Atypical appendicitis. The first symptoms of appendicitis

Appendicitis is a disease characterized by inflammation vermiform appendix rectum. It can be recognized by acute abdominal pain, vomiting and increased body temperature.

The first symptoms of appendicitis

Recognizing the first symptoms of appendicitis in adult women is quite simple. This disease manifests itself in their acute form. In just a few hours, their pain in the lower abdomen increases significantly, nausea and vomiting appear, and their body temperature rises to 38-39 degrees.

At the very beginning of this process, the following manifestations can be distinguished:

Sudden chest pain, above the navel or without a specific location - on initial stages inflamed appendicitis practically does not hurt, a person can think about completely different reasons for the discomfort that appears.
Nausea and vomiting- due to blockage digestive tract And inflammatory process, the body cannot absorb the food entering it. A distinctive feature of vomit from appendicitis can be called bile impurities.
Lack of appetite due to pain in the stomach area.
Increased body temperature– this sign is formed against the background of a powerful inflammatory process in the body.
Indigestion– due to the fact that food cannot be digested normally, a person experiences constipation or, on the contrary, diarrhea. The volume of urination also increases significantly, and the urine itself becomes dark.

The main danger of the first signs of appendicitis in women lies in the fact that a person can for a long time not pay enough attention to them or suppress them discomfort painkillers. This can lead to necrosis or rupture of the appendix.

Particular symptoms of appendicitis in women

Any attending physician can tell exactly where appendicitis is located and its symptoms in women. With the right approach to diagnosis, this inflammation can be recognized even in its inception stage by:

bloating caused by obstruction of the digestive tract;
white or yellow plaque on the tongue;
unpleasant pulling sensations in the right side;
loss of appetite;
dry mouth;
general malaise;
rapid heartbeat;
high blood pressure;
pain in joints and bones.

How clearly you will experience the symptoms and signs of appendicitis depends on the degree of inflammation and the general condition of the body. In some cases, people may experience convulsive attacks and loss of consciousness. Manifestations of appendicitis of infectious origin develop most quickly.

Stages and symptoms of female appendicitis

The severity of appendicitis symptoms depends on what stage it is in. Remember, the sooner you can diagnose this inflammation, the sooner you can take action and begin treatment. It is strictly forbidden to ignore the manifestations of the disease, so as not to provoke the development of serious complications.

Dangerous manifestations of appendicitis

Even though appendicitis is a fairly common disease, it is not always possible to diagnose it at the initial stage. The fact is that in some cases its symptoms may be reflected and regarded completely incorrectly. Various gynecological pathologies can also provoke the development of complications in women.

When aching and nagging pain in the lower abdomen, you should immediately consult a doctor.

With the help of modern diagnostic capabilities, the attending physician will be able to quickly determine the cause of increasing pain. You can recognize appendicitis, which is accompanied by serious complications:

black stool, which appears due to bleeding in the digestive tract;
vomit in which there are no bile impurities - indicates blockage of the bile ducts;
prolonged absence of menstruation;
belching and heartburn, excessive gas formation are signs that a woman has an inflamed pancreas;
Previously suffered genital infections - in this case, there is a high risk of genitourinary infections.

The main danger of the symptoms described above is that a person can be treated for a long time for a completely different disease. All this can easily lead to extremely serious complications. Particularly dangerous is the occurrence of peritonitis - inflammation of the abdominal wall - or rupture of the appendix.

Signs of acute appendicitis in women

In 30% of cases, symptoms of appendicitis occur suddenly. In such cases, the woman should immediately call an ambulance and go to the hospital. This will help her minimize the risk of complications and even fatal outcome. You should not endure the pain or suppress it with painkillers - this will only make it worse. Recognize acute form appendicitis can be done by:

If several signs appear at once, the treating specialist should immediately examine you and conduct detailed palpation. If there is any suspicion of such dangerous disease you must be taken to the surgical table immediately.

Manifestations of appendicitis in pregnant women

The hardest thing to determine signs of appendicitis in pregnant women, especially in the first trimester. Also, enormous difficulties for the doctor are caused by the increasing size of the fetus and uterus, which constantly displace the intestinal loops. Because of this, the appendix can move directly to the liver, which changes the location of pain.

They can easily be confused with inflammation biliary tract or cholecystitis. It is also quite possible to confuse appendicitis with kidney disease, since the appendix can move closer to the back. Appendicitis in pregnant women can be recognized by pain that:

appear lying on the right side– due to pressure of the uterus on the appendix;
appear lying on your back, if you press on the left rib.

It is strictly forbidden to self-medicate or endure unpleasant sensations. The fact is that pregnant women often experience serious complications. The attending physician must definitely send you to ultrasound examination, MRI, X-ray, blood and urine tests. If there is evidence that a woman has appendicitis, she is immediately placed on the surgical table and the inflamed appendix is removed. In such an operation, the most important thing is to save the woman’s life.

How can you tell if a woman has appendicitis?

Of course, no one other than a doctor can tell whether you have appendicitis or not. However, when collecting anamnesis, the specialists themselves pay attention to a number of features that arise only with this disease. You can recognize inflammation of this appendix at home by the following signs:

the pain intensifies and then goes away;
when coughing, laughing, hiccups and any other movements, the pain in the side increases;
if you turn over from one side to the other, the discomfort increases;
after vomiting there is no relief;
Most often, attacks of appendicitis occur in the evening or at night;
When palpating the abdomen, the patient feels severe pain.

If you suspect you have appendicitis, do not take painkillers under any circumstances.

Symptoms of chronic appendicitis

Recognizing the signs of chronic appendicitis in women after 40 is not so difficult. Most often, ladies complain about regular painful sensations in the area around the navel or under the right iliac band.

In rare cases, discomfort can spread to the entire right side of the peritoneum. The pain can be described as paroxysmal, nagging, and constantly aching.

Typically, the pain caused by appendicitis increases significantly in the evening or at night.

At chronic form A woman with appendicitis should be monitored by a doctor. It is necessary to strictly follow all his recommendations and prescriptions, completely abandon any loads and heavy lifting. Typically, the symptoms of chronic appendicitis are as follows:

indigestion in the form of constipation;
constant nausea and vomiting during periods of exacerbation;
when examined by a gynecologist, severe pain occurs due to an uncomfortable position;

Inflammation of the appendix is the most common cause purulent peritonitis. If you recognize the first signs of appendicitis in time and begin treatment, then severe consequences can be avoided.

Symptoms of the disease are associated with inflammation of the appendix of the cecum

How does appendicitis develop?

The causes of appendicitis are still not fully understood. There are several theories about the development of the disease. Unanimous opinion about the presenter etiological factor has not been developed in the scientific community.

Possible causes of inflammation of the appendix:

mechanical blockage of the opening between the cecum and the appendix;
violations nervous regulation vessels of the intestinal wall;
excessive production of serotonin by cells of the APUD system in the appendix;
disturbances of peristalsis and constipation;
dietary features (lack of vegetable fiber in the menu, excess protein and fat).

On early stages Appendicitis is characterized by swelling of the mucous and submucosal membrane of the appendix, impaired outflow of contents into the cecum, deterioration of microcirculation in arterioles, venules and capillaries, and activation of microflora. The first symptoms of appendicitis are associated with the development of the initial phenomena of inflammation.

Signs of appendicitis in adults

Signs of appendicitis appear acutely against the background of good health.

The first symptoms of appendicitis:

loss of appetite;
diarrhea;
nausea, vomiting;
fever.

Symptoms of inflammation of the appendix in the first 6-12 hours constantly bother the patient, but do not disturb his general condition.

Signs of inflammation of the appendix are gradually increasing. Abdominal pain increases, fever and nausea increase.

Pain from appendicitis

Discomfort and pain with appendicitis in the first stages is felt in the epigastrium or in the central part of the abdomen. A few hours later in classic case with typical localization of the appendix, unpleasant sensations migrate to the right iliac region.

If the patient has anatomical features of the location of the appendix, then the pain can move from the epigastrium to the lumbar region, right or left hypochondrium, to the periumbilical region.

If the appendix is close to the ureters or internal genital organs, frequent urination and irradiation of discomfort to the groin area are triggered.

At the initial stages of inflammation, the pain syndrome is quite moderate, but the intensity of the discomfort is constantly increasing.

Important: If you have acute abdominal pain, you should not take painkillers until examined by a doctor.

Digestive tract disorders

Nausea, vomiting and loose stool occur as a reflex in appendicitis. They appear secondarily after the onset of acute pain.

Loss of appetite occurs several hours before abdominal discomfort appears. Patients do not refuse to drink water.

Nausea is persistent and increasing. But vomiting is observed only 1-2 times. Loose stools occur in a small percentage of patients.

Frequency of symptoms of digestive tract disorders:

loss of appetite – 99-100% of cases;
nausea – 40% of cases;
vomiting – 20% of cases;
diarrhea – 10% of cases.

Fever

How it manifests itself general reaction body for appendicitis? Patients experience fever (low-grade fever) from the first hours. An increase in body temperature is a manifestation of work immune system. In the early stages of inflammation of the appendix, the fever does not exceed 37.5-38 degrees Celsius.

Important: If sharp pain in the abdomen combined with fever - seek medical advice immediately medical assistance.

Early signs of appendicitis in children

Symptoms of the disease on initial stage depend on the age of the patient. The first signs of appendicitis in adults and children can differ dramatically. Preschool children often experience an atypical onset of the disease. The first manifestations of inflammation of the appendix may be high fever, vomiting, deterioration of general condition.

Young children are less able to tolerate discomfort and have difficulty describing how they feel. The development of acute pain is indicated by the forced position of the child’s body (tucked legs), increased crying in the arms of adults.

Tips for parents: Do not apply a heating pad (warm diaper) to the baby's belly. Give your child enough water, do not insist on eating.

Symptoms of the disease in men and women

Features of appendicitis in representatives different genders related to location internal organs in the pelvis, the likelihood of pregnancy or ovarian apoplexy in women.

Inflammation of the appendix occurs 2 times less often in men. Likely to be involved in pathological process vermiform appendix occurs with oophoritis, salpingitis, endometritis, colpitis.

Advice: Women with chronic pelvic inflammatory disease should undergo full course treatment by a gynecologist. By eliminating the infectious process in the genitals, you will reduce the risk of appendicitis.

Women usually develop appendicitis between the ages of 20 and 40. This period of life is characterized by high fertility. The first signs of appendicitis in women may resemble ectopic implantation of the fertilized egg, spontaneous abortion or ovulation. To exclude problems of the reproductive system, it is necessary to undergo ultrasound imaging of the pelvic organs. The diagnosis of appendicitis is made after examination by a gynecologist.

Unfortunately, inflammation of the appendix often occurs in pregnant women. Surgical intervention for this reason is the most common abdominal surgery in expectant mothers. The first signs of appendicitis in pregnant women are subtle. A blurred clinical picture often leads to late diagnosis diseases. In addition, difficulties in detecting appendicitis are associated with changes in the position of the appendix in pregnant women. After 20 weeks, the characteristic acute pain is usually recorded in the right hypochondrium, and not in iliac region. To detect inflammation of the appendix in expectant mothers, Michelson and Taranenko symptoms are checked.

They often fit into the classical picture and are easier to evaluate. To confirm the diagnosis, the doctor must check the symptoms of Horne, Laroque, Britten.

Pain with appendicitis in men

The first signs of appendicitis indicate inflammation of the extreme part of the cecum and require immediate hospitalization. The sooner a patient seeks help, the higher the chances of full recovery body without consequences.

It is not difficult to determine appendicitis at home, since the disease is accompanied by very intensive clinic. And the symptoms tend to only increase.

Causes of inflammation

There are many causes and predisposing factors for inflammation of appendicitis. All of them are based on damage to the structure of the lining tissue, as well as the ingress of microbes onto it. This can happen if the appendix is damaged due to blunt trauma to the abdomen or clogged with feces. Human immunity is also important. The appearance of the disease also depends on how strong it is.

The main triggers for inflammation of the appendix are:

non-compliance with nutritional rules;
availability concomitant diseases gastrointestinal organs intestinal tract;
dysbacteriosis;
regular constipation;
peritoneal injury.

The presence of one or more predisposing factors in the patient's history increases the risk of developing inflammatory disease of the appendix.

Reviews from gastroenterologists indicate that signs of appendicitis in men are sometimes less pronounced than in women. At the same time, the weaker half of humanity may suffer not only from inflammation of the appendix, but also from ectopic pregnancy and other gynecological problems.

Attention! If appendicitis is inflamed, the first signs are difficult to miss. As a rule, it hurts pointwise and intensely. The exception is the elderly and children, in whom the clinical picture of the disease is often erased.

In adults

The main symptoms of appendicitis are pain in the peritoneum, fever and stomach upset. Unpleasant sensations can be very pronounced or, on the contrary, weak, but do not stop for a minute. Analgesics help temporarily, after which the discomfort reappears.

How to recognize appendicitis in adults:

Pain syndrome.

Most often, with inflammation of the appendix, pain appears in the right iliac region, under the ribs. It is cutting, slightly subsides when positioned on the right side and intensifies on the opposite side. Often radiates to other organs, as well as to lower limbs. Often the patient complains of pain in the lower back, lower abdomen, or throughout the entire peritoneal area. This is due to the location of the organ, which may differ slightly from person to person.

Temperature.

Low-grade fever or an increase in body temperature to high levels is the main sign of any inflammation. In this way, the body tries to eliminate harmful microorganisms. When the thermometer shows the number 37-38, while phlegmonous will be accompanied by a temperature of 39-40 degrees.

Indigestion.

Poor digestion is another sign of appendicitis. Sometimes the patient is bothered by nausea, single vomiting, diarrhea or constipation. Based on this manifestation, one cannot speak for sure about the presence of inflammation, but the triad of these signs almost always indicates appendicitis.

The deterioration of the condition in acute appendicitis is directly related to the duration of the disease. In the first hours, the patient may only feel pain; subsequently, with the accumulation of pus in the organ, the symptoms will intensify significantly.

Attention! Sometimes there is a “lull” and the pain goes away, but then returns with severe symptoms. This indicates that peritonitis is developing in the body.

How to recognize a teenager

The signs of appendicitis in a teenager are practically no different from adults. Sometimes puberty girls is accompanied by abdominal pain, which can be confused with inflammation. However, the discomfort in women is more spasmodic, while in acute appendicitis the pain is constant and cutting.

To determine appendicitis at home in adults, children, and adolescents, it is necessary to palpate the peritoneum.

The main sign of inflammation of the appendix is pain, so you can independently determine its location and level of intensity. Palpation must be done very carefully, as the risk of organ rupture is high. In that case surgical care will be required immediately, and its absence may cost the patient his life.

What will indicate appendicitis:

pain subsides when lying on the right side;
reduction of pain with short pressure on the right iliac region and intensification when releasing the hand;
the appearance of discomfort when pressing on the left side.

This way we can understand that the teenager has developed inflammation of the appendage of the cecum. You should not try to drown out the unpleasant sensations with analgesics on your own. In this case, it is recommended to immediately contact emergency medical care.

Inflammation in a child

A child under 4-5 years old cannot yet independently form his feelings and describe them correctly. Therefore, the behavior of children with acute appendicitis differs significantly from the standard clinical picture.

What signs should parents be wary of:

forced posture of the baby, the desire to pull the knees to the stomach;
gastrointestinal upset (nausea, vomiting, diarrhea);
gas formation;
increase in body temperature.

It is not recommended to independently examine a child for appendicitis, since the risk of damage to the inflamed organ is too high. If you have one or more signs of the disease, it is recommended to immediately seek medical help. Treatment tactics in this case are always surgical.

Diagnostic signs of the disease

Before surgery, the patient is always prescribed preliminary studies. In most cases, they are minimal, which will be enough for a competent doctor to make a diagnosis. If in doubt, it may be prescribed diagnostic laparoscopy with the possibility of subsequent removal of the appendix.

How is appendicitis determined by the signs in the tests:

a general blood test shows an increase in leukocytes, as well as a shift leukocyte formula left;
A general urine test also indicates the presence of inflammation in the body (leukocytosis, the presence of protein);
ultrasound examination - the organ is enlarged in size and may be surrounded by exudate.

Availability of analysis data and visual inspection is a sufficient basis for making a correct diagnosis. If there are suspicions, additional examinations are prescribed, including ECG, X-ray of the lungs and ultrasound of all organs abdominal cavity.

Severe pain always indicates some kind of problem in the body, which is why it should not be tolerated. If there is a suspicion of appendicitis, it is recommended to immediately contact a gastroenterologist to confirm or refute existing concerns.

Appendicitis is an inflammation of the appendix, which is a long tube from 5-7 to 20 cm, weighing no more than 7 grams. For some time now, there was an opinion in medicine that the appendix was nothing more than a vestige from our ancestors. Recent studies have shown that the appendix contains lymphoid tissue inside. The purpose of the fabric is to protect against viruses and hostile bacteria. If the appendix becomes inflamed, it causes significant harm to health or causes death.

As a rule, the appendix can become inflamed suddenly and unexpectedly, then the disease passes in the acute phase.

Symptoms of appendicitis:

increasing pain in the right side of the abdomen;
pain in the right iliac region upon palpation (pressure);
muscle tension in the right iliac region during palpation;
increased body temperature;
nausea and vomiting.

The doctor can easily feel it or determine it through tests. The only treatment, indicated for inflammation of the appendix - appendectomy surgery.

Of all surgical interventions in the abdominal region, most cases occur due to inflammation of the appendix. Mostly appendicitis is excised in people aged 10–30 years, of any gender. Inflammation of the appendix rarely occurs in infants and children under 5 years of age. The anatomy of a child’s body makes adjustments to the development of the disease. During this period, the appendix is presented in the shape of a funnel and is easily emptied.

In medicine, there are two types of inflammation: acute and chronic. In acute illness, symptoms develop rapidly, from 6 hours to 3 days. The non-acute inflammatory process is sluggish, without brightness. severe symptoms. It is mainly found in women under 25 years of age. Diagnosis of the disease is difficult because the signs are not expressed.

It has been proven that appendicitis is hereditary disease. This means that in carriers of a certain antigen the disease is inherited.

At the first signs of illness, you will need to call an ambulance, which should hospitalize the patient. Rescue depends on efficiency measures taken. If treatment is delayed, a complication develops - peritonitis, leading to death.

The main factors that provoke exacerbation of the disease are not fully understood, and doctors cannot indicate reliable sign when inflammation occurs. The main reasons relate to microorganisms that densely populate the appendix cavity. In the absence external factors lymphoid tissue inhibits the proliferation of pathogenic bacteria and prevents the disease from developing.

Let's consider what reasons served as the impetus for inflammation of the follicular apparatus.

The lumen of the process is blocked

There are many reasons for a blocked passage. Tumor formations, as they grow, compress the process, which leads to the impossibility of outflow of mucus produced in the organ. They block the outflow, forming in the rectum and penetrating into the appendix. The presence of worms in the body causes blockage of the lumen of the appendix.

Lymphoid tissue is constantly renewed, and when its volume exceeds the norm, the appendicitis canal is completely filled and inflammation occurs.

Impaired blood supply

The appearance in the lumen of blood vessels supplying the appendix with oxygen and nutrients, blood clots lead to disruption of blood supply. Hypoxia of organ tissue occurs, causing inflammatory processes inside. Lymphoid tissue loses its protective properties, pathogenic bacteria begin to multiply.

Eating disorder

For the normal digestion process, it is necessary that dietary fiber be present in the incoming food. They stimulate the walls of the intestinal tract, promote better progress feces along the channel to the exit. If dietary fiber little intake is received, intestinal function decreases sharply, which leads to stool stoppage. Liquid comes out of it and hardens, then fecal stones appear and travel through the intestines. When such a pebble appears in the lumen of the appendix, the passage is blocked. The mucus loses the ability to exit the organ normally, and inflammatory processes occur. It is recommended to eat more coarse fiber to prevent stagnation in the intestines.

Allergy

The lymphoid tissue located inside the appendix is considered a kind of immune system of the digestive tract. But when, under the influence of certain factors immune cells begin to produce more enzymes, allergic reaction, leading to inflammatory processes.

Constipation

In a person prone to constipation, the risk of inflammation is extremely high. When the intestines work poorly, its motor functions are reduced, the organ is called lazy. Fecal matter moves at low speed, moisture is released from it and hardening occurs. Then the feces are transformed into stones that fall into the lumen of the organ.

Classification

The first thing that becomes inflamed in the appendix is its internal mucous membrane. Then the inflammatory process moves inside the appendix, gradually covering the entire area. The disease is recognized as simple and complex. In medicine they are divided into 4 forms.

Catarrhal

Clinic of the indicated form of the disease - characteristic features swelling of the mucous membrane. It increases in size, the clearance decreases. The appendix enlarges, and the pressure inside the organ also increases. Precursors of inflammation: tolerable pain on the right. Other disorders in the gastrointestinal tract may also occur. The patient complains of nausea, vomiting, dry mouth, and bloating.

The inflammatory process at the first stage shows two development options:

With good and strong immunity The adult body itself is able to cope with inflammation. In this case, the swelling of the appendix subsides, surgery is not required.
If the body's immunity is reduced, the inflammatory process will begin to aggravate the disease. Development takes six hours.

Due to the subtle manifestations, it can be difficult to make a correct diagnosis. Blood tests show slightly elevated leukocytosis and a moderate erythrocyte sedimentation rate.

Purulent or phlegmonous

At the time of inflammation, pus is released inside the appendicitis. With this form of the disease, not only the mucous membrane of the organ suffers. Purulent inflammation covers all layers of the appendix, accumulates inside and poisons the follicular apparatus. The appendix enlarges and the internal pressure rises. The pain becomes more intense.

Serous appendicitis affects the appendix itself and nearby organs. In this regard, the pain syndrome spreads throughout the entire abdominal cavity, but the main localization is observed on the right in the iliac region. Along with the development of purulent inflammation, the patient’s temperature rises, chills and general weakness. He is tormented by nausea, vomiting, and pain in the right lower abdomen. The development of the disease occurs over a period of 6 hours to 24 hours.

Doctors additionally distinguish apostematous appendicitis as a subform of a purulent disease. The disease is characterized by the appearance of pinpoint foci of inflammation, where dead tissue and neutrophilic leukocytes collect.

Purulent appendicitis is easily diagnosed due to the symptoms of abdominal irritation that occur. It is necessary to do blood tests that will show increased leukocytosis.

Gangrenous

Advanced inflammatory process. The development of this type of appendicitis begins 24 hours (maximum period 72 hours) from the onset of the disease. The disease is characterized by the death of organ tissue. Necrosis affects the nerve endings located in the organ and blood vessels. IN certain moments the symptoms of appendicitis subside, the patient feels better. Nausea goes away, vomiting stops, pain goes away. It's a matter of time, then the symptoms return. False symptom recovery occurs due to the death of nerve endings and the pain goes away a little.

The patient weakens, organ tissues die, decay products are carried by the bloodstream throughout the body, poisoning other internal organs. As a result of severe intoxication, the patient’s temperature rises sharply to fever (from 39 to 40 degrees), blood pressure drops to 90 mm Hg. The heart rate can reach up to 100 beats per minute. It is worth noting that gangrenous appendicitis can occur without fever; the heart rate always increases and can reach 120 beats/min. The patient does not feel severe pain, but there is general weakness in the body. Vomiting is observed for a long time, but it does not get easier; on the contrary, the body quickly loses fluid, and symptoms of dehydration appear.

An external examination of the patient makes it possible to recognize gangrenous type appendicitis. Pale skin, tongue covered with a gray coating, dry mouth. The abdominal muscles are tense, the intestines do not work. The patient's abdomen is hard, swollen and painful to the touch.

If left untreated, the patient may experience complications. The inflamed appendix can burst, then the contents spread throughout the free abdominal cavity, causing necrotic processes in the tissues of other organs. Urgent surgical intervention is needed.

Perforated

In another way, the mentioned form is called the rupture stage. The walls of the process cease to be unified and collapse. The contents of the appendix enter free cavity peritoneum. Pus is distributed in the layers of the peritoneum, and inflammatory processes occur on their surface - peritonitis. Peritoneal phenomena require immediate hospitalization and surgical intervention.

When peritonitis develops inside, the patient's condition deteriorates sharply. Blood pressure drops, heart rate increases significantly, the patient is in a semi-conscious state. The skin turns pale, a brown coating is visible on the tongue. Being in a critical condition, a person may not feel pain - this is a bad sign.

A hidden type of disease is often diagnosed in diabetics. The pain is not severe, weakly indicating the source.

Symptoms

Inflammation of the appendix manifests itself differently in children and adults. The most important and first symptom is severe pain syndromes. At first, a person gets the impression that there is pain in the abdomen, but gradually, over the course of 5-6 hours, the pain syndrome shifts to the right, to the iliac region.

An atypical type of appendicitis manifests itself with different locations of the appendix, which in turn provokes different localization pain. With the classic location of the process, pain is felt on the right in the iliac region. If the congenital appendix is located higher than it should be, the pain will go to the hypochondrium. A strongly drooping process radiates pain to the pelvic area where the bladder is located. In people with a mirror arrangement of internal organs, left-sided appendicitis is observed.

As the disease develops, the pain becomes more intense, especially when coughing, laughing, or walking. Slight subsidence pain occurs when horizontal position bodies on the right side.

A disorder of the digestive tract is expressed in constant nausea and vomiting. Periods of constipation are followed by periods of diarrhea and flatulence. The pulse quickens and ranges from 90 to 100 beats per minute.

With purulent or gangrenous appendicitis the patient experiences general severe intoxication of the body, which is expressed by weakness, pallor skin. When in abdominal area an abscess forms. It is possible that blood clots may form in the arteries supplying the follicular apparatus with blood.

The disease manifests itself differently in children, pregnant women, older people, and men.

In children

Acute appendicitis is extremely rare at 4-5 years of age. From birth to seven years of age children's body the anatomical structure of the cecum differs from that of an adult. It has the shape of a funnel ending in appendix, there is no sphincter. Stagnation does not appear with the described structure. But gradually the body is rebuilt, and the cecum and appendix change accordingly.

Inflammation of the follicular apparatus provokes the appearance of intoxication symptoms. Reason: in a child's body nervous system unstable and easily excited.

The onset of the disease is unexpected, the baby’s condition deteriorates sharply, and the body temperature increases to 39 degrees. If you go up, you can knock her down. Vomiting and loose stools are frequent companions. The color of stool and urine may change. When being examined by a doctor, the first suspicion is that there is an infection in the intestines; they do not talk about appendicitis.

Specific signs of the inflammatory process in the appendix are a wandering pain syndrome in the abdominal area, spreading over the entire surface, without localizing the source. Small children feel pain concentrated near the navel. These symptoms do not allow the disease to be correctly diagnosed.

In pregnant women

Dangerous for the health of mother and baby. The largest amount of diagnosed inflammation occurs in the first three months of gestation (approximately 75%). In the second trimester, the percentage of cases decreases to 53. In the last three months before giving birth, 15% of women complain of appendicitis.

Symptoms depend on the period of treatment. In the first trimester, when the size of the fetus is small, the signs of acute inflammation do not differ from the general ones. As the uterus grows, internal organs shift, taking into account their initial positions. The cecum also undergoes changes.

The pain begins in the right hypochondrium, the abdominal muscles are not tense. The analysis for leukocytosis does not give reliable result, since during pregnancy there is increased value. As a result, a correctly diagnosed diagnosis occurs in fewer than forty women out of a hundred cases. The remaining 60 receive a doctor's preliminary opinion about a possible miscarriage.

Staging correct diagnosis and surgical actions do not reduce the risk of consequences. If appendicitis is uncomplicated, then the risk of possible miscarriage remains at 2-12%. Rupture of the appendix increases the risk to 50%. Even after surgical removal there remains a risk of infectious inflammation.

Possible complications that occur in pregnant women:

An attack caused by an infection. Catarrhal appendicitis provokes up to fifteen percent, rupture of the appendix increases the risk to 90%.
Obstruction of the intestinal tract. The occurrence of the disease occurs in 20 cases out of 100.
Miscarriage after appendix removal occurs in a quarter of all cases.
Maternal death occurs in 16% if peritonitis develops. With appendicitis that occurs without complications, there is no mortality.

First signs

The manifestation of the disease depends on the patient’s age and gender. Doctors identify common first signs of appendicitis that are present in everyone:

Pain in the abdomen, epigastric region and lower back.
Weakness throughout the body.
Body temperature is increased.
Nausea and vomiting. The symptom is constantly present, and vomiting does not bring relief.
A person's sweat production increases.
The pulse rapidly increases.

As a rule, body temperature does not exceed 38 degrees. Since it does not always increase, it is worth getting indicators of the rectum. Rectal temperature is required to be measured if there is a suspicion of illness. The patient has visible early symptoms: walking in a bent position, chills and fever at the same time, lack of desire to eat, pain in the navel.

If the inflamed appendix is removed in a timely manner, the prognosis for the patient is positive.

Appendicitis is an acute surgical pathology that requires emergency care. From time immemorial, inflammation of the appendix has been one of the the most important problems medicine. The causes of this condition are still not fully understood.

Despite the fact that the process is well known, it has a characteristic clinical symptoms, occurrence severe forms and mortality remains at high level.

According to statistics, young women are most susceptible to this disease, due to the structural features of the body.

Therefore, for them the questions: what is appendicitis, symptoms in women, where is the appendix located, are especially relevant.

It is important that it is the most common surgical pathology in pregnant women. This poses a particular danger to the life of the mother and the unborn baby.

Therefore, signs of appendicitis in women, symptoms that occur when carrying a child, should be noticed in the early stages of development of the inflammatory process.

What is appendicitis

Appendicitis is inflammation of the tissues of the vermiform appendix (appendix).
It is located near the valve that separates the large and small intestines.

In a typical location, the appendix extends from the cecum forward and downward in the right iliac region.
But often the localization may be different. Therefore, if appendicitis occurs, on which side the stomach hurts in women will be determined by its position in the abdominal cavity.
Thus, the appendix may rupture:

Retrocecal - behind the cecum;
Retroperitoneal (retroperitoneal) - behind the peritoneum (the serous membrane covering the walls and organs of the abdominal cavity ();
Pelvic – in the pelvic area, with prolapse of the intestine or a large length of the process;
Medial – closer to the middle of the abdomen;
Subhepatic - in close proximity to the lower surface of the liver;
Left-sided - with the left-sided position of all abdominal organs (a rare congenital anomaly).

The vermiform appendix is a cord in the form of a cylinder, about 1 centimeter in diameter, about 10 centimeters long.

There are variations in length from 2 to 30 centimeters.
It consists of several layers: internal - mucous membrane membrane, submucosal, muscular and serous - outer membrane.

The spread of the inflammatory process relative to the layers determines how it hurts. Symptoms in women will vary depending on the stage of the process.

The vessels through which blood and lymph circulation occurs, as well as nerve fibers, pass in the fold of the peritoneum (mesentery), which is attached to the appendix at the point where it departs from the cecum.

The submucosal layer is rich in lymphatic cells, therefore, according to one medical theory, the appendix is an organ of the immune system, providing local protection at the location.
It is not involved in digestion, although it belongs to the organs of the gastrointestinal tract.

Reasons

Inflammation in the appendix is infectious nature. But the specific causative agent of the disease could not be identified. The pathological process is caused by pyogenic bacteria that are found in the intestines of all people (conditionally pathogenic flora). But in order for it to arise, provoking factors are needed.

Of these, the following are distinguished possible reasons development of the inflammatory process:

Stagnation of feces in the area of the cecum due to constipation;
Blockage of the lumen with “fecal” stone;
Foreign body, caught in the cavity of the appendix (fruit pits, bone fragments, bristles from a toothbrush);
Overgrowth lymphoid tissue submucosal layer;
Torsion and compression of the process (with a long mesentery);
Infringement or blockage (thrombosis) of feeding vessels;
Worm infestation;
Abnormal structure of the appendix (duplication, consisting of several parts);
The predominance of protein products in the diet (provoke rotting processes in the intestines);
Dysbiosis intestinal flora(predominance pathogenic flora over beneficial bacteria);
Inflammatory diseases of the colon and small intestine;
Intestinal infections of various origins;
Adhesive process in the area of the cecum;
Infringement of the process in the inguinal or femoral hernia.

For any reason or a combination of them, the evacuation of the contents of the appendix is disrupted, it stagnates, and when bacterial flora joins, a putrefactive process begins. In this case, damage occurs gradually in all layers of the process.

Clinical manifestations

Due to the anatomical features of the location of the appendix, the clinical picture of inflammation can be very diverse. Only with typical localization will symptoms be characteristic features. The stages of the disease correspond to the degree of tissue damage.

Highlight following forms appendicitis:

Spicy:

Catarrhal - damage only to the mucous layer;
Phlegmonous - the submucosal layer is involved, swelling of the serous membrane, around the application of fibrin, pus accumulates in the lumen;
Gangrenous – the walls of the appendix with areas of necrosis (necrosis);
Perforated - destruction of the walls (destruction) occurs with the release of pus into the peritoneal cavity.

Chronic:

Primary;
Recurrent (with periods of exacerbation).

Complicated:

Peritonitis - inflammation of the peritoneum (local or widespread);
Appendicular - a conglomerate of organs adjacent to the appendix fused together;
Abscesses (collection of pus) of the abdominal cavity different localization;
Cellulitis of the cellular spaces behind the peritoneum;
Pylephlebitis - inflammation portal vein liver.

Its complications can be either a consequence of inflammation of the appendix or occur in the postoperative period.

If there is acute appendicitis Symptoms in adult women usually appear against the background full health.

The following clinical manifestations of the disease are distinguished:

Nonspecific first symptoms of appendicitis (lethargy, dry mouth, nausea, deterioration in general condition);
Vomiting is reflexive in nature and occurs once;
In most cases, stool is not disturbed; if the appendix is localized in the pelvis, it can be liquid;
The pain is constant, initially noted in the epigastric region or “throughout the abdomen”, then moves to the right iliac region (Kocher’s symptom);
Pain may intensify as the disease progresses or decrease (with the death of nerve cells);
When coughing, walking, or changing body position, the pain intensifies;
Low-grade fever (37 - 38°C).

Pain in a typical process is not characterized by irradiation (spread beyond the lesion) to the lumbar, supraclavicular, and groin areas. This requires excluding other diseases or atypical location of the appendix.

Features of the clinic of inflammation of the appendix with an atypical location

With a retrocecal location, the pain may be of low intensity.
The process is usually limited.

Irradiation is noted in lumbar region. Increased pain is detected when lying down, when trying to lift right leg.

When the appendage is localized retroperitoneally, the characteristic signs from the abdomen are erased.

The pain is localized in the lumbar region and intensifies with beating.
Signs of urinary dysfunction appear. rises above 39 °C.

When the appendix is in the pelvis, there is slight pain above the pubis. There is loose stool, the urge to defecate, and difficulty urinating.

With a midline position, the pain is localized around the navel. There is a high fever and flatulence. There is tension in the abdominal muscles in the umbilical region.

If the appendix located in the subhepatic space is damaged, the clinical picture is identical to acute cholecystitis (inflammation of the gallbladder). There is a dull pain in the right hypochondrium.

With left-sided appendicitis, pain is localized on the left. With right side indicates the reverse arrangement of organs.

Empyema of the appendix

This type of inflammation refers to phlegmonous form.
In this case, as a result of blockage of the lumen, a cavity filled with pus appears.

The process expands in the form of a flask. What is characteristic of this form is that serosa is not damaged and inflammation does not spread to the peritoneum.

The clinical picture of empyema shows the absence of Kocher properties.
If your appendix is blocked, the sensations will be slightly different.

The pain is localized immediately in the right iliac region and increases over several days, becoming throbbing.
There may be one or two vomitings. Body temperature gradually increases.

Chronic inflammation of the appendix

Very rarely occurs chronic appendicitis Symptoms in women include intermittent moderate pain in the right iliac region.

The pain may also increase with physical activity, during menstruation or during sexual intercourse. There are no signs of peritoneal irritation.

Arises chronic process in the appendix as a result of regression ( reverse development) inflammation in acute catarrhal appendicitis.
In this case, adhesions are formed between the appendix, the dome of the cecum and the peritoneum.

Diagnostics

Determining damage to the appendix in typical cases does not present any difficulties for an experienced surgeon.

Diagnosis is carried out based on the analysis of data on the development of the disease, as well as the identification of appendicular signs during direct examination:

Soreness and muscle tension localized on the right;

When gently tapping, symmetrically on both sides, pain is detected in the right iliac region (Razdolsky's symptom);
When pulling the patient's shirt and running your hand along it from the epigastric region (epigastric) to the right iliac, while exhaling, it is determined sharp pain on the right (Voskresensky symptom);
Increased pain on the right when turning on the left side (Sitkovsky's symptom);
The appearance of sharp pain on the right when removing the hand from the site of inflammation after pressing (Shchetkin-Blumberg symptom);
Pain when pressing in the right iliac region, when raising the right straightened leg (Obraztsov’s symptom).

Instrumental and laboratory methods diagnostics:

Ultrasound is performed on all women admitted to the clinic. acute abdomen. Fast and affordable, but not always informative method;
Computed tomography carried out subject to technical capabilities and time availability. It is an accurate and non-invasive (non-penetrating) examination;
Diagnostic endoscopic laparoscopy is the “gold standard” in detecting inflammation of the appendix. Three small punctures are made in the abdominal wall (for the gas pump, for the videoscope and the manipulator). The right iliac and other areas of the abdomen are objectively examined. Can be expanded to perform appendectomy (removal of appendix).
Detailed blood test. Detects markers of acute inflammation (increased leukocyte levels, shift in leukocyte formula, increased ESR).

Given atypical appendicitis, symptoms in women where the appendix is located may mask the pathology of other organs located nearby.

Therefore, it is necessary to carry out differential diagnosis with the following diseases:

Ectopic pregnancy. At the same time, there are indications of transferred gynecological diseases, cycle disorders, positive test for pregnancy. The disease occurs acutely, possibly with loss of consciousness, pallor of the skin, and a drop in blood pressure. Sharp pain radiating to right shoulder. At vaginal examination an overhanging painful posterior arch.
Acute inflammation of the uterine appendages (adnexitis). Soreness is determined in the lower abdomen, lower back, and radiates down the leg to the knee. Marked purulent discharge from the vagina. At gynecological examination determined painful ovary.
Torsion ovarian cyst. Pain in the lower abdomen is accompanied by vomiting. There is no Kocher sign. A vaginal examination reveals a soft elastic formation above the pubis.
Food poisoning characterized by uncertainty pain syndrome. Predominance dyspeptic disorders(nausea, vomiting, diarrhea). There is an indication of eating poor quality food.
Right-handed renal colic or pyelonephritis is accompanied by lower back pain radiating to the genitals. Restless behavior and urination problems are noted. Blood, bacteria, and leukocytes are found in urine sediment.
Acute intestinal obstruction characterized by severe cramping pain, flatulence, vomiting, delayed passage of gas and stool. The diagnosis is confirmed by x-ray (in case of obstruction, swollen loops of intestine with fluid levels are determined).
Probodnaya. There is a sharp “dagger” pain in the epigastrium, vomiting blood. There is a “board-like” tension in the abdominal muscles. The patient's face is pale, with a pained expression, covered with sticky cold sweat.
Acute cholecystitis. With it, the pain is localized in the right hypochondrium, is cramping in nature, and radiates to the area right scapula and shoulder. Vomiting mixed with bile is possible.
Acute pancreatitis characterized by diffuse girdling pain in the upper abdomen. Accompanied by indomitable, debilitating vomiting and discoloration of the skin.

Treatment

Treatment of appendicitis is surgical.
It is carried out urgently when the diagnosis is confirmed.

Only if the patient has developed peritonitis, the operation is postponed for a short time to stabilize vital signs and carry out preoperative preparation.

Surgery It is performed under general endotracheal (insertion of a breathing tube into the trachea) anesthesia. Depending on the nature of the inflammation, the operation can be performed through incisions (laparotomy) or punctures (for insertion of endoscopic instruments).

For catarrhal and phlegmonous appendicitis, laparoscopic surgery is possible.
And in case of gangrenous and development of complications, only general access with opening of all layers of the abdominal wall, with possible expansion of access in the presence of massive damage to the abdominal organs.

In the postoperative period, antibacterial and restorative therapy is prescribed.
The dressings are changed regularly, the sutures are treated, and the drains (a means of draining fluid from the abdominal cavity) are changed.

The passage of gases is actively stimulated in order to prevent intestinal paresis due to the action of anesthetic drugs.
Complications may require treatment in the intensive care unit.

The recovery time in each case is individual and depends on age, the presence of concomitant pathology, the stage of inflammation and the timing of treatment. medical care.

With catarrhal and uncomplicated phlegmonous appendicitis, provided that the postoperative period is smooth, recovery occurs in 7-14 days.

Appendicitis in pregnant women

If appendicitis occurs in a pregnant woman, the symptoms of the disease may be masked by the usual manifestations of the period of bearing a child.

Nausea as a manifestation of toxicosis, pain as a reaction to a growing uterus, leukocytosis as a general reaction of the body to pregnancy.

This is associated with late seeking of help and, as a consequence, delayed diagnosis. Therefore, the most common form of appendicitis in pregnant women is phlegmonous.

Inflammation of the appendix occurs in pregnant women more often than in other groups of the population, this is due to the fact that the growing uterus displaces the cecum with the appendix upward, causing it to be pinched, torsion and decreased blood supply.

Which leads to stagnation of feces and the development of pathogenic microflora. Because of hormonal changes there is a decrease in immunity, it contributes to inflammation with the development destructive forms diseases.

Clinical manifestations in the first half of pregnancy are no different from sensations in non-pregnant women.
In the second half, there is some difference in how appendicitis hurts; symptoms in women are associated with displacement of organs by an enlarged uterus.

Pain in pregnant women is mild and localized above the iliac region, depending on the gestational age.
Muscle tension due to their stretching is also not detected.

Body temperature is moderately elevated. You need to carefully palpate the appendix area, placing the woman on her left side.

Appendectomy is performed regardless of the month of pregnancy.
In the early stages, the operation is performed, if possible, laparoscopically.

On later the incision is made higher, in accordance with the location of the displaced appendix.
If the term is full term, an emergency delivery is first carried out, based on the patient’s condition, through the natural birth canal or by means of caesarean section.

At natural childbirth shorten the period of pushing and expulsion of the fetus by applying a vacuum extractor, obstetric forceps, and making an incision in the perineum.

Treatment tactics must be agreed upon with an obstetrician-gynecologist. In the postoperative period, drugs that reduce the tone of the uterus (tocolytics) and hormonal drugs are prescribed to prevent the threat of miscarriage.

Currently, acute and chronic appendicitis is quite common. Symptoms in women may be typical or may differ from the usual clinical picture due to structural features female body.

The issue of inflammation of the appendix in pregnant women is especially relevant, which can cause the death of mother and child.

Therefore, seeking medical help as early as possible, in the initial stages of the disease, will determine the prognosis for life and recovery time.