of appendicitis in the world is declining. The exact cause of this is unknown, but the relatively low level of pathology in developing countries (especially in some regions of Asia) suggests a possible role of nutritional factors.
The only method for treating acute appendicitis is surgical removal of the appendectomy (anendectomy). Today, operations from laparoscopic access have become widespread.
fast recovery
After surgery, patients usually recover quickly. The risk of spreading the infection is minimized by intravenous administration of antibiotics. If there is an abscess, it must be drained. An extensive lesion involving the cecum or the small intestine loop requires the removal of the entire contents of the abscess followed by the imposition of ileostomy (removal of the lumen of the small intestine on the surface of the skin).
Preventive measures
During the operation, the abdominal cavity and intestine are carefully inspected for possible pathology. For example, a surgeon can detect a rare anomaly - the so-called Meckel diverticulum (a small protrusion of the wall of the small intestine). Even in the absence of signs of inflammation, it is necessary to remove it in order to prevent possible complications.