Acute appendicitis is an emergency surgical pathology, which is manifested by inflammation in the area of the appendix (vermiform process of the blind intestine).
Acute appendicitis is manifested by abdominal pain, nausea and a violation of the general condition. Requires immediate surgery to remove it, late diagnosis threatens with serious complications up to death.
The appendix is a lymphoid organ, a large number of immune cells are concentrated in it, it helps to carry out the immune protection of the digestive organs. On average, the appendix has a length of up to 5-6 cm, thickness up to 1 cm. The appendix can be located both in the classical position, moving down from the intestine in the region of the right iliac bone, and lying in other directions. This is important in the diagnosis of appendicitis.
Reasons for inflammation of the appendix are enough:
- its blockage by dense stool,
- blocking dense food fragments (bones, seeds, dense food pieces),
- tissue growth,
- an increase in lymphoid zones, lymph nodes with occlusion of the lumen,
- vascular thrombosis
- intestinal infections
- staying on strict diets, poor nutrition,
- genetic predisposition, stress, bad habits,
- transfer of infection from other organs (in women, from the organs of the small pelvis).
The duration and severity of the process distinguish acute and chronic appendicitis.
Acute appendicitis, based on the stage of the process and the duration of the flow is divided into:
- catarrhal stage, it lasts the first 6 hours,
- phlegmonous stage, it lasts until the end of the first day,
- gangrenous stage, its duration until the end of 3 days,
- appendix perforation and peritonitis , characterized by rupture or melting of the walls and the release of contents into the abdominal cavity with the formation of peritonitis.
The disease has a clear staging and its severity depends on the duration of inflammation, however, only a surgeon can determine it.
It is important for the patient to identify dangerous symptoms that would indicate acute appendicitis. These include:
1. The first signs of appendicitis:
- pain in the stomach or podlochechkoy , around the navel or spilled nature,
- pain gradually over 3 hours flow into the right side, in the region of the Ilium.
- strong pain, intensified when rising and walking, lying on the left side.
- in the position on the right side the pain is reduced.
2. The occurrence of pain in the evening or at night, less often in the morning
3. Against the background of pain, nausea and scant, single vomiting, diarrhea or constipation.
4. Against the background of pain, the temperature gradually rises, the condition worsens, lethargy, glitter of the eyes, pallor, and coated tongue appear.
Even in the absence of all the described symptoms, except for abdominal pain, if it lasts more than 4-6 hours, hospitalization and inspection by a surgeon is necessary.
Age-related symptoms of appendicitis
- Children: the rapid increase in manifestations. Body temperature is often high. Vomiting and diarrhea more pronounced. Early return to full physical activity.
- Elderly: eroded appendicitis manifestations may be the cause of late diagnosis and hospitalization.
- Pregnant women: diagnosis is difficult, because the vermiform process is displaced upward by the pregnant uterus, which leads to a change in the typical location of pain, and its location behind the uterus reduces the severity of signs of peritoneal irritation. Fetal fetal death occurs in 2–8.5% of cases.
Despite all the advances in medicine, it is not always easy to make a diagnosis of acute appendicitis. It consists of:
- complaints and typical onset of the disease,
- inspection data and the identification of special symptoms when probing the abdominal cavity,
- data from rapid blood and urine tests,
- additional instrumental data (ultrasound, x-ray, diagnostic laparoscopy).
With a typical location of the appendix, the diagnosis is usually established quickly, but when it is atypical, it must be distinguished from:
- intestinal obstruction,
- gastric and duodenal ulcers ,
- cholecystitis and pancreatitis,
- acute inflammation of the appendages and ovarian apoplexy among women,
- pyelonephritis, renal colic .
Diagnosis should be done only by a surgeon in the emergency department of a surgical hospital, for women and girls, a gynecologist’s consultation is obligatory.
It is extremely important for appendicitis to correctly provide first aid in order not to further blur the clinical picture and not complicate the diagnosis.
For pain, you can take antispasmodics – no-shpu or papaverine, no more than 2 tablets, and only 1 time. Next, you need to contact a surgeon or call an ambulance.
- use of dipyrone and its containing preparations,
- use of Ketorol , Nimesulide or NSAIDs ( Nurofen , Indomethacin ).
- applying heat to the belly, hot water bottles, compresses,
- the use of laxatives, enemas, folk remedies,
- use of antibiotics and intestinal antiseptics ( nifuroxazide ).
Today, the only treatment for acute appendicitis is an appendix removal surgery – appendectomy . It is carried out in two ways:
- classical operation with cuts,
- laparoscopy with punctures of the abdominal wall and removal of the process with manipulators during visual inspection.
The operation is carried out urgently, after conducting emergency preoperative preparation for 1-2 hours – blood and urine tests, examination and questioning of the patient with the identification of allergies and health problems.
The operation is performed under general anesthesia, it lasts from half an hour to several hours, depending on the severity and complications.
In uncomplicated cases, preference is given to laparoscopy. After it almost no seams and recovery is faster. If the gangrenous form and perforation are suspected, classical and advanced operations can be applied.
After the operation, the first day shows strict bed rest and light meals, and the regime gradually expands. Stitches are removed after a week, discharge within 5-10 days.
Appendicitis is an insidious disease, often with serious complications. These include
- abscesses in the area of the appendix or in the abdominal cavity,
- development of purulent peritonitis, adhesive processes,
- appendicular infiltrate formation with the impossibility of removing the appendix without injury to adjacent organs.
Also, inflammation may develop in the vascular area, vein thrombosis, extending from the appendix. Such complications can disrupt the function of the liver and even cause death.
Methods for the specific prevention of acute appendicitis has not been developed. You need proper nutrition, rational mode and timely treatment for help from a doctor in case of abdominal pain.