Reliable symptom of appendicitis. The main symptoms of appendicitis

Acute appendicitis is inflammation draw-shaped process blind intestine (appendix), which is located in the right iliac region ( bottom part abdomen).

The risk group consists of adults aged 20 to 30 years, this disease is most dangerous for pregnant women, for children, for the elderly and for people in high age.

With the appearance of appendicitis symptoms, emergency medical care is necessary, and the only treatment of the disease is an emergency operation to remove the inflamed process, which is called appendectomy.

Any delay can lead to the emergence of serious, life-threatening complications, such as peritonitis, pylephlebit, blood infection, and even death

• direct infection from the blood due to the presence of infectious diseases of the intestine or the presence of chronic inflammatory diseases (in women it is more often a disease of the small pelvis organs, such as adnexith or inflammation of the ovaries),
• appearance of tumor
• increased lymph nodes
• glisal formations
• disorders of small peripheral vessels due to leaning to thrombosis,
• mechanical damageobtained as a result of injury.

Therefore, the prevention of the disease includes:

• Proper nutrition
• Timely treatment of inflammatory diseases (especially if they switched to chronic form)
• Anticlineal therapy

Classification of acute appendicitis

Typically, appendicitis is divided by location and by the degree of development of pathology.

By location, it is divided into typical and atypical (ascending retrocecal, sub hook, medial, downward pelvic)

At the stage of development of the disease, the classification of appendicitis looks like this:

At the beginning of the attack, the first 12 o'clock appendicitis is called simple or catarrhal, and then it goes into a destructive stage (it can be phlegmous, phlegmozno ulcerative, purulent, perforated - from 12 to 48 hours and, gangrenose after 48 hours).

The phlegmosic stage is a stage when the inflammatory process goes into all the fabrics of the appendix. The mesentery becomes edema, and inflammation goes to the peritoneum.

The gangrenous form is the most dangerous, as it leads to peritonitis (the nerve endings die, Gangrena begins, the progestion is perforation and purulent allocations go to abdominal cavity).

The photo below shows how perforative appendicitis looks like

In most cases, appendicitis develops in two three days (children even less in about 36 hours).

The acute forms of the disease differs from the sluggish chronic inflammation of the appendix, when a person more than one year can disturb periodically emerging pain in the right iliac region and other typical symptoms accompanying the exacerbation of the disease. In the second case, it is necessary special treatment And the planned removal of the process in the Surgery Department.

Possible complications

If it urgently does not remove appendicitis, it leads to complications that carry a danger to the life of the patient, among them can be listed:

• Spilled peritonitis, when, due to gangrenes, the walls of the process and purulent or serous discharge (effusion) occur in the abdominal cavity and affect the intestines and other organs.
• Local abscesses of abdominal cavity (intercircuit, pelvic, Douglas Space)
• Intestinal fistula or affection
• Appendicular infiltrate - a dense formation around appendix, which leads to the development of chronic appendicitis and the emergence of appendicular abscesses
• Pilyphlebit is the defeat of the liver vessels, almost always leading to death, often to treat the patient in such a state late.
• Sepsis or general blood infection

Symptoms of acute appendicitis

Most early sign Appendicitis - abdominal pain. Then other clinical manifestations of the disease appear. At various age, men and women are manifested in different ways. Below is a table where it can be seen how the disease manifests itself different groups of people.

Symptom	In adults	In the elderly	In children	In pregnant women
Abdominal pain	The attack begins with the appearance of characteristic pain in the navel area (epigastric area), then it goes into the lower zone of the right half of the abdomen. There are sleep disorders.			Depending on the term, the pain appears in the field of navel, or in the hypochondrium in the last weeks
Temperature	Subfebrile. Increased to 37 ° C, and in recent stages above 38 ° C	May not rise in mind age-related changes	Above 38˚С. On the the last stage rises to 40 ° C.	Up to 38˚С
Chair	Bloating, meteorism and diarrhea (liquid chair) or in rare cases, constipation
Language	At the beginning, the language is wet and white only at the root In the phlegmonous stage, it is still wet, but is already fully covered with a specific raid On the gangrenoz stage, the tongue is covered with a white bloom, dry mouth
Nausea	Constant
Vomot	Single or 2-fold	Children's appendicitis is accompanied by multiple vomiting	Single or multiple depending on the location of the process
Urination	Dysuric disorders may be observed (urination rapid urinary)
Pulse	fought

Diagnosis of acute appendicitis

In order to put an accurate diagnosis, first of all, it is necessary that the patient examines the doctor. Therefore, the appearance of pronounced pain syndrome, it is necessary to urgently cause ambulance And until the doctor comes to provide a patient with full peace and stick to a number of contraindications. This means: in no case give him anesthetia, do not put the heating on the stomach and do not try to treat himself, otherwise the clinical picture of the disease will be blurred and the doctor may allow a mistake when diagnosis. This will complicate the situation and can lead to the death of the patient.

If the doctor out of ambulance insists on hospitalization in a medical institution, should not refuse it. Attempting to treat appendicitis without being in the hospital in the hospital department, is dangerous for the patient's life. Therefore, to be in the clinic under the supervision of medical professionals it will be necessary as much as necessary. The main feature of the pathology is that the only method of treatment is an urgent operation to remove a worm-like process.

When the patient enters the surgical department, it once again examines the surgeon, and also conduct all the necessary laboratory and instrumental research.

Medical checkup

In case of suspicion of appendicitis, at first, the doctor listens to the patient's complaints, learn whether he suffers from some kind of chronic diseases, whether any operations suffered, the presence or absence of pregnancy (in women), etc. All this contributes to the formulation of an accurate diagnosis.

After that, the patient examines the doctor surgeon. During the inspection, it applies a classical diagnostic methodology for determining pathology features, based on a positive reaction in a number of appendicular symptoms.

Symptom	How to analyze the reaction on the symptom	Availability of appendicitis
Kohler	At the beginning of an attack acute appendicitis The characteristic dull pain in the epigastria appears.
Kohler - Volkovich	the pain from the epigastric area is irradiated or goes into the right iliac region (PPO)	100%
Brushnikina - Blumberg	Symptom of irritation of peritoneum. The doctor slowly presses the abdominal wall to the right, and then sharply raises his hand. If a strong pain appears with a hand-positive symptom.	98%
Aarona	When pressing with a hand on the iliac region, pain in the navel area appears and a feeling of cutting occurs.
Anargua - Ichinhorloo - Gosha	Positive is considered if the PAP palpation is observed with a pulse of 10-15 shots.
Batomier - Michelson	The patient lies on the left side, the palpation is carried out in the area of \u200b\u200bApandicitis. If the response has appeared positive.	60%
Sitkovsky	The patient is asked from the position lying to roll over to the left side. When turning, there is a pulling pain at the location of appendicitis.
Bassra	When pressed on the abdominal wall, between the navel and the right iliac bone, the pain is enhanced.
Vyrame.	Compare temperature in the right and left axillary depression. If the temperature is left above, the appendicitis is often detected.
Resurrection (symptom of shirt)	The patient lies on his back, the doctor pulls the shirt with one hand, and the other hand makes a sliding movement along the shirt from the navel to the lower right half of the abdomen and back. With a downward movement, pain in the PPO occurs.	60% - 90%
Voventa	The patient breathes the abdomen, in the process of breathing, the lower part of the abdominal wall does not participate, as it is tense
Volkov (Reverse Kohler)	Irradiaration (relocation) pain from the right iliac region to the neppet area. If the symptom is positive about the rapid development of the disease.
Dumbadze	When the doctor enters the finger in the navel of man and slightly presses towards PPO, pain appears.
Examples - Meltle	Pope palpation in a patient who lies on the back with a right foot raised. If pain appeared - the reaction on the symptom is positive.
Triad Dielafua	During PPO palpation, the doctor draws attention to three signs of appendicitis: the presence of pain, muscle tension and special sensitivity (hyperesthesia).	99%
Zavyalova	The doctor collects the skin of the front abdominal wall in a fold, lifts her and let go. In the presence of appendicitis in the right side of the abdomen, the procedure causes a pain to man.
Zaitseva	The abdominal wall is subjected to continuous concussion for a few seconds, while the patient causes the stomach muscle tension and a sharp increase in pain.
Ivanova - to Tui - Meyer	The navel and the white line of the belly are shifted in the right due to the fact that the abdominal wall muscles are tense. To determine asymmetry, measure the distance from the navel to the right and left alcoholic bends.
Ikramova - Kooup	The doctor shifts his finger right femured arterial vessel. In this case, the pain is enhanced at the location of the appendicitis.
Kooup	The patient again lies on the left side. The doctor takes his straightened right leg back. This appears pain in the iliac zone.
Mendel - Murphy Razdolsky	The doctor picks his fingers on the front of the abdominal wall, if the peritonean is irritated, the pain of pain occurs in the Apandicitis zone.	85%
Madelong - Lenander - Paskovis	The doctor measures the temperature in the right axillary depression and the rectal temperature. If the difference is 1.5 degrees, there is a risk of inflammation in the abdominal cavity.
Yavorsky - Ostrovsky	The patient lies on the back. The doctor asks for a patient, raise the right leg up. And at the same time prevents the patient while holding the leg in the knee. The pain is intensified in the right iliac zone.
Kister	The patient lies on his back and raises up the left leg, and the doctor presses the left lumbar muscle at this time, with a positive reaction, pain in the right half of the abdomen appears.
Pisaha (transport symptom)	Conduct inspection along the path to the hospital. Shaking on the road causes a patient with acute pain, localized in the stomach.
Prone - Boyko	The patient gets up and rises on the socks, and then sharply falls on the heels. By shaking, pain appears in the lower right side of the abdomen.
Chemical	In case of inspection of very complete people. The patient lies on the stomach, the doctor presses on the front abdominal wall, the patient will feel pain when he lets his hand, pain is enhanced.
Rough	When examining women. The doctor conducts a vaginal study if the pain is increasing, appendicitis is diagnosed.
Wahenheim - Redrere	Rectal examination. During the examination, the patient hurts in the right iliac region.
NLATON - Crimean - Gurevich	When examining men. Survey of the posterior wall of the right inkhan canal, through the subcutaneous groove ring, the tip of the index finger. This causes an increase in pain in the right-wing area. A more brightly visible response with cough.
Britten.	When examining men. The doctor pulls the skin fold in the place of maximum pain. This causes the tension of the abdominal wall, and pulling the right egg to the top of the scrotum. After inspection, the testicle returns to the place.

Symptoms at the atypical arrangement of appendicitis:

Symptom	How do the reaction test
With a retrocecore location
Gabay	The doctor presses in the triangle of the PH, the patient may feel little painand when the doctor releases his hand, pain is enhanced
Crade	During the rectal examination, the patient experiences pain when the doctor presses in the zone of the right locking hole
Yaur - Rosanova	About the retroperitoneal arrangement of appendicitis says the pain that appears in the triangle of the PC when pressing.
With a pelvic location
Triad "Paira"	At the same time, the patient has hyperesthesia (severe sensitivity) of the sphincter, tenesms (false calls for defecation, accompanied by soreness) and spastic chair or constipation, accompanied by the fact that the formation of gases increases and the pain in the intestine increases.
Mochpieze	Student painful urination.
Supold - Selle	The patient takes a deep breath. At the same time, he appears pain behind the bladder.

Appendicular symptoms during pregnancy:

Laboratory research

Blood analysis

The first thing they do in the hospital is to take blood for analysis. If there is an inflammatory process, the level of leukocytes in the blood (leukocytosis) should be elevated. This feature does not allow to accurately determine appendicitis in pregnant women, since at this time the leukocytes themselves are over themselves. The rate of leukocytes is 9, and if this indicator is from 11-7, then the inflammatory process is diagnosed, if above 20, then the risk is very high, which will detect the spilled peritonitis. In the elderly, on the contrary, the level of leukocytes, even when inflammation remains normal.

At appendicitis in the leukocyte formula, neutrophilic leukocytes prevail (two thirds of cases 75% of neutrophils are detected).

The increase in C-reactive protein may also indicate inflammation. If this indicator does not increase - appendicitis is excluded.

For women, there is also an analysis of the HCG hormone level (human chorionic gonadotropin) which is produced during pregnancy. This is done to eliminate ectopic pregnancy.

Analysis of urine

Urine analysis is a mandatory component of diagnostic measures. It takes to eliminate the existence of kidney problems.

With a retrocecular and pelvic appendicitis, the amount of leukocytes and red blood cells changes in the urine, this is explained by the fact that inflammation affects the ureters or bladder, is found in 25% of cases.

On the early stages There is no classic appendicitis of changes in the composition of urine. The presence of the inflammatory process also indicates an increase in the level of sialic acids (normal indicator from 100 to 250). This indicator also defines the step of appendicitis. On the first, catarrhal stage, this indicator is 290 units, and on destructive (phlegmous, phlegmonous-ulcerative and gangrenous) - 335.

Instrumental research

In combination with medical examination and laboratory research The analysis of blood and urine, apply the following types of instrumental examination:

• Radiography,
• Radioscopy,
• Laparoscopy
• Irrigoscopy.

Ultrasound

One of the most affordable methods for diagnosing appendicitis - ultrasound (ultrasound examination) of the abdominal cavity. The survey more often makes young women, children and older people, as they have a clinical picture may be implicit.

If the survey conducts an experimental doctor in 90% of cases according to ultrasound, the inflammation of the process can be identified. Obstaculation of beneficial data can be obesity, pregnancy in late terms, intensive formation of gases in the intestines.

The main feature is an increase in the process in diameter (norm to 4 - 6 mm, and during appendicitis it increases to 8 - 10 mm.), And besides the wall of appendix become thick (normal wall - 2 mm., Inflated - 4 - 6 mm. )

The inflammation of appendicitis may indicate the following indirect signs:

• Changing the form of Appendix
• Bryzhek infiltration
• The presence of a cluster of fluid in the abdominal cavity

How is the survey?

To conduct an ultrasound during appendicitis, the patient does not need additional preparation (enema or intestinal emptying).

1. The patient lies on his back
2. The instrument sensor is set in maximum pain, the doctor smoothly presses this point, reducing the distance to appendix to 3 cm, after which its structure is visible on the screen. Women's survey is also transvaginally (when additional examination is needed).

Radioscopy.

In 80% of cases, the abdominal radioscopy helps to identify the following signs of acute appendicitis:

• Increased fluid level in a blind intestine (guarding loop)
• Pneumatosis of the right side of the colon and the iliac
• Changing the medial blind intestine contour
• The presence of gas in the abdominal cavity may indicate that the perforation of the process has occurred.

Laparoscopy

Most effective method The detection of pathologies inside the abdominal cavity is a laparoscopic examination. The effectiveness of the method is 95% - 98% it allows you to see both direct and indirect signs of the presence of inflammation.

Direct signs can be attributed to:

1. Rigidity or loss of ability to reduce the walls of Apandix
2. Voltage and thickening of the process, as well as Fibrin
3. A very magnified extension of greenish-black color with multiple hemorrhages indicates a gangrenozidal stage of the disease.
4. Hyperemia (overcrowding blood vessels) visceral peritoneal and serous shell
5. Hemorrhage by serous sheath Appendix
6. Bryzhek infiltration

Indirect signs include:

1. Muddy serous fibrinous effusion in the abdominal cavity, concentrating in the field of small pelvis and in the right iliac yam
2. Infiltration of the wall of the rectum

Irrigoscopy

Irrigoscopy is one of the species x-ray research. Apply this species Examination only when it is advisable and there are difficulties with diagnosis. Before the procedure of the patient, the intestine is introduced by Barieving mixture, which the doctor sees in the study. Filling the process indicates that there is no appendicitis.

Treatment of acute appendicitis

The only treatment is to carry out an operation to remove appendicitis, which is called Appendectomy. You can make it a classic method through an open section or through three cuts (less than 1 cm.) Laparoscopic method. The decision, which tactic of the operation better depends on which stage is appendicitis.

Preparation for the operation

Often, the operation on the removal of appendicitis is carried out in an emergency order, so it can be done already two hours after entering the surgical department of the hospital, so there is no time for special training. Appendectomy itself can last 40 minutes, and maybe several hours. It depends on whether there is complications.

Mandatory patient preparation includes:

• Examination of the condition of the cardiovascular system
• The determination of which anesthesia is suitable for a patient (perform an inspection, on the absence of an allergic reaction to painkillers)
• The patient is intravenously introduced isotonic solution to eliminate the symptoms of intoxication and to prevent dehydration.
• Purify the stomach (as a rule, the patient does not eat anything and does not drink, so it is often not necessary)
• Removal of hair in the field of operation
• Disinfection of skin

Tactics of classical appendectomy

Conducting Appendectomy Laparoscopic Method

Laparoscopic removal of appendix is \u200b\u200bcarried out under general anesthesia Three small cuts with a diameter of less than one centimeter. After one surgeon, it introduces a laparoscope, video from which can be seen on the monitor screen. With this tool, the doctor can carefully examine appendicitis and the surrounding fabrics. After the operation, there is no long scar.

Laparoscopy allows you to avoid errors in diagnosis. In particular this modern method Reduces by 30% the number of erroneous operations on appendicitis. As a rule, at first, the procedure is made to clarify the diagnosis, and if it is confirmed, go to the direct removal of the appendix.

Since Laparoscopy is the most minimally invasive method of appendectomy, it is prescribed during obesity of 2-3 degrees and during diabetes mellitus.

Contraindications of laparoscopy

• Late time of pregnancy
• Allergic reaction on the components of anesthesia
• Heart attack or pre-infarction

Important! With peritonitis, only a band transaction is shown.

Stages of laparoscopy

1. The workspace is disinfect
2. Make an incision in the aircraft region for the introduction of the pumping of the pumping carbon dioxide (it is injected in order to expand the inner space)
3. Then the laparoscope is administered through the same incision with a hollow tube.
4. The doctor examines appendix and abdominal cavity, assessing the degree of inflammation. Based on this inspection, it makes decisions regarding the further course of the operation. If the appendicitis is uncomplicated, and it can be further done with laparoscopy:
5. The doctor makes two more cuts: one above the pubic, and the second in the right hypochondrium for the introduction of manipulators tools.
6. Conduct appendix and remove it through a hollow tube or trocar. At the same time, they adhere to the basic principle: to prevent the contents of the appendix to switch to other organs.
7. The surgeon examines the abdominal cavity again, it holds its sanitation and establishes a drainage tube, if there is such a need.

Postoperative period

Duration rehabilitation period It depends on how launched was appendicitis, from the age and health of the patient, as well as from the method of appendectomy. Children under ten years are restored longer, as well as people suffering from obesity.

After the operation, the patient needs from two weeks to a month to fully recover. Seams take off for 7 - 10 days.

If the drainage was installed, then it is removed on the third day. As a rule, such a need is when the patient was diagnosed with gangrenous appendicitis.

Within 5 - 7 days, a hyperthermia may occur in a patient after surgery. At this time, antibacterial therapy is often carried out. To speed up healing and avoid complications these days you need to strictly stick to the diet, until the intestine will work normally. In addition, it is important to seriously refer to restrictions on physical exertion, and the recommendations of the doctor relating to the reception of drugs, visiting the baths, drinking alcohol and the abandonment of smoking.

The hospital leaf in connection with an appendicitis operation is discharged by a maximum of 1 month. But even after going to work, it is important to remember that within four months it is impossible to raise more than 10 kg.

Early postoperative complications

• Even during the operation, the surgeon may encounter internal bleeding From the culture of mesenter, this complication may arise due to insufficiently durable vessel dressing that feeds appendix. Solves the problem re-bandage vessel. The blood that fell into the abdominal cavity is necessarily removed.
• Early complications include the formation of infiltrate in the thicker of the abdominal wall. This may lead to the fact that it is necessary to remove the accumulated fluid between the edges of the wound by means of puncture. The presence of temperature and pain in the area of \u200b\u200bthe wound, indicates that there is a risk of the emergence and development of suppuration. To solve the problem on the second day after surgery, two, three sutures, to open the wound and the pus forming leaves out. In difficult cases, the wound is completely disclosed and drainaged.

Late complications

• Intestinal fistula. Often is the consequence of peritonitis. To eliminate complications, it is necessary to conduct re-surgical intervention.
• Douglas Abscess. An ulcer is revealed through the vagina in women or through the rectum of men.
• Pilefelbit. Life-threatening condition that is manifested by an increase in temperature to 40 - 41 C˚, increased sweating, vomiting and jaundice. In this case, first of all, sources of inflammation are eliminated and transferred to intensive treatment with the use of antibiotics.
• Intestinal obstruction. The problem may appear as immediately after the operation and after a while, when it seems that the wound healed. Spikes guts provoke sharp abdominal pain and vomiting. If traditional treatments do not help and the condition deteriorates, a re-operation is necessary to eliminate complications.

Differential diagnosis

In their symptoms, acute appendicitis is similar to the following pathologies:

• Pancreatitis
• Cholecystitis
• Ulcer stomach or duodenal gut
• Crohn's disease
• Gastritis
• Colitis
• Intestinal obstruction
• Divertikulit Meckel
• Renal colic
• Food infection
• Cystitis
• Abdominal form of myocardial infarction

Women are similar in symptoms of the disease of the genital organs, such as:

• Right-sided apoplexy of the ovarian
• Twisting the cyst of the ovary
• Ectopic pregnancy
• Acute adnexit

Appendix, Lat. Appendix Vermiformis is a black-shaped process, 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 female and male. Very rare appendicitis occurs in young children, which is explained by the age anatomical feature of the appendix, which has a funnel form and easily empties, and the weak development of the lymphoid apparatus of the process.

Among all diseases of the abdominal cavity bodies, which require urgent surgery, appendicitis is the most common. If the attack of a sharp appendicitis happened, it is necessary to bring the ambulance brigade as soon as possible. If the appendicitis is not treated, peritonitis can develop - a complication that leads to a fatal outcome.

As appendicitis, symptoms and signs of this urgent state should know every person. The main symptom of appendicitis in adults and children - pain. It occurs in the top of the abdomen or near the navel, sometimes it is not possible to specify the place of pain ("all the stomach" hurts). Then the pain moves to right part belly. Such a migration of pain is considered a very specific feature of the disease.

Causes of appendicitis

The following reasons for the development of inflammation of appendix are distinguished:

Appendix is \u200b\u200ba small outflow of a blind intestine. For most people, it is placed in the right side of the abdomen, below the navel. To which side, the person's appendicitis can affect the state of the intestine. If the appendicular peritonitis developed, the symptoms are pronounced brightly and acutely, the localization of appendicitis pains with 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 an emergency removal operation.

Appendicitis can be in different ways located in the region of the peritoneum, which gives an unequivocal picture in the localization of symptoms, pain can give both to the right side and in the region of the lower back, or in the area of \u200b\u200ba small pelvic, the genital organs of the patient. The nature of the pain has a different intensity, reinforcing or subsided, grasp, can last as a long time or brief.

Signs of appendicitis

There are many different signs of appendicitis in adults and children. Signal of the beginning of the disease is a strong pain. At the very beginning, it does not have a clear location. A person may seem that he just hurts the belly. However, after 4-5 hours, the pain concentrates closer to the right iliac region.

It is worth noting that Appendix different people It can be located differently, it all depends on the body structure. In case the process has a normal position, the pain will be observed in the right iliac region. If the process is located somewhat higher, the pain will be right under the ribs. Well, if the process is lowered down, it will be sick in the area of \u200b\u200bthe pelvis. Among other things, the patient can disturb and vomiting, and in some cases diarrhea.

Among other popular signs of appendicitis can be noted as follows: dryness of the language, urine darkening, an increase in temperature that can reach 40 degrees, in pregnant women there can be an increased pain during rotation from the left side to the right.

Symptoms of appendicitis

In the case of the development of acute appendicitis, the symptoms are pronounced. There is an attack of pain in the right iliac region, a pronounced local and general response of the body. As a rule, pain in acute appendicitis starts suddenly.

At the beginning of the attack, they are often localized in the epigastric area in the area of \u200b\u200bthe navel or throughout the stomach, and in a few hours (sometimes after 1-2 days.) - in the right iliac region. More often pain is constant in nature, they do not irradiate anywhere, but intensify when shaking. does not give a patient to fall asleep, but its intensity is usually small; It is 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. Chair and gases are often delayed. Significantly less frequently observed liquid feces (mainly during severe intoxication). The body temperature rises to 37.5-38 °, less often remains normal. The pulse in the first day from the beginning of the disease is read up to 90-100 shots in 1 min, the blood pressure does not change and only during severe intoxication it decreases somewhat. The language at the beginning is slightly covered and is dominated, but soon becomes dry.

Also during appendicitis there are other symptoms. For example, when inspection of the abdomen often determine the lag at the breath of the lower vehicles of the abdominal wall. Palpation of the belly should be carried out carefully, starting with its left half. At the same time, in the right iliac region, as a rule, there is a sharp pain, combined with the protective tension of the muscles of the abdominal wall in a limited area. In most patients, a slight tapping fingers in various areas of the abdominal wall helps to quickly establish the place of the greatest pain.

However, not always symptoms and the course of acute appendicitis are so characteristic. Especially peculiar to the clinical picture of the disease in children, elderly and senile ageAs well as with atypical arrangement of a worm-shaped process. In any case, when symptoms are similar to appendicitis, it is necessary to cause ambulance.

It flows with a stupid pain in the right iliac region, which can be periodically intensified, especially with physical tension.

Signs of appendicitis in women

The inflammation of appendicitis slopes are more than women than men whose symptoms appear more often at the age of twenty, forty years. This is due to the physiological structure of the female organism, the pelvis, so it can flow differently. Especially different during pregnancy. Since Appendix is \u200b\u200blocated near the right appendages of the uterus, there are more often signs of inflammation more often than the men's population.

1. When palpation, women arise painful sensations, which indicates the inflammation of the abdominal cavity.
2. If you press the point below the navel of a woman, it can occur pain that intensify when rolling, which indicates the involvement in the inflammatory process of childbearing organs.
3. When examining the vagina in a woman, pain is found, especially when examining the cervix, in appendicitis indicates inflammation of the appendages.

When diagnosing and diagnosing a diagnosis, a woman checks not only the state of a heart-shaped process, but the state of genital bodies as a whole.

Diagnostics

The diagnosis is based on characteristic symptoms Appendicitis. Confirm the diagnosis of "inflammatory signals" of general blood test. The most reliable method is laparoscopy.

Clarification of the morphological form of appendicitis (catarrhal, gangrenous, phlegmonous) is possible in operational intervention: spend histological examination Remote Appendix. Of tool methods Ultrasound examination, abdominal cavity radiography, irrigoscopy, computed tomography.

Treatment

Generally accepted tactic with acute appendicitis is as early as possible. surgical removal Inflamed duct-like process. After 36 hours from the moment of the appearance of the first symptoms, the probability of perforation (rupture) of appendix is \u200b\u200b16-36% and increases by 5% each next 12 hours. Therefore, after confirmation of the diagnosis, the operation must be performed without unnecessary delay.

At the stage of inventive assistance, in suspected of acute appendicitis, bedding is shown, the exclusion of fluid and food intake, the application of the cold to the right iliac region. It is categorically revealed by the reception of laxatives, the use of heating, the introduction of analgesics to the final diagnosis.

Currently, with a simple form of appendicitis, laparoscopic operations are preferred, which do not require the cut of the abdominal wall. In this case, the endoscopic tool is introduced into the abdominal cavity through a small puncture in the tissues. The removal of appendicitis this way allows you to avoid operating injuries, and reduce the recovery period at times. Risk of development postoperative complications When removing appendicitis, the laparoscopic method is minimal.

In the case of chronic appendicitis, appendectomy is shown if the resistant pain syndrome is observed, damping the patient of normal activity. With relatively light symptoms, a conservative tactic can be applied, including the elimination of constipation, the reception of antispasmodic drugs, physiotherapy.

From the blind intestine, a special worm-shaped process is departed, the inflammation of which is subject to immediate elimination and is referred to as appendicitis. Men's people aged 10 to 30 years old and women from 20 to 45 years are exposed more often than this disease. Every year with the symptoms of appendicitis in the hospital, there are about one and a half million patients, of which almost a million people turn out to be on the operating table with a confirmed diagnosis. Of the total number of patients, about 3% of complications fall on children and young people, while the overwhelming majority of postoperative inflammation (30-35%) occurs in the elderly. The main reason for complications was and remains peritonitis, arising in most cases due to delay, attempts independent treatment And hopes for "maybe".

If there is no question in the body of the heart, light or kidney in the body of the heart, light or kidney, then the localization of appendix is \u200b\u200ba few, with the exception of knowledge about the right side of the abdomen. Approximately locate the black-shaped outflow, separating the body with imaginary lines. The vertical feature is carried out from the nipple right chest down, horizontal - right from the navel around the abdomen.

The point below the horizontal line and the right door of the vertical line is an approximate location where Appendixes is located. The zone is called the right iliac area. However, Appendix is \u200b\u200bpretty cunning process: due to an elastic mesentery ( connective tissue) He can shift. That is why the question of diagnosis before surgical manipulations is a task of paramount importance.

For a couple of decades ago, Appendix was considered, in fact, a useless body, no one who does not respond, not regulating anything, and therefore it was even removed as planned and without specific testimony. However, scientists got to the truth, finding out that the outflow of a blind intestine is a peculiar prototype of pelvic almonds, which are a cluster of lymphoid tissue and a natural barrier for pathogenic organisms. Appneldix performs a similar function: lymphoid cells take directly and not the last participation in protecting the tract of the tract from various types of infections. In addition, it is in a worm-like process that representatives of intestinal microflora accumulate, so necessary for the normal functioning of the gastrointestinal operation. It is notified that people with a remote appendix are more susceptible to intestinal infections and are restored longer after long-term antibiotic therapy than patients with a healthy process.

General symptoms of the disease

Special term "acute abdomen" or "syndrome acute belly»Combines all urgent states characterized by painful sensations, nausea, fever and intoxication. A symptoms similar to appendicitis can indicate the infection of the gastrointestinal tract, genital organs, kidneys, become an indicator of ectopic pregnancy or climax. Even food poisoning It looks like the inflammation of the appendix. Therefore, medical assistance and surveys should be carried out immediately when:

• increasing pain in the right iliac region;
• unpleasant sensations under the spoon or in solar plexus, which are gradually enhanced and transferred to the right illeg;
• nausea, severe vomiting;
• feverish state;
• chills, sticky sweat;
• disorders of the tract (diarrhea or constipation);
• rapid heartbeat;
• coloring language in brown color;
• weakness, apathy.

The emergence of such symptoms is a real reason to quickly seek medical advice.

In no case cannot:

• take pain relief;
• heat, rub, to mive the location of the localization of pain;
• use any compresses, ointments and gels;
• each food and liquid.

If a painfulness Udychi, it says not about wonderful healing, but the transition of the disease to another, more serious and dangerous level.

The first signs of inflammation

The development of inflammation is characterized by specific and existing phenomena in certain procedures.

1. Pain. Initially, it makes itself felt with sharp sudden jokes in the field of solar plexus, under the spoon or in the communal zone. It may be a strong or weak intensity, periodic or constant by nature. In this case, painful sensations may occur without specific location. After some time, the pain moves closer to the right side of the abdomen, it becomes a constant character, it is intensified with cough, attempts to change the position of the body, movement.
2. Nausea and vomiting. Often the episode of vomiting is one-time, and nausea is preserved for a long time. Neurotic vomit urge arise due to irritation of the abdominal wall. In this case, the contents of the stomach mixed with bile.
3. Temperature rise. Fever within 37-38 degrees - frequent phenomenon with inflammation of appendix.
4. Violation of the gastrointestinal tract (dyspepsia). The development of the disease is often accompanied by constipation, but more often - diarrhea. Often, these phenomena occur against the background of urination rapidly, while the color of urine becomes concentrated, brown.

Although appendicitis in the overwhelming number "goes" on a specific path, the deviation from the graph of the appearance of symptoms, their order or the attachment of other signs is the phenomenon is incredible.

Danger in symptoms

The appearance of the following symptoms is a certificate of truly serious danger. Deletion with the appeal medical help With such signs, it may cause fatal outcome:

• sharp increase in temperature up to 39 degrees and higher;
• a sudden drop in thermometer indicators to normal values \u200b\u200band below 36 degrees;
• disappearance or damping of pain for several hours and longer with the subsequent sharp occurrence of pain syndrome;
• pain with the slightest touch to the skin in the affected area;
• confused, nonsense, hallucinations and lack of reflexes.

These signs speak of the development of the most dangerous state - peritonitis, when the account is not on the clock, but for moments.

No less threatening can be symptoms distracting from the main ailment. This happens if the patient has a history of:

• sex infections;
• ectopic pregnancy;
• urinary system diseases;
• cholecystitis;
• ulcer;
• intestinal infections.

To eliminate the likelihood of other states and speed up the production of the correct diagnosis, it is always worth telling doctors about previously transferred diseases, even if they, according to the patient, do not matter.

Other diseases, the symptoms of which affect the picture of what is happening or taken for appendicitis can also be "activated".

• helping masses of black or dark red color - a sign of bleeding from upper departments intestinal tract;
• pronounced heartburn, belching, reinforced gas formation and a large number of feces - testimony of pancreatic diseases;
• ventolation without signs of bile is a symptom of blockage of the outflows of a gallbladder or cholecystitis;
• lack of monthly women in pain - the possibility of ectopic pregnancy.

Timely appeal to the specialists makes it possible to diagnose and identify the true perpetrator of the disease.

Causes of inflammation of Appendix

Reliable evidence that specifically provokes the damage to the draft-like process is absent. Common myths about clustering in the cavity of the appendix of small particles of food and foreign objects (for example, husks from seeds, fruit peel, etc.) do not have an evidential justification, since the hole of the outflow does not exceed 1-2 mm.

There are three leading theories about the causes of appendicitis. The most reasonable and confirmed version is associated with the intestinal infection. The human body "lives" a lot of varied microorganisms that constrain each other and are quite normal inhabitants. But, it is worth the situation favorable for them, as part of the microbes, is activated and causes a disease. To such factors belongs:

• irregular reception of antibacterial drugs;
• congenital anomalies of the structure of the gastrointestinal tract;
• blockage of holes in appendix by the carte masses, neoplasms;
• lesions blood vesselssupplying the walls of a heart-shaped process;
• frequent and long constipation, defective intestinal emptying;
• violation of peristaltics.

In the risk group there are people suffering from cardiovascular diseases, infectious intestinal lesions, systemic diseases, allergic manifestations. This also includes patients with solar harmful habits, diseases of the abodes of a small pelvis, women with gynecological ailments. In childhood, the starting point in the development of appendicitis may be angina.

Views of Apandicitis

Like other diseases, the inflammation of the transformation of the blind intestine can flow in acute and chronic form.
1. Acute appendicitis. The main feature is a sudden, rapid development of symptoms. In this classification, three options are distinguished:

• catarrhal, not causing the destruction of the walls of the process;
• accompanied by the thickening of the organs of the organ, the suppuration and development of numerous abscesses;
• (destructive), is characterized by the transition of inflammation to the adjacent tissue and the destruction of the process.

2. Chronic appendicitis. This type refers to independent diseases and is divided into two subspecies:

• primary, meaning that systematic pains in the right ilok arise in patients who were not previously acute;
• secondary, which is a consequence of the suffered acute appendicitis (both one and several attacks).

But most often, there has nothing to do with the chronic character pains, and operational interventions become in vain, since the culprit of the disease is only "disguised" under appendicitis. The cause may be damage to the urinary sphere, gynecological or urological diseases, systemic exacerbations of gastrointestinal diseases, infectious inflammation.

To the question of diagnosis

To identify and confirm appendicitis, the optimal is considered to be the differential diagnosis, which includes instrumental, physical and laboratory methods for studying with the collection of anamnesis and traditional methods Palpation.

The focus is on pain, because it is precisely all of all other signs of the disease remains stable and pronounced. On localization, duration and nature of pain syndrome, a doctor can determine which authority is involved in inflammation, whether there is a focus of infection, which is the duration of the disease, and also pay attention to the key concomitant symptoms.

1. Localization. If the affected organ is located close to the peritonean wall at the "place", pain in the right iliac region acquires a well-pronounced character. Appendix displacement changes the shape of pain syndrome, removes it from the usual location. In this case, the methods of manual inspection come to the aid: tapping, touch; They allow you to determine the displacement point. In case of acute uncomplicated form of inflammation, pains are enhanced when the patient is trying to get up, raise his right hand or leg, pull the belly. When palpation, pain is manifested brighter in the right ilch. And also on the right side of the navel and at points on an imaginary diagonal line, conducted from the navel to the pelvic protruding bone.
   

   If, with lung pressure and even the slightest touch to the skin in the region of the navel, severe pain arise, and general analysis blood shows the decrease in leukocytes below normal indicatorsThis indicates the development of peritonitis and the need for immediate intervention.

2. Reflection. In some cases, appendicitis may be accompanied by pain, which arise perfectly in other departments of the body: back, legs; Men can irradiation in the scrotum.
3. Duration. Against the background of constant or periodic pain in the acute form of appendicitis, one or two main peaks are observed. The first, as a rule, is associated with the initial development of the disease, and the second most often indicates the accession of peritonitis. The bake-up peak can continue from half an hour to several hours, in the running cases - several days.
4. Intensity. Although the pain is a sign of a subjective, since each person has its own threshold of sensitivity, for inflammation of appendixes are characterized by sudden and strong attacks. If the painting of pain syndrome is unclear, the severity of the disease is determined by a combination with other symptoms (fever, vomiting, intoxication).
5. Character. On this separation, pain may be somatic (arising from the excitation of receptors in the peritoness wall) and visceral (emanating from the internal organs).

Vomiting and temperature - the second significant signs with which experts determine the form and risk of damage to the worm-like process. Under the acute appendicitis of nausea and subsequent vomiting most often becomes a reaction to severe pains and occurs in the first few hours of the disease. Repeated repetition of vomiting urges for a long time - the life-threatening sign that talks about non-standard disease flows, about strong intoxication and possible development Peritonitis or perforation (break) tissues.

For appendicitis characteristic febral temperature Within 37-38 c °. Fevering states - an important indicator for diagnosis, since most infectious diseases proceeds with an increase or significant decrease in temperature. Thus, for renal and intestinal colic, hypothermia is characterized, and the temperature leap beyond 39 degrees may be an indicator of appendicitis complications or the development of other no less hazardous states.

As instrumental research methods for the diagnosis of inflammation of the appendix, ultrasound or radiography of the abdominal cavity and laparoscopic examination are used. The most reliable method, allowing to fully inspect the lesion zone and identify the features of the disease - laparoscopy.

Laboratory research methods include general blood and urine tests, in rare cases, with confctuered symptoms, an analysis of the vomit and cart wings is carried out.

Features of diagnostics in children

The younger child, the less information he can provide concerned parents and doctors. Pain and discomfort is expressed in one way - wech. Primary diagnosis Apandicitis in young children includes:

• the flexion of the right leg in the knee - with intensive pain in the right iliac region will follow a strong reaction;
• palpation of the belly with a sharp removal of the hands inspiring from the presumptive zone of the defeat - with appendicitis there is a response in the form of severe pain;
• manual feeling - in appendicitis the abdominal muscles are intense, but there is no gas formation.

Parents can independently notice signs of appendicitis on the behavior of the child and to score alarm in time:

• refusal to move, "self-appointed" kid bedding;
• suffering grimaces on the face when jumping, walking, running;
• forced posture or lying poses, uncharacteristic for a child;
• vomiting preceding pain (in contrast to adult appendicitis, in children vomiting the urges provoke primarily into intoxication, and then pain);
• any touch to the right side of the abdomen is accompanied by stormy tears or scream;
• increase temperature to indicators 38-39 degrees;
• chair disorders.

In some cases, skin rashes are possible, an increase lymph nodes, lesions of mucous membranes.

In children of infant age, any abdominal pain cause jogging legs, but under appendicitis, the right side is more involved. The final diagnosis is made on the basis of laboratory tests and instrumental methods.

With any abdominal pain, accompanied by a change in the state of the child, increasing the temperature, vomiting and pain, the appeal to urgent medical care is urgent.

In no case to the parents can not be suspected of a child's appendicitis:

• give painkillers and antipyretic drugs;
• allow drinking and eat;
• put on the stomach roofing, compresses;
• rub the skin in the field of lesion by ointments, creams;
• use the means of traditional medicine;
• produce laxatives or controversial agents;
• press up on the stomach, try to apply the palpation methods in the absence of medical knowledge.

In children over 5-6 years, along with ordinary "adults" methods of diagnosis, in the first place, infection with such infections as measles, scarletin or diphteria is excluded.

Signs in men and women

The main features of a general plan appendicitis in men can join:

• reflex tightening of the right eggs up with a manual inspection of the right iliac region;
• spontaneous pull-up of both testicles with the grazing palpation;
• pain in the right testicle with a slight pullback of the scrotum.

On average, the majority of inflammation of the heart-shaped process in men falls at age from 10 years to 30-35 years, while the number of necrosis and perforations of appendix is \u200b\u200bsignificantly higher than in women.

Gynecological health plays a considerable role in the diagnosis of inflammation of the blind process in women. A symptoms similar to appendicitis can be caused by lesions of appendages, kidneys, ovaries, ectopic pregnancy, miscarriage and even painful monthly.

The average age of the "female" appendicitis is from 20 to 40 years. Sharp pains in teenage girls can be provoked by natural hormonal changes and the onset of the first menstruation.

Apandicitis in old age

For people over 50-55 years old are characterized by a calm beginning of the disease: normal temperature Body or minor hyperthermia, pain of light intensity and inaccurate localization, general state quite satisfactory. The definition of appendicitis is hampered, since the painting of the disease turns out erased. The stake of doubt makes such a phenomenon as the intestinal paresis, accompanied by vomiting, swelling the abdomen, increased gas formation and constipation. At the same time, the food adopted by the patient is not absorbed, but it turns out almost immediately after eating in undigested form.

Despite the completely tolerant general condition and unlight pain, it is in old age that appendicitis is accompanied by the greatest risk of complications. About 30% of all peritonitis occurs in patients of the older age group, therefore, even with obscure signs and easy discomfort, inspection with doctors is required.

Inflammation of appendix during pregnancy

The defeat of the blind process in the first trimester of pregnancy in terms of diagnosing problems does not cause; Conventional research methods are carried out, with the exception of radiography. But, starting from 4-5 months of tooling the fetus, the uterus increases in size and shifts intestinal loops from the usual place. Together with them changes its position and appendix, shifting above towards the liver. In some cases, pain gives to the area of \u200b\u200bthe kidneys or the loin.

Since in the period of carrying the pitch wall in a woman in constant voltage due to the growing uterus, the usual palpation methods do not have diagnostic force. And the identification of appendicitis during pregnancy becomes a real medical task having a lot of nuances.

Among the clinical manifestations of the lesion of the blind process in women during the period of having a child can be noted:

• the occurrence of intense pain in the lying position on the right side, which is due to the pressure of the uterus on the inflammatory hearth;
• the appearance of strong pain syndrome in a horizontal position on the back, when exposed to the left edge.

During pregnancy, the inflamed appendix is \u200b\u200bdetermined by the help of the effective methods of ultrasound, MRI and, when confirming the acute form, surgical intervention immediately prepare. In the course of surgical manipulations, all actions are aimed at preserving the life of the future mother and fetus.

Appendicitis, despite its prevalence and sufficient studies, remains a very serious state that threatens the life and health of people. With the appearance of any signs that may be symptoms of inflammation of the transformation of a blind intestine, medical care is required.

Apandicitis or inflammation of the Cell-shaped transformation of a blind intestine (appendix) is a common pathology, which is treated only with the help of a surgical operation.

Appendix is internal organwhich is usually located in the lower right of the abdomen.

The risk group includes both adults and children, starting with 3 years of age. Symptoms in appendicitis differ depending on the stage of the disease and from the age of the patient (young women are sick more often than men and the elderly).

Particularly dangerous appendicitis for pregnant women and for the elderly.

The first sign of appendicitis in men women and children - abdominal pain

The main and main symptom of appendicitis with a classic location - constant stitching (sometimes new) painwhich begins suddenly, without a pronounced reason, more often in the afternoon.

Initially, characteristic pain is felt in the navel area and above (this is the epigastric zone), then there is a change in the nature of pain, they become more pronounced, intense and localized on the right side in the iliac region (at the bottom of the abdomen on the right).

A person in this state can not easily walk. As when walking, with cough and with a laugh of a person, the attacks of severe acute pain bouts. The only thing that can do the patient is to lie in a certain position on the right side or on the back, otherwise the soreness is significantly intensified.

If the location of appendix is \u200b\u200batypical (Retrocecal appendicitis occurs in 5% -12% of cases, and pelvic at 8 - 19%), then the painful sensations from the epigastria (so-called the octopupecific region) are shifted not to the lower right section of the abdomen, but in the inguinal region, to the lower back or in the hypochondrium Depending on the features of the arrangement of appendix. Although, as well as in ordinary appendicitis, constant, staging pain sharply occurs sharply, in these cases, there is often a slow increase in symptoms, they are weakly pronounced, which is why the clinical picture of the disease is not bright.

At the pelvic arrangement of appendix (The blind intestine is located in the area of \u200b\u200bthe small pelvis and is often close to the bladder and to the rectum) can be sick in the area above the pubic. Paints are unpleasant and similar to those observed with inflammation of the organs of the urogenital system.

Important! If the pain swept sharply and disappears, this may indicate the beginning of the process of death of nerve cells of the walls of the process. This is a faithful sign that it will be peritonitis (which is accompanied by very strong pain, weakness, fever and even loss of consciousness), which leads to complications and even to death. Therefore, in suspected appendicitis, it is necessary to urgently cause ambulance.

Development Stages or Types of Apandicitis

The total development date of appendicitis is 48 hours or two days. After that, inflammation leads to serious complications, which is dangerous to human life.

The classification of forms of acute appendicitis by the degree of its development is as follows:

1. Classic appendicit Begins with the emergence favorable conditions For the development of pathogenic microflora, as a result of which an inflammatory process appears on the mucous membrane of the shell of the inner walls of the process. This is a catarrhal stage in which the symptoms are hidden. It goes into a superficial form when the focus is already visible. The initial stage lasts during the first 12 hours of the attack.
2. Second phlegmonous stage - This is when developing destructive changes begin to appear, leading to inflammatory processes in all tissues of the appendix walls. After that, the peritonean is inflamed and her irritation causes the main symptoms or manifestations of the disease. The first sign of characteristic pain in the right iliac region. It happens that the formation of several foci of inflammation occurs, then they talk about phlegmozno ulcerative appendicitis. It lasts this stage about 36 hours and starts on the second day after the start of the disease. During this time, the removal of appendicitis does not lead to severe consequences and proceeds easily for humans.
3. Gangrenoz form, this is a launched destructive stage The lesions, when due to necrosis (samples) of the tissue of the process, the loss of sensitivity occurs and permanent pain disappear. The following perforative stage is a hole (gap) or perforation of the walls leads to purulent peritonitis (Pump comes out of Apandix, falls into the abdominal cavity). It is accompanied by the fact that sharply appears sharp pain, and if death comes urgently, death comes.

Chronic appendicitis It is found in 1% of cases, more often in young women. In this disease, the inflammation of a heart-shaped process is gradual, slowly developing. The main symptom is the strengthening of painful sensations in the right iliac area during exercise, during the tension of the abdominal muscles during defecation or during coughing.

It happens that the symptoms of chronic appendicitis are worried about a person for several years. The disease can go to acute form Throughout this period. In this case, conservative treatment is used, so remove inflammation, swelling and restore the process of blood circulation (reception of antibiotics, diet and diet by the clock)

During the periodic exacerbation, nausea and vomiting appears, and stool disorders are observed (constipation, or diarrhea) and other symptoms of acute appendicitis. For treatment, there is an operation to remove Appendix (Appendecture).

The most frequent causes of appendicitis and its prevention

Possible causes of appendicitis:

Prevention of appendicitis:

Changing the clinical picture in adults by the clock

Symptom	Stage I Stage Catarial (first 12 hours)	Stage II Phlegmonous (from 12 - 48 hours)	III Stage Gangrenous (after 48 hours)
Appetite and general condition of the body	The earliest sign, loss of appetite and overall discomfort. Bad sleep.	There is no appetite. A person can only lie on the right side, either falls on his back.	The condition of the body similar to severe intoxication in food poisoning
Pain	Initially, the pain is weak in the epigastric area (in the navel area). If the pain from the very beginning is very strong, it speaks of a serious violation of the blood circulation of the process due to the thrombosis of the appendicular artery.	Strengthening and localization of pain in the right lower abdomen.	Very strong. Then, due to the death of nervous cells, the pain pokes. If the appendicitis is bursting or perforation of the process and its contents will be released in the abdominal cavity (the infection is distributed to the abdominal cavity), it is manifested by sharp pain.
Weakness	Insignificant	Stronger	It is impossible to do anything. Strong weakness can lead to loss of consciousness. This is a very dangerous state.
Body temperature	Normal or subfebrile temperature (37.3 ° C - 37.5˚С)	Raising up to 38 ° C (according to the symptomic type, the temperature in the right axillary depression is slightly higher than in the left). In the rectum with inflammatory processes, the temperature is higher than in the armpit about 10 degrees.	High (from 38˚С - 40˚С). Can lead to hyperthermia or for fever
Language	There is no dryness in the mouth, the base has a specific white flare.	Not dry, all white	Language dry and all white
Nausea and vomiting	6 hours after the start of the attack, nausea appears, the vomit reflex is weak.	One-time or twofold vomiting indicates the development of destructive changes. It does not give relief and, in fact, is a reflex reaction of the body to pain.
Dry mouth	No	Begins	Strong
Chair	Disorders of Defecation (constipation, sometimes diarrhea diarrhea, meteorism, bloating, liquid stool) With the pelvic arrangement of appendix - a frequent liquid stool with mucus and blood
Urination	Students of urination (dizuriy), if appendicitis is located near the bladder
Pulse	Disrupted if there are related diseases	80-85 wt. / Min.	Student (tachycardia)
Pressure	Pressure increases if there are related diseases that are exacerbated during appendicitis. For example, shortness of breath arises (breathing difficult)		Increased

Symptoms of appendicitis in children

The total time development of the disease in children is much less than in adults and lasts 24 - 36 hours. The table below provides information on the manifestations of the disease in the three main ages, when there is a possibility of appendicitis. Appendicitis in one year old children is practically not found, but in adolescents (from 11 to 18 years old) the symptoms are similar to the signs of the disease in adults.

Symptom	In children under 3 years	In children from 3 - 6 years	In children from 7 - 10 years
Feature of age	Can not tell where it hurts.	It can tell where it hurts, but may not pay attention to weak pain and not to speak to parents.	A child may be afraid to tell the parents about his stomach pain due to the fact that he is scared.
Loss of appetite	Refusal of food allocate as the earliest sign of appendicitis in children
General condition of the body (weakness)	The baby is sluggish, his constantly worries something ( bad Son.), sharp monotonous crying.	Weakness. Unreasonable irritation and crying.	Weakness.
Pain	I have a stomachache. The pain is intensified when the slope is right. The child cannot lie on the left side. Painful sensations when walking. When pressing the pain pokes, and if you let go of the hand intensifies.	Stomach hurts, what character pain, the child is not able to say	First, all the stomach hurts, then after 2-3 hours in the classic case goes into the right lower half. The pain is intensified when the slope is down.
Body temperature	Up to 40 ° C.	38˚С - 39 ˚С	Up to 38 ˚С (chills)
Language	In the 1st stage: there is no dryness with a white raid at its base In the 2nd stage: no dryness, all with a white bloom At the 3rd stage: Dry, all tongue with bloom
Nausea and vomiting	There is nausea and multiple vomiting		Vomiting 1 - 2 times
Dry mouth	Present at the last stage of the disease (the child wants to drink)
Chair	Liquid (sometimes with mucus), causing dehydration of the body.	Bloating (flatulence or increase gas formation), stool delay, but not constipation	Rarely present constipation
Urination	Painful	Normal	Normal in a typical case (or frequent, with a pelvic location)
Pulse	Above norms		The "symptom of toxic scissors" the pulse does not correspond to the body temperature. It is usually higher than the norm. Normally, the pulse should rise by 10 ° C. / min. When increasing the temperature to 1 ° C
Baby behavior	Small child It does not allow yourself to inspect and pulls up his right leg.	Restless	Weakness

Important! If a child has a stomach ache within 6 hours, there is a temperature and other signs of appendicitis, it is necessary to urgently contact the doctor.

Diagnosis of Apandicitis - Symptoms by the Authors

Diagnostic events begin with the fact that the doctor receives data on the complaints of the patient and conducts an inspection. What methods are used to make a diagnosis - appendicitis? Below are the symptoms of the authors and small information About how they are checked.

Author clinical symptom	As check	When the symptom is positive (diagnose appendicitis)	CHEMA
Brush Blueberg	The doctor presses the right hand to the right iliac region, then sharply release his hand.	A man feels strong pain when the doctor lends his hand.
Kohler (symptom of migration pain)	The most important symptom. The pain begins in the epigastric area (near the navel) and goes into the right lower half of the abdomen
Resurrection (symptom of shirt)	Surgeon with left hand pulls the patient's shirt below. The patient makes a deep breath, and the doctor at this moment holds his attachment from the opposite region to the right side.	During the movement of the movement at the very end, a sharp pain appears without cutting from the abdominal wall
Batomier - Michelson	Patient to go to the left side. The doctor presses the place where appendicitis is located.	Painting is intensified during palpation
Roving (rivoving)	The surgeon presses his fingers to the left iliac area of \u200b\u200bthe abdomen, and at this time the right hand spells along the course of the rectum. The movement of gases in the colon causes irritation of the process.	There is soreness in the right iliac region (irritation of the inflamed appendix causes pain).
Razdolsky (Mendel)	The patient lies on the back. The one who spends inspection performs a slight tapping on the front abdominal wall in the right iliac area.	Pain appears.
Sitkovsky	Man fall on the left side.	The pain in the right iliac region appears or enhances.
Ivanov	Compare the distance from the navel to the most protruding part of the pelvis on the left and right.	Right less than the left
Ostrovsky	In the lying position, the straight right leg of the patient rises at an angle of 130 ° C and is held in this position, and then dramatically released.	Hurts in the right iliac area.
Aarona	The doctor presses in the right iliac region	In the epigastria area there is a feeling of cutting
Volkovich	The patient leans on left	The pain is enhanced in the field of a heart-shaped process
Crimea	The doctor conducts palpation of the outdoor hole in the inguinal canal.	There is soreness in the right half of the abdomen below
Example	Apply to the diagnosis of acute retrocecal appendicitis. Patient, lying on his back, raises the straight leg.	Painty sensations appear
Kooup	Apply to the diagnosis of pelvic appendicitis. There are two types of checking this symptom: The patient lies on the left side. The doctor takes a straight leg back (so a person can pull out the iliac muscle). The patient lies on the back. Right leg bended in the knee, if pain appears, the symptom is considered positive.	Pain appears at the location of appendicitis
Gabay	Similar to the symptom of the brush of Blumberg, (first pressed, and then they are sharply released) only the palpation is carried out in the lumbar of the triangle Petitov region	The characteristic pain appears on the right
Jaur Rosanova	Apply only, with atypical (retrocecal) arrangement of appendix. The doctor presses the finger at the so-called. "PH"	Pickiness appears

In men, appendicitis is also manifested by a light tightening of the egg on the right side during the inspection by the method of palpation. Easy shrinking of the scrotum also causes pain in the right testicle.

In women, the diagnosis complicates significantly if the attack has begun during menstruation.

Important! To make a diagnosis it is necessary to see complete clinical picture. Therefore, if you suspect the patient's appendicitis, you need to appeal to the doctor and urgent hospitalization for a more thorough examination. At home this is not possible.

In the hospital to determine the disease, it is necessary to take a general analysis of blood and urine. Rarely Surigue appoints a rectal survey (only with a low pelvic location) or a rather frequently vaginal study (women are so eliminating the presence of gynecological and urological problems). If the picture is unclear, additional consultation of the gastroenterologist and the gynecologist is often needed.

If a general blood analysis Shows an increased amount of leukocytes in the blood (above the norm 9 in the absence of pregnancy in women), this indicates the presence of an inflammatory process. If it is revealed that this indicator exceeds 20, there is a possibility of gap of appendicitis (peritonitis). Leukocytosis is observed in 52% of cases of the disease. Otherwise, medical professionals say that it is possible that there is a hidden appendicitis (history or symptoms of this disease there is somewhat different). The number of C-jet proteins in the blood also shows the presence of inflammation (the norm in adult men and women is 10 mg / l, the indicators above the norm may indicate the inflammatory process, with the exception of pregnant women for which the norm is 20 mg / l). Reactivity indicators are increased 12 hours after the start of the attack.

General urine analysis In 25% of cases (with pelvic and retrocenecal appendicitis), shows the presence of a small amount of retrocytes and leukocytes.

If this is not enough and accurately diagnose appendicitis, except for analyzes and examining a patient with a surgeon, for further diagnostics and detection is carried out. row tool Research . More often ultrasound organs of small pelvis and laparoscopy. Unlike ultrasonic researchThe laparoscopic method allows you to accurately determine the presence or absence of pathology, and if the diagnosis is confirmed, the appendicitis is immediately removed. More often laparoscopy is carried out under general anesthesia, so it has a number of contraindications.

What is dangerous appendicitis and its complications?

Appendicitis is dangerous by its complications, or rather their consequences. Many of them pose a threat to human life and health. Therefore, the most important thing in successful treatment pathology and reducing the risk of death has timely appeal to the doctor and early diagnosis.

The most common complications of appendicitis are:

Indicators of the number of deaths (deaths) from appendicitis are significantly increasing, in critical cases of admission to the hospital of patients requiring emergency care, with a launched disease in the later stages with a complex peritonite or pylephlebit.

Important! In suspected appendicitis, be sure to urgently contact the ambulance regardless of your location! This measure can save life! Before the medical examination, it is impossible to put the heating floor, to give painkillers or laxative.

Appendicitis treatment - urgent appendectomy

Appendices treatment is an urgent operation to remove it or appendectomy. Surgical intervention is carried out either through one large incision (7-10 cm), or through three small cuts (1 - 2 cm.) Laparoscopic method under general anesthesia.

In order to determine the place of the cut, focus on the point of the poppy.

The earlier the disease was diagnosed, the easier the operation proceeds for the patient.

Often there are cases when the surgeon is already visible during the operation that there is no appendicitis, then intraoperative differential diagnosis. Special attention during laparoscopy is given to gynecological pathologies.

Case of life. One patient made laparoscopy. During the survey, they found that appendicitis is combined with the rupture of the ovary.

In most cases, the forecast is positiveDifficulty represent cases when there is:

• elderly age
• the presence of a large number of concomitant chronic diseases (Serious heart disease, kidneys, liver and other internal organs)
• the launched stage of the disease.

Complications after appendectomy can be:

• Internal bleeding
• Postoperative groove hernia (depends on the patient)
• Education infiltrates
• Inner abscesses
• Suggestion of seams due to infection
• Fearing processes in the intestine, leading to the formation of fistulas (after removing appendicitis with a spilled peritonitis)
• Intestinal obstruction (a person suffers from harsh pain and from other dangerous consequences)

Postoperative period

Immediately after appendectomy for about 12 hours You need to lie down, and it is impossible to eat and drink. If necessary, there is a special drainage tube at the scene, which is necessary for removing the inner liquid and for the introduction of antibiotics. She is removed on the third, fourth day. For a while after surgery, the doctor prescribes the reception of painkillers.

In the second half of the first day You can drink a small amount of acidified water.

On 2 day, you can eat low-fat kefir or cottage cheese a little. It is already necessary to try to climb from bed and slowly walk. In active patients, the restoration of the body proceeds faster.

For 7 - 10 days after surgery, seams are removed.

Somewhere for one and a half weeks you need to stick to the diet, and then you can gradually introduce the usual food.

During recovery, we must wear a pulling bandage and reduce any physical exercise (in no case, do not lift gravity).

Important! The postoperative period after the appendectomy of simple appendicitis lasts from 20 days to the month. If the operation was made by an older person or removed appendicitis with peritonitis, then for the full restoration of the body, it may be necessary to six months.

+ + True ulcer
duodenal gut + + + Pancreatitis + + + + Diverticulitis Meckel + + + + Adnexit
(inflammation of the appendages of the uterus) + + + Apoplexy
(ovarian break) + + + + Colitis + + + Tuberculosis of the intestine + + + + Cystitis + + + Kidney inflammation + + + Cholecystitis + + + +

Appendicitis May occur at any age and people of any sex. However, statistics show that most often it is inflamed in people aged 5-40 years.
Among the victims at the age of 20-40 years are twice as many women than men, while among patients under the age of 20 men prevail.
Women in general are sick of a little more often. After 40 years, the probability of the occurrence of the disease is significantly reduced, but does not become zero.
Therefore, appendicitis can meet in the elderly. Also, appendicitis occasionally diagnose in children under 5 years old.

For your information!

It is proved that people with remote appendix have problems with a sufficient amount of useful microorganisms in the intestine. However, the Appendix does not apply to the number of vital organs, without which the body cannot exist

The functions of Appendix Not exactly found out. Previously, Appendix was considered as a simple evolutionary rudiment, as in animals with a herbivore diet and now functionally useless. Now there are serious grounds to believe that it plays an important role in endocrine and immune processes, as well as in the formation of intestinal microflora.

Classification of appendicitis

The main stages of the development of appendicitis:

• Catarial
• Phlegmonous
• Gangrenous
• Perforated

One of possible causes and factors provoking development of acute appendicitisis a violation of the evacuation function of the appendix, as a result of which the reproduction of its own microorganisms of the process and the occurrence of inflammation occurs. In childhood, the cause of acute appendicitis Cars can become.

The main symptoms of acute appendicitis

• nausea, vomiting
• body temperature rise up to 37.5-38 ° C
• stool delay (sometimes), diarrhea (rarely)
• student urination (when the proceedings are arranged in the cavity of a small pelvis)

For your information!

If the pain extends throughout the stomach, this may indicate the development of peritonitis, which requires immediate operational intervention.

Pain, gradually increasingMost often arises suddenly in the iliac area to the right (this is the bottom of the abdomen) or under the spoon, sometimes in the epigastria (top of the abdomen) or in the navel area (parambilical). Usually after 2-3 hours, the pain is focused on the right lower abdomen, acquiring a permanent character. Movement and voltage enhance pain, rest reduces.

Nausea It happens quite often, as well as vomiting, more often, eaten food. When developing peritonitis, vomiting may resume and repeated repeatedly.
In suspected of acute appendicitis, it is necessary to urgently cause "ambulance", as the earlier the operation will be carried out, the less the risk of developing the hardest complications.

How to check out appendicitis or not ...

Appendicitis is difficult to recognize, It should do a surgeon. Its main symptom is pain. The pain is most often localized to the right at the bottom of the abdomen. Due to the characteristics of innervation, sometimes it is necessary to determine what exactly hurts, it is impossible: there is no point in which the pain concentrates.

therefore appendicitis usually begins with pain in general in the stomach or around the navel. Then the pain can move to the right, but it is not necessary. Pain constant and gradually enhanced.

It is impossible to put on your own on the stomach and try to try to try, which is sick there. Due to the strong impact, appendix can, roughly speaking, break through. This will lead to complications.

You can only spend safe tests:

• Cough. With the cough, the pain of the right will increase, it is a symptom of a cough push
• To lie down in the embryo pose (curl up) on the right side. At the same time, pain should calm down.
• Turn on the left side and pull the legs. With appendicitis, pain will be stronger and must be localized at the bottom of the abdomen on the right.
• Lyzha on the left side, slightly push the palm to the sore place, then let go cold. With appendicitis, pain will be stronger at the moment when they release.

Complications of appendicitis

With late appealing for medical care and attempts to self-medication, such complications such as infiltrate, abscess, peritonitis, etc. can develop.

Infiltrate - involvement in the inflammatory process of neighboring organs of the abdominal cavity (glazing, blind intestine, loops of the small intestine) with the formation of a seal that either is absorbed under the influence conservative treatment, either driving, turning into an abscess.

Abscess - Purulent inflammation, causing local inflammation adjacent to Appendix of the peritoneum.

- Purulent inflammation, spread throughout the peritoneum in the absence of measures aimed at treatment of abscess.

After these complications often occur spikes of intestines with other organs.

Diagnosis and treatment of appendicitis

ATTENTION IMPORTANT!

1. Before the "ambulance" arrival and until the diagnosis is not established, the use, laxatives and heels on the belly are unacceptable.
2. In the absence of available qualified medical care or during its long waiting, it is necessary to put the patient, put it cold on the stomach and do not eat food ("cold, hunger and peace"); Only drinking a small amount of water is allowed.

The following research is carried out in the hospital to confirm the diagnosis:

• blood and urine test
• antimgen of the abdominal cavity and chest

One of the early indicators of acute appendicitis is an increase in the number of leukocytes with normal ESO (erythrocyte sedimentation speed), shift leukocyte formula Left.

It should be noted that there are many diseases that are similar to appendicitis symptoms (acute gastroenteritis, adnexitis, pancreatitis and cholecystitis, right-sided renal colic, right-hand, ectopic pregnancy, etc.), with most of which the operation is not shown.
Therefore, in difficult cases do diagnostic laparoscopywhich not only prevents in vain surgical intervention, reliably excluding appendicitis, but also (when confirming the diagnosis) allows you to perform an operation less traumatic endoscopic method.

The operation is not made with the calm flow of appendicular infiltrate if the tendency to its absorption is observed. In such situations, observing bed mode use cold to the right iliac region, a slight diet and antibacterial drugs. However, after the resorption of infiltrate, after 3-4 months after recovery, the removal of appendix is \u200b\u200brecommended, due to the fact that the danger of its re-inflammation in such people is significantly higher.

Transition acute appendicitis in chronic (manifested by non-space permanent or chicken pains mainly in the right iliac region) occurs extremely rarely, usually in the event that the patient for any reason was not operated, but all acute signs Diseases subsided.

Frequently asked Questions:

Appendicitis from which side? - Answer: Appendix is \u200b\u200blocated (right) in the right iliac region!

Attention! The information on the site is not a medical diagnosis, or leadership to action and It is intended only for familiarization.