Appendicitis : Causes, Symptoms , Diagnosis and Treatment
Gastroenterology / / April 26, 2016
Appendicitis - is swelling and inflammation of the appendix otrostka- appendix, small, about 5-17 cm long, finger-like organ, resembling a bag, adjacent to the top of the first part of the colon..Appendicitis always requires surgery.
Causes of appendicitis
Appendicitis is one of the most common reasons for the use of emergency abdominal surgery.It usually occurs when the appendix is blocked by layering thick mucus within the appendix, feces, foreign objects, or (rarely) tumors.
Among the possible causes of appendicitis can also select:
- Infection. Chronic tonsillitis, inflammation of the tonsils and other infectious diseases can trigger the development of diseases.Bacteria can penetrate the wall of the appendix of its lumen or may be entered the bloodstream of another chamber;
- Parasites and worms also can lead to blockage of the appendix, the development of infection and inflammation;
- Chronic constipation. The violation Ottke feces, they mass harden, become dense, like a stone, and
- FACT power. Studies have shown that people who constantly consume large amounts of meat, appendicitis sick more often than people with a high content of fiber in the diet.Fiber improves bowel motility and beneficial movement of intestinal contents;
- Anomalies of the appendix. Anomalies structure of the appendix, such as bends, a large length of the appendix may also cause stagnation of its contents;
- Thrombosis of the arteries supplying the appendix. People with atherosclerosis and heart disease with impaired heart rate, inflammation of the appendix is much more common;
- Hereditary predisposition. scientifically proven fact of the disease in carriers of specific antigens;
- Lifestyle. constant stress, fatigue, alcohol abuse, smoking significantly increases the risk of appendiuita.
- Paul. risk of developing the disease in women is slightly higher than men.This is due to the close proximity of the appendix to the uterus, diseases and inflammation which can easily pereydti in the appendix.Therefore, regular checkups gynecologist, prevention and treatment of gynecological diseases can reduce the risk of developing appendicitis.
symptoms and the stage of acute appendicitis
Osoobennost acute appendicitis lies in the fact that it is developing rapidly, and is characterized by several stages, each of which has different symptoms:
- initial stage, or it is also called catarrhal appendicitis.At this stage, there is a slight thickening and inflammation of the appendix.The attack of appendicitis is often late at night or in the morning chasy.Sostoyanie patient during this period may be accompanied by pain in the upper abdomen and nausea.Initially, pain occurs around the navel or around the abdomen.It has a fuzzy bursting pulling harakter.Cherez 3-4 hours the pain shifts to the right iliac region, where it remains .;
- purulent appendicitis occurs after catarrhal.At this stage in the walls of the cavity and the appendix formed pus pockets.During this period, the pain moves from the upper abdomen to the right side of the area, it is a constant, a stronger, enhanced with walking, lying on the left side .;
- Phlegmonous appendicitis followed by purulent.At this stage, there is a significant increase in the appendix, and it is almost completely saturated with pus.There is nausea and vomiting, schache not abundant, single, not bringing relief.There is an intestinal disorder: constipation or conversely diarrhea, fever appears.The higher the temperature, the more pronounced inflammation.
- Rupture of the appendix.After some time after the stage of appendicitis appendix abscess may burst.At this stage, the pain usually decreases, but after a time resumed with renewed vigor.apppendiksa gap very serious situation that requires immediate surgical intervention.Otherwise, the disease ends in death.
Now consider the symptoms in more detail.The symptoms of appendicitis can vary widely.
first symptom of appendicitis in patients is often pain around the navel.The pain can be seemingly insignificant, but over time it becomes more and more sharp and strong, appetite decreased, and the patient may experience nausea, vomiting, and low body temperature.Often the pain moves to the right lower abdomen, where it becomes more tangible.
When appendix inflammation increases, the pain tends to move to the right lower abdomen (right iliac).It focuses directly above the appendix, in a place called "dot-Mac Bernie."It most often occurs in the period from 12 to 24 hours after onset of the disease.
If a violation of the appendix - open (rupture), then for a short time, the patient may experience a reduction in pain.However, once the abdominal cavity lining becomes inflamed, or rather, it develops a condition called peritonitis, the pain increases.
patients with appendicitis often prefer to lie down and also because any sudden movement causes them great pain.It is necessary to ask the patient to cough and to track whether it causes severe pain in the abdomen, as a rule, it is important priznok disease.
Late symptoms of appendicitis include:
- high body temperature;
- decreased appetite.
Simtomy chronic appendicitis usually are mild.The patient complains of weak dull pain in the lower abdomen.Nausea and fever can not be observed.In addition, in contrast to the acute form of appendicitis, chronic form may be completed by a sudden recovery , that in very rare cases the acute form.
When should you call the doctor
encourage the patient to see a doctor, if he has pain in the right lower abdomen, or any other symptoms of appendicitis, and, if the patient:
- pain is severe, sudden or sharp;
- there is a high body temperature, along with the pain;
- vomiting blood or bloody diarrhea;
- hard stomach palpation (probing fingers);
- the patient is unable to defecate, especially if it also has vomiting;
- pain in the chest, neck or shoulders;
- dizziness or loss of consciousness;
- nausea, pain and lack of appetite;
- the patient loses weight in spite of himself;
- yellowing of the eyes or skin;
- bloating for more than 2 days;
- diarrhea for more than 5 days, or if a child has diarrhea for 2 days or vomiting for 12 hours (if the child is under the age of 3 months - he has diarrhea or vomiting);
- had abdominal pain for more than 1 week;
- there is a burning sensation during urination or urination occurs more often than usual;
- the pain was intensified when the patient began to take antacids or eat something harmful;
- there is pain (and the patient is pregnant).
If the patient developed appendicitis, the pain he will increase whenever the doctor gently presses on the lower right part of the stomach and releases the hand sharply.If the patient - peritonitis, touching it to the area of his stomach can cause muscle spasm.
Doctors usually make the diagnosis "appendicitis" on the following factors:
- description of the symptoms;
- diagnostic examination;
- laboratory tests.
In some cases, may be needed and other tests, including:
- abdominal CT;
- abdominal ultrasound.
If the patient has symptoms of appendicitis, it is recommended immediately seek medical attention.It is strictly forbidden to use heating pads, enemas, laxatives or other treatments at home to relieve symptoms.
When the diagnosis is not clear, your doctor may prescribe CT (computed tomography) or ultrasound, to ensure that the cause of the problem is an inflamed appendix.Women have also carried out inspection of the pelvis to avoid the pain caused by the ovaries or uterus.
very important to rule out diseases with similar symptoms, including:
- Meckel diverticulum. This slight protrusion of the intestine wall, which is usually located in the right lower abdomen near the appendix.Diverticulum may become inflamed and may even cause it to break.If the inflamed diverticulum or perforated, it is removed surgically.
- Gynecological disorders. right fallopian tubes and ovaries are located near the appendix.Women who are sexually active can be infected with infectious diseases that affect the fallopian tubes and ovaries.Generally, antibiotic treatment is sufficient, and there is no need to remove the ovary and fallopian tube.
- Inflammatory diseases in the upper right abdomen. liquid from the upper right abdominal area can flow into the lower part of the abdomen, where it simulates inflammation and appendicitis.Fluid may flow out of perforated duodenal ulcer, bladder or liver abscess.
- Right-sided diverticulitis.Although most diverticula disposed on the left side of the colon, they sometimes occur and right.If sided diverticulum ruptures, inflammation develops, the symptoms like the inflammation of appendicitis.
- Kidney disease. right kidney is located so close to the appendix that inflammatory process, such as an abscess, may also produce symptoms like appendicitis.
Alas, no study, except for laparoscopy, with which you can diagnose appendicitis sure.However, by laparoscopy in the diagnosis of zaboleaniya resort is extremely rare.
Treatment appendicitis - appendectomy
If the patient has no complications - the surgeon will likely remove the appendix soon after the diagnosis of the problem state.
Since the tests used to diagnose appendicitis, are not perfect, and sometimes surgery can show that the process is normal.In this case, the surgeon will remove the same appendix and examines the remainder of the patient's abdominal pain on other reasons.
appendectomy - surgery to remove the appendix.
appendectomy is done using the following types of anesthesia:
- spinal anesthesia.The drug is administered in the back to back is numb below the waist.The patient will also receive a medication that may make him drowsy (sedation);
- general anesthesia.The patient during the operation will sleep and will not feel any pain.
Depending on the state of health of each patient, appendix removal can be accomplished in one of two ways: through an open incision or via laparoscopy.
In an open technique, an incision is made in the lower right abdomen, through the skin, abdominal wall muscles.The surgeon finds the appendix, then carefully and gently releases it from the surrounding structures, trying not to damage them, and deletes.
When laparoscopic technique, the surgeon performs a few small incisions in the abdomen.In one section of the laparoscope is inserted, which has a tiny video camera lens.Appendectomy is performed by the surgeon, looking at the screen (monitor) connected to the camcorder.Small instruments are inserted into other sections and can also be used to remove the appendix.
If the infected appendix, or a gap, the abdominal cavity of the patient during the operation must be carefully handled.
- appendectomy - surgery removal of the appendix cecal when inflammation (performance of equipment)
- Appendicitis with amoebiasis
- Retrograde appendectomy
- Abdominal pain and their underlying causes
- Peritonitis: Causes, symptoms, diagnosis, treatment
Recovery from a simple appendectomy usually happens pretty quickly.As a rule, after simple appendicitis patients recover quickly.Most patients leave the hospital for 1-2 days after surgery and are back to their normal activities within 2-4 weeks after discharge.If
process in place - abscess or rupture, the patient's recovery may be slower and more difficult, it requires a medication for the treatment of infection (usually, antibiotics).
human life without an appendix causes no known health problems.
Complications of appendicitis
- the formation of a fistula between the abdominal organs or between these organs and the skin surface;
- blockage of the intestine;
- an infection inside the abdomen (peritonitis);
- an infection of the surgical wound, etc.