How does appendicitis progress? How does appendicitis hurt?

Inflammation of appendicitis is a process that affects the appendix. This element belongs to the caecum and is referred to in medicine as the "appendix". vary somewhat, this is determined by the form and individual characteristics of the patient. Allocate chronic and acute inflammation of appendicitis in children and adults. The first option in the last few years is much less common than before. As a rule, the reason is that acute inflammation proceeded with complications, due to which removal was impossible.

acute form

With this type of disease, several stages are distinguished. One stage eventually passes into another, if there was no intervention from the doctors. They talk about:

Catarrhal appendicitis at this stage usually affects only the mucosa of the appendix.
surface form. In this case, progress is observed relative to catarrhal, which leads to damage to the mucous membrane of the organ. By examining the lumen of the process, you can see leukocytes and blood.
Phlegmonous stage. It is characterized by inflammation that affects all layers of the tissues of the body. Destructive processes are affected, including the outer shell of the appendix.
Phlegmonous-ulcerative. This form is characterized by ulceration of the mucosal surface that protects the organ from the outside.
Gangrenous. This stage is characterized by necrosis of the process wall. Often there is a breakthrough of tissues, causing the contents of the appendix to pour into the abdominal cavity, which provokes peritonitis. With the development of appendicitis to this stage, the probability of death is high.

Time does not endure

As a rule, inflammation of the appendix goes through all the steps described earlier in just 48 hours. Acute inflammation of appendicitis is a dangerous disease that does not tolerate delay.

At the first sign, it is urgent to visit a surgeon. If the disease has reached the phlegmonous stage, the risk of complications increases.

Pain as the first signal

Highlighting the signs of inflammation of appendicitis, pain is first mentioned. It appears in the area near the navel. Feels dull, does not go away with time, constant. Sometimes around the middle. Less often, painful sensations cover the abdomen completely. Sometimes the pain is felt on the right in the iliac region.

Strengthening of unpleasant sensations occurs when a person walks, bends over. Pursued by sharp discomfort when coughing and laughing. It hurts a lot to sneeze. But the elderly are characterized by the absence of pain.

Please note that with an atypical location of the appendix, pain may be felt in an unpredictable place. Sometimes it hurts on the right under the ribs, near the pubis or in the region of the kidneys, ureters. Pain may radiate to the hips or lower back. In some cases, it is noted that pain is felt in the external genitalia. An undefined area on the left side of the body may hurt.

A few hours after the initial appearance of the pain syndrome, sensations shift towards the appendix. These signs of inflammation of appendicitis in women are very important: if you suddenly stop feeling pain, there is a high probability that the disease will go into a gangrenous form, which is associated with the death of nerve endings in the affected area. You can’t pull: you need to urgently call a doctor!

Nausea and vomiting is also appendicitis

Particular signs of inflammation of appendicitis in adult men and women are vomiting and nausea accompanying the pain syndrome. Please note: before the onset of pain, such sensations are not observed. If nausea first appeared, and only then the pain came, it is likely that the matter is not in the inflamed appendix, but in another pathology, which the doctor will definitely be able to diagnose.

You should also know that in most cases, vomiting occurs only once. Why is this characteristic inflammation of appendicitis? Symptoms in adults suggest that this is a reflex rejection of toxins by the body.

Language and temperature

The characteristic symptoms of inflammation of appendicitis in women and men include changes in the tongue. At the beginning of the disease, it is usually moist and covered with a thin white coating. As appendicitis progresses, the tongue becomes dry. This shows that inflammation of the peritoneum has begun.

The temperature usually rises insignificantly. How to determine the inflammation of appendicitis, focusing on it? Remember that patients usually have a temperature of 37 to 38 degrees. It remains unchanged for a long time. In rare cases, a rise above 38 degrees is recorded. But if the body temperature has risen even higher, it is safe to say that the inflammatory process is progressing in earnest.

What else to pay attention to?

Characteristic signs of inflammation of appendicitis, suggesting the disease, include stools, although this is more typical for older people. Constipation noted. If the appendix is near loops of the small intestine, diarrhea is more likely. For this reason, cases of erroneous hospitalization of the patient in the infectious diseases departments are not uncommon.

Due to the severe condition of the body, sleep is disturbed. General discomfort greatly affects a person's feeling of his body, pursues a state of fatigue, lethargy, indifference.

Appetite in acute appendicitis usually disappears completely.

Chronic form

Statistics show that this form develops very rarely, no more than one percent of all cases of inflammation of the appendix. Inflammation after appendicitis is manifested by pain on the right in the iliac region. Feelings are dull. Localization of pain is valid for a typically located organ.

How to determine the inflammation of appendicitis if the disease has become chronic? There is only one option: visit a doctor who will conduct a full range of diagnostics. The study usually includes:

laparoscopy;
tomography.

easy to confuse

Chronic appendicitis in its manifestations is close to a number of diseases, including:

pyelonephritis;
ulcer;
chronic form of cholecystitis.

Chronic inflammation of appendicitis can be suspected if you regularly suffer from soreness that increases when a person moves the body (bends, turns). When the disease worsens, the temperature rises slightly, the general manifestations are similar to the acute form.

What is dangerous?

Chronic appendicitis is dangerous primarily because it can cause peritonitis. If a disease is suspected, it is necessary to urgently visit a doctor in order to assess exactly how serious the patient's condition is.

In general, practice shows that it is the timely visit to the doctor that saves people's lives. Having tightened up with an ambulance call, at best, you can “reward” yourself with very unpleasant moments of sharp pain, at worst, a fatal outcome awaits.

That also happens!

One of the most famous cases of treatment of appendicitis in modern medicine occurred at a Soviet station in Antarctica, where a doctor was among the permanent staff. During his stay at the station, due to obvious symptoms, the specialist diagnosed himself with inflammation of appendicitis in an acute form.

At first there were attempts to apply conservative methods of treatment: they resorted to ice, antibiotics and fasting. But this practice did not show results. There were no other doctors at the station at the time. The doctor decided to independently perform the operation on himself and immediately began to do so.

During the operation, the mechanical engineer of the research station held the mirror, a meteorologist was involved - he gave the tools. The doctor operated on himself for almost two hours. The result was successful. Just a week later, the physician was able to perform his regular functions again. An example of this operation is one of the most famous in our world, demonstrating human courage and readiness to fight any difficulties.

And if in ordinary life?

Of course, stories about incidents at the Arctic stations are curious for everyone, but in ordinary life, in everyday life, everything is much simpler. With signs of appendicitis, there is no need to show miracles of courage and become a hero, you just need to get medical help in a timely manner. Who to contact if you suspect appendicitis?

Call an ambulance first. As a rule, by the time a person realizes that he needs the help of a doctor, it is already too late to go to the clinic himself - the pain that accompanies every movement is too strong, and even a slight cough. Turning to the services of emergency medical care, the patient quickly, already in his bed at home, receives a primary diagnosis.

The next stage is the examination of the patient by a therapist in a hospital setting. Here, under the supervision of an anesthesiologist, an accurate diagnosis will be made and it will be determined what the stage of the disease is and what measures need to be taken. In some cases, inflammation of the appendix is accompanied by severe pathologies that develop against the background of the disease of the appendix. Then you will have to involve specialized doctors in the treatment. The most difficult cases of inflammation of the appendix, accompanied by:

recent myocardial infarction;
decompensated diabetes mellitus.

Children are a special case

As a rule, diagnosing inflammation of the appendix in young children is characterized by increased complexity. The child cannot explain clearly and distinctly what exactly hurts him and where. In some cases, inflammation develops at such an early age that the baby does not even know how to speak. How to suspect the disease in this case?

Usually, with the development of the appendix, a small child cries a lot, worries, as if showing his stomach to others. But if adults try to touch, he protests and only cries and screams even louder. The disease develops gradually, the symptoms increase over time.

During the day, a sick child squats down and bursts into crying without any prerequisites. At night, children often wake up from pain. The development of the disease manifests itself as vomiting and nausea. If in adults this is a one-time phenomenon, then in young children it is repeated many times. Doctors say that this is a reflex reaction of the body to toxins, the release of which accompanies the inflammatory process.

Elderly people have their own characteristics

As for older people, their inflammation of appendicitis occurs with a number of characteristic features that complicate the diagnosis of the disease. First of all, it is a weak pain syndrome, which is often absent altogether. Because of this, the definition of appendicitis occurs with a significant delay.

You can suspect something was wrong by the missing appetite and the tension inherent in the muscles on the right, in the iliac region. You can feel it by palpation of a part of the body. However, it is not recommended to examine the body on your own, as you can harm yourself. Also, in the elderly, various atypical manifestations of appendicitis are observed, which science has not yet been able to systematize. Therefore, it is recommended to visit a doctor for any doubtful signs, to undergo an examination and a full range of studies. This will determine whether the appendix has become inflamed, as well as identify comorbidities.

Acute appendicitis- one of the most common acute (requiring emergency surgery) surgical pathologies, which is characterized by inflammation of the appendix - the appendix of the intestine.

Acute appendicitis: numbers and facts:

In developed countries (Europe, North America), acute appendicitis occurs in 7-12 out of 100 people.
From 10% to 30% of patients hospitalized in a surgical hospital for emergency indications are patients suffering from acute appendicitis (takes second place after acute cholecystitis - inflammation of the gallbladder).
Between 60% and 80% of emergency surgeries are performed for acute appendicitis.
In Asia and Africa, the disease is very rare.
3/4 of patients with acute appendicitis are young people under the age of 33 years.
Most often, inflammation of the appendix occurs at the age of 15 - 19 years.
With age, the risk of developing acute appendicitis decreases. After the age of 50, the disease occurs in only 2 out of 100 people.

Features of the structure of the appendix

The human small intestine consists of three parts: the small intestine itself, the jejunum, and the ileum. The ileum is the final section - it passes into the large intestine, connecting with the colon.

The ileum and colon are not connected end-to-end: the small intestine, as it were, flows into the large one from the side. Thus, it turns out that the end of the large intestine is, as it were, blindly closed in the form of a dome. This segment is called the caecum. A worm-shaped process departs from it.

The main features of the anatomy of the appendix:

The diameter of the appendix in an adult is 6 to 8 mm.
The length can be from 1 to 30 cm. On average, 5 - 10 cm.
The appendix is located in relation to the caecum medially and slightly posteriorly. But there may be other location options (see below).
Under the mucous membrane of the appendix is a large accumulation of lymphoid tissue. Its function is to neutralize pathogens. Therefore, the appendix is often called the "abdominal tonsil".
Outside, the appendix is covered with a thin film - the peritoneum. It's like he's hanging on to her. Vessels feeding the appendix pass through it.

Lymphoid tissue appears in the child's appendix from about the 2nd week of life. Theoretically, at this age, the development of appendicitis is already possible. After 30 years, the amount of lymphoid tissue decreases, and after 60 years it is replaced by dense connective tissue. This makes it impossible for the development of inflammation.

How can the appendix be located?

The appendix can be located in the abdomen in different ways. In such cases, acute appendicitis often resembles other diseases, and the doctor has difficulty making a diagnosis.

Variants of incorrect location of the appendix:

Image	Explanation
	Near the cross.
	In the pelvis, next to the rectum, bladder, uterus.
	Behind the rectum.
	Near the liver and gallbladder.
	In front of the stomach - this arrangement of the appendix occurs with malrotation - a malformation when the intestine is underdeveloped and does not occupy a normal position.
	On the left - with the reverse position of the organs (in this case, the heart is on the right, all the organs are, as it were, in a mirror image), or with excessive mobility of the caecum.

Causes of Appendicitis

The causes of acute appendicitis are complex and not yet fully understood. It is believed that the inflammatory process in the appendix is caused by bacteria that live in its lumen. Normally, they do no harm, because the mucous membrane and lymphoid tissue provide reliable protection.

The main symptoms of acute appendicitis:

Symptom	Description
Pain	Pain occurs due to inflammation in the appendix. In the first 2-3 hours, the patient cannot pinpoint exactly where it hurts. Pain sensations are as if spilled over the entire abdomen. They can occur initially around the navel or "under the pit of the stomach." After about 4 hours, the pain shifts to the lower part of the right half of the abdomen: doctors and anatomists call this the right iliac region. Now the patient can tell exactly where it hurts. At first, the pain occurs in the form of attacks, has a stabbing, aching character. Then it becomes constant, pressing, bursting, burning. The intensity of pain increases as inflammation in the appendix increases. It depends on the person's subjective perception of pain. For most people, it is tolerable. When the appendix fills with pus and becomes distended, the pain becomes very severe, jerking, throbbing. The person lies on his side and draws his legs to his stomach. With the necrosis of the wall of the appendix, pain sensations disappear for a while or become weaker, as sensitive nerve endings die. But pus breaks into the abdominal cavity, and after a short improvement, the pain returns with renewed vigor. The pain is not always localized in the iliac region. If the appendix is located incorrectly, then it can shift to the suprapubic region, the left iliac region, under the right or left rib. In such situations, there is a suspicion not of appendicitis, but of diseases of other organs. If the pain is constant and persists for a long time, you should consult a doctor or call an ambulance!
Increased pain	Actions during which pain in acute appendicitis increases: straining; abrupt rise from a prone position; jumping. Increased pain occurs due to the displacement of the appendix.
Nausea and vomiting	Nausea and vomiting occur in almost all patients with acute appendicitis (there are exceptions), usually several hours after the onset of pain. Vomiting 1-2 times. It is caused by a reflex that occurs in response to irritation of the nerve endings in the appendix.
Lack of appetite	A patient with acute appendicitis does not want to eat anything. There are rare exceptions when the appetite is good.
Constipation	Occurs in about half of patients with acute appendicitis. As a result of irritation of the nerve endings of the abdominal cavity, the intestine stops contracting and pushing the feces. In some patients, the appendix is located in such a way that it is in contact with the small intestine. With its inflammation, irritation of the nerve endings, on the contrary, increases intestinal contractions and contributes to the appearance of loose stools.
Tension of the abdominal muscles	If you try to feel the right side of the abdomen from below in a patient with appendicitis, then it will be very dense, sometimes almost like a board. The abdominal muscles tense reflexively, as a result of irritation of the nerve endings in the abdominal cavity.
Violation of general well-being	The condition of most patients is satisfactory. Sometimes there is weakness, lethargy, pallor.
Increase in body temperature	During the day, the body temperature in acute appendicitis rises to 37 - 37.8⁰С. An increase in temperature to 38⁰С and above is noted in the serious condition of the patient, the development of complications.

When should an ambulance be called for acute appendicitis?

Appendicitis is an acute surgical pathology. Eliminate it and avoid a threat to the life of the patient is possible only through an emergency operation. Therefore, at the slightest suspicion of acute appendicitis, you should immediately call the ambulance team. The sooner the doctor examines the patient, the better.

Before the arrival of the doctor, no medicines can be taken. After taking them, the pain will subside, the symptoms of appendicitis will not be so pronounced. This can mislead the doctor: after examining the patient, he will come to the conclusion that there is no acute surgical disease. But the well-being caused by the effects of drugs is temporary: after they stop working, the condition will worsen even more.

Some people, when they begin to worry about constant pain in the abdomen, go to the clinic to see a therapist. If there is a suspicion that the patient has an "acute abdomen", he is sent for a consultation with a surgeon. If he confirms the fears of the therapist, then the patient is taken away by ambulance to the surgical hospital.

How does a surgeon examine a patient with acute appendicitis?

What might the doctor ask?

Where does the stomach hurt (the doctor asks the patient to indicate himself)?
When did the pain appear? What did the patient do, eat before?
Was there nausea or vomiting?
Has the temperature risen? Up to what numbers? When?
When was the last time you had a chair? Was it liquid? Did it have an unusual color or smell?
When did the patient last eat? Do you want to eat now?
What other complaints are there?
Has the patient had his appendix removed in the past? This question seems trivial, but it is important. Appendicitis cannot occur twice: during the operation, the inflamed appendix is always removed. But not all people know about it.

How does the doctor examine the abdomen, and what symptoms does he check for?

First of all, the surgeon lays the patient on the couch and feels the abdomen. Feeling always starts from the left side - where there is no pain, and then moves to the right half. The patient informs the surgeon about his feelings, and the doctor feels muscle tension over the location of the appendix. In order to feel it better, the doctor puts one hand on the right half of the patient's abdomen, and the other on the left, simultaneously palpates them and compares the sensations.

In acute appendicitis, many specific symptoms come to light. The main ones are:

Symptom	Explanation
Increased pain in the position on the left side and decrease - in the position on the right side.	When the patient lies on his left side, the appendix is displaced, and the peritoneum on which it is suspended is stretched.
The doctor slowly presses on the patient's abdomen at the location of the appendix, and then abruptly releases the hand. At this point, there is severe pain.	All organs in the abdomen, including the appendix, are covered with a thin film - the peritoneum. It contains a large number of nerve endings. When the doctor presses on the abdomen, the sheets of the peritoneum are pressed against each other, and when the doctor releases, they sharply unstick. In this case, if there is an inflammatory process, irritation of the nerve endings occurs.
The doctor asks the patient to cough or jump. This intensifies the pain.	During jumping and coughing, the appendix is displaced, and this leads to increased pain.

Is it possible to immediately accurately diagnose?

Over the past century, more than 120 symptoms of acute appendicitis have been described by surgeons. But none of them allows you to accurately diagnose. Each of them only says that there is a focus of inflammation in the abdomen. Theoretically, it is quite simple to make a diagnosis, but at the same time, in practice, in many cases it is very difficult.

Sometimes it happens that the patient is taken to a surgical hospital, he is examined by a doctor, but even after a thorough examination, doubts remain. In such situations, the patient is usually left in the hospital for a day and monitored for his condition. If symptoms worsen and there is no doubt that acute appendicitis is present, surgery is performed.

Observation of a patient with suspected acute appendicitis cannot be carried out at home. He must be in a hospital, where he will be regularly examined by a doctor, and if his condition worsens, he will be immediately sent to the operating room.

Sometimes it happens that there are clear signs of acute appendicitis, and after making an incision, the surgeon discovers a healthy appendix. This happens very rarely. In such a situation, the doctor should carefully examine the intestines and abdominal cavity - perhaps another surgical disease has “disguised” itself under acute appendicitis.

Gynecological pathologies : inflammation and ulcers of the fallopian tubes and ovaries, ectopic pregnancy, torsion of the legs of the tumor or cysts, ovarian apoplexy.
Renal colic on the right .
Acute inflammation of the pancreas .
Acute inflammation of the gallbladder, biliary colic .
An ulcer in the stomach or duodenum that goes right through the wall of the organ .
intestinal colic is a condition that often mimics acute appendicitis in children.

In order to understand the cause of abdominal pain and take the necessary actions in a timely manner, the patient must be examined by a doctor. And, first of all, the patient must be shown to the surgeon!

Analyzes and studies in acute appendicitis

Study	Description	How is it carried out?
General blood analysis	The changes detected in the patient's blood, together with other signs, confirm the diagnosis of acute appendicitis. An increased content of leukocytes is revealed - a sign of the inflammatory process.	Blood is taken immediately after admission to the surgical hospital.
General urine analysis	If the appendix is located near the bladder, then erythrocytes (red blood cells) are detected in the urine.	Urine is collected immediately after the patient enters the hospital.
X-ray of the abdomen	The study is carried out according to indications. During an x-ray, the doctor can see on the screen: Specific signs of acute appendicitis. Fecal stone that clogs the lumen of the appendix. Air in the stomach- a sign that there is a destruction of the wall of the appendix.	Radioscopy is performed in real time: the doctor receives an image on a special monitor. He can take pictures if necessary.
Ultrasound procedure	Ultrasound waves are safe for the body, so ultrasound is the preferred method for suspected appendicitis in pregnant women, young children, and the elderly. In the presence of inflammation in the appendix, its increase, thickening of the walls, and change in shape are detected. With the help of ultrasound, acute appendicitis is detected in 90-95% of patients. Accuracy depends on the skill and experience of the doctor.	It is carried out in the same way as a conventional ultrasound. The doctor lays the patient on the couch, applies a special gel to the skin and places a sensor on it.
CT scan	The study is carried out according to indications. This method is more accurate than radiography. During computed tomography, appendicitis can be detected, distinguished from other diseases. CT is indicated for acute appendicitis, accompanied by complications, if there is a suspicion of a tumor or abscess in the abdomen.	The patient is placed in a special apparatus, a CT scanner, and pictures are taken.

Laparoscopy for appendicitis

What is laparoscopy?

Laparoscopy is an endoscopic technique that is used for the diagnosis and surgical treatment of diseases. The surgeon inserts special equipment with a miniature video camera into the patient's abdomen through a puncture. This makes it possible to directly examine the affected organ, in this case, the appendix.

What are the indications for laparoscopy in acute appendicitis?

If the doctor observes the patient for a long time, but still cannot understand whether he has acute appendicitis or not.
If the symptoms of acute appendicitis occur in a woman and strongly resemble a gynecological disease. As statistics show, in women, every 5th to 10th operation for suspected appendicitis is performed erroneously. Therefore, if the doctor is in doubt, it is much more advisable to resort to laparoscopy.
If symptoms are present in a patient with diabetes mellitus. Such patients cannot be observed for a long time - they have impaired blood circulation, reduced immune defense, so complications develop very quickly.
If acute appendicitis is diagnosed in an overweight patient with well-developed subcutaneous fat. In this case, if laparoscopy were to be abandoned, a large incision would have to be made, which takes a long time to heal, and can be complicated by infection and suppuration.
If the diagnosis is not in doubt, and the patient himself asks to perform the operation laparoscopically. The surgeon may agree if there are no contraindications.

What will the doctor see during a laparoscopy?

During laparoscopy, the surgeon sees an enlarged, edematous appendix. It has a bright red color. A network of dilated vessels is visible around it. Also on the surface of the appendix, pustules can be seen. If the appendix began to collapse, then the doctor sees spots of a dirty gray color on it.

How is laparoscopy performed for acute appendicitis?

Laparoscopy is a surgical procedure. It is carried out in the operating room, under sterile conditions, under general anesthesia. The surgeon makes one puncture in the wall of the abdomen in order to insert an instrument with a video camera into it, and the required number (usually 3) in order to insert surgical endoscopic instruments. After the intervention is completed, stitches are applied to the puncture sites.

Is it possible to immediately operate on acute appendicitis during diagnostic laparoscopy?

Laparoscopic removal of the appendix is possible in approximately 70% of patients. The rest have to go to the cut.

Treatment of acute appendicitis

Surgical treatment of acute appendicitis

Immediately after the patient is diagnosed with acute appendicitis, surgical treatment is necessary. A favorable outcome depends on the amount of time that has passed since the onset of the first symptoms before the operation. It is believed that, ideally, surgery should be performed within 1 hour of diagnosis.

Surgery for acute appendicitis is called appendectomy. During it, the doctor removes the appendix - there is no other way to get rid of the focus of inflammation.

Types of surgery for acute appendicitis:

Open intervention through the incision. It is performed most often, since it is simpler and faster, it does not require special equipment.
Laparoscopic appendectomy. It is performed according to special indications (see above). It can only be performed if the clinic has endoscopic equipment and trained specialists.

The operation is always performed under general anesthesia. Sometimes, in exceptional cases, local anesthesia may be used (adults only).

Medical treatment for acute appendicitis

With the help of drugs, acute appendicitis cannot be cured. Before the arrival of the doctor, you should not take any medications on your own, as this will reduce the symptoms and the diagnosis will be incorrect.
Medical therapy is used only as an adjunct to surgical treatment.

Patients are prescribed antibiotics before and after surgery.:

In the second half of pregnancy, it can be difficult for a woman to feel her stomach. An enlarged uterus pushes the appendix upward, so pain occurs above its normal location, sometimes just below the right rib.

A reliable and safe method for diagnosing appendicitis in a pregnant woman is ultrasound.
The only treatment is surgery. Otherwise, both the mother and the fetus may die. During pregnancy, laparoscopic surgery is often performed.

Acute appendicitis in a child

In children older than 3 years, acute appendicitis proceeds almost the same as in an adult. The main symptoms are abdominal pain, nausea, and vomiting.

Features of acute appendicitis in children under 3 years of age:

It is impossible to understand if the child's stomach hurts, and if it hurts, then in what place. Little kids can't explain it.
Even if the child can point to the location of the pain, he usually points to the area around the navel. This is due to the fact that the appendix at an early age is not quite the same as in adults.
The child becomes lethargic, capricious, often cries, kicks his legs.
Sleep is disturbed. Usually the child becomes restless in the late afternoon, does not sleep and cries all night. This makes parents call an ambulance in the morning.
Vomiting occurs 3-6 times a day.
Body temperature often rises to 38 - 39⁰С.

It is very difficult to make a diagnosis. Doctors often have doubts, the child is left for a day in the hospital and observed in dynamics.

Prevention of acute appendicitis

Proper nutrition. The diet should contain a sufficient amount of dietary fiber (vegetables and fruits), dairy products.
Timely treatment of any infections and inflammatory diseases.
Fight against constipation.

There is no special prophylaxis that could 100% prevent acute appendicitis.

12.12.2019

Women are more likely to experience appendicitis than men. Signs of gynecological diseases are similar to the symptoms of appendicitis in women, it is important for everyone to know how to determine the source of pain at home. Diagnosis can be difficult due to the proximity of the reproductive organs to the appendix.

The incidence of appendicitis in women

Appendicitis is an inflammation of the appendix. The appendix is a small, worm-shaped appendix of the caecum. The disease is eliminated by surgical intervention.

In women, appendicitis often develops between the ages of 20 and 40. One of the triggers is pregnancy. As a result of the growth of the fetus, the organs are displaced. This causes inflammation of the appendix.

Causes of the disease

Appendicitis can occur at absolutely any age. But more often it is faced by young women. The causes of the disease are as follows:

violation of the blood flow of the process or its displacement;
inflammatory process in adjacent organs;
intestinal infection;
an excess of serotonin;
blockage of the organ with small objects (seeds, bones, etc.);
clogging of the lumen with feces.

In women, appendicitis often occurs with gynecological diseases. One of the most common causes of the disease is the inflammatory process in the pelvic organs. No less influence on the state of the appendix has a diet, lifestyle and the presence of stress. The development of the disease occurs in stages:

The initial stage of inflammation is called catarrhal.
The next stage is characterized by the formation of purulent ulcers.
The phlegmonous stage is characterized by an increase in the appendix and its filling with pus.
At the last stage, the appendix is ruptured.

How to identify signs

The main symptom of appendicitis is abdominal pain. It intensifies during laughter or movement. In some cases, discomfort is given to the right leg. At the initial stages, it is difficult to understand the symptoms of appendicitis in women, how to determine their manifestation at home, you need to learn in advance. Inflammation develops rapidly, so it is important to consult a doctor in time. There are some signs that you should pay attention to. At the initial stage, the pain is aching in nature. It is able to radiate to any area of the peritoneum. It can easily be mistaken for signs of cholecystitis, gastritis or gynecological diseases. A little later, the clinical picture becomes more pronounced.

External

The external signs of appendicitis include subfebrile temperature. It is characterized by fluctuations in body temperature in the range from 37.1 to 38 degrees. Deterioration of well-being is accompanied by vomiting, which does not bring significant relief. In pregnant women, there is a petrification of the abdomen and shortness of breath. The skin becomes pale, the tongue is covered with a yellowish coating.

Internal

With the inflammatory process of the appendix, appetite may disappear. Difficulties with urination and stool disturbance are possible. The most common is diarrhea. Clinical symptoms depend on the location of the process. When he is behind the caecum, the pain is muffled. Localization of the appendix in the pelvis leads to atypical pain.

Internal signs of appendicitis are determined by palpation. The right iliac region and the umbilical ring are examined. With slight palpation, the tone of the anterior wall of the peritoneum increases. With a deep breath, an increase in pain is felt.

Pain localization

When alarming signals occur, it is necessary to pay attention to the local location of painful sensations. The appendix is located on the right side, so the greatest concentration of sensations is noted there. Pain is noted in the area from the navel to the lower abdomen, where the ovaries are located in women.

A few hours after the onset of the first symptoms, unpleasant sensations capture other organs. There is discomfort in the epigastric region, aching pain in the lower back develops, discomfort increases when walking.

Features of the flow

The danger of appendicitis is the possibility of death. In the absence of timely assistance, peritonitis develops. The inflammatory process can be sluggish. In this case, the pain is not very pronounced, but the following symptoms periodically appear:

vomit;
pain during bowel movements;
discomfort during sexual intercourse;
decrease in working capacity;
discomfort in the abdomen after eating, during laughter or hiccups.

Diagnosis at home

The final diagnosis is made by specialists. You don't need to take any action on your own. If you suspect appendicitis, you can not drink water and carry out active movements. This will prevent premature rupture of the appendix. It is advisable to wait for an ambulance, taking a horizontal position. At temperatures below 38 degrees, the use of antipyretic drugs is not required.

You can distinguish appendicitis from other diseases at home. The main thing is to do all the manipulations carefully. Initially, the symptoms of appendicitis in women are evaluated, how to determine the focus of pain at home is no less important. You need to press your fingers into a place on two fingers to the right of the navel and sharply release them. The pain at this point will be more intense.

In the hospital

After admission to the hospital, a diagnostic study is carried out. It includes the following steps:

examination by a surgeon;
visit to the gynecologist;
blood donation;
Ultrasound monitoring.

The gynecologist conducts an examination for the presence of gynecological diseases. If they are not there, the woman is referred to a surgeon. He will palpate the abdomen and ask questions about the stool and the last meal. Donating blood helps to determine the level of leukocytes and ESR. An increase in indicators indicates an inflammatory process. An ultrasound examination is prescribed if doctors have doubts about the diagnosis.

Who prescribes the operation?

The decision to perform a surgical operation to eliminate appendicitis is made by the surgeon. He analyzes the condition of the woman, studies the tests and the conclusion of the gynecologist. Based on these data, the type of surgical intervention is selected.

Appendectomy

The operation to remove appendicitis is performed by classical appendectomy or by laparoscopy. Appendectomy is a classic abdominal operation. Laparoscopy is an operation that does not require abdominal incisions on the skin. It is less traumatic, but has a number of significant contraindications. Classical appendectomy is performed much more frequently.

General anesthesia is given before the operation. Then access to the affected organ is provided. In the case of laparoscopy, small punctures are made on the skin. The process is completely removed, after which the abdominal cavity is drained. The final step involves suturing the puncture or incision sites.

Postoperative period

After the operation, the doctor prescribes antibiotic therapy. Medicines and the scheme of their reception are selected individually. If there is a predisposition to thromboembolism, anticoagulants are prescribed.

A scar up to 10 cm in size is formed at the site of the operation. It heals for about six months. Immediately after the operation, it has a burgundy hue, and over time it turns white. For its resorption, specialized ointments and creams are prescribed. Compliance with the recommendations of the doctor ensures a quick recovery. With proper care, the likelihood of wound suppuration is significantly reduced.

Diagnosis is simplified by the specific symptoms of appendicitis in women, how to determine the disease at home, it becomes clear after studying physiology. The main difference lies in the localization and nature of painful sensations. But the final diagnosis can only be made by a specialist.

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

Symptoms of the disease are associated with inflammation of the process (appendix) of the cecum

How does appendicitis develop?

The causes of appendicitis are still not fully understood. There are several theories for the development of the disease. There is no consensus on the leading etiological factor in the scientific community.

Possible causes of inflammation of the appendix:

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

In the early stages of appendicitis, there is swelling of the mucous and submucosal membrane of the appendix, impaired outflow of contents into the cecum, deterioration of microcirculation through 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:

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

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

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

Pain with appendicitis

Discomfort and pain in appendicitis in the early stages is felt in the epigastrium or in the central part of the abdomen. A few hours later, in the classic case, with a typical localization of the appendix, discomfort migrates 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, the right or left hypochondrium, to the umbilical region.

With a close location of the appendix to the ureters or internal genital organs, frequent urination, irradiation of uncomfortable sensations to the groin area are included.

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

Important: In case of acute pain in the abdomen, you should not take painkillers until you see a doctor.

Disorders of the digestive tract

Nausea, vomiting and loose stools occur with appendicitis reflexively. They appear a second time after the onset of acute pain.

In acute appendicitis, loss of appetite occurs several hours before abdominal discomfort appears. Patients refuse to take water.

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

The frequency of occurrence of symptoms of disorders of the digestive tract:

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

Fever

How does the general reaction of the body to appendicitis manifest itself? Patients have a fever (subfibrillation) from the first hours. An increase in body temperature is a manifestation of the immune system. In the early stages of inflammation of the appendix, the fever does not exceed 37.5-38 degrees Celsius.

Important: If acute pain in the abdomen is combined with fever, seek medical help immediately.

Early signs of appendicitis in children

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

Small children are less able to tolerate discomfort and can hardly describe how they feel. The development of acute pain is indicated by the forced position of the child's body (tight legs), increased crying in the hands of adults.

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

Checking for symptoms of peritoneal irritation in a child

Symptoms of the disease in men and women

Features of appendicitis in representatives of different sexes are associated with the location of internal organs in the pelvis, the likelihood of pregnancy or ovarian apoplexy in women.

Inflammation of the appendix occurs in men 2 times less often. It is likely that the appendix is involved in the pathological process with oophoritis, salpingitis, endometritis, colpitis.

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

Women usually get 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 fetal egg, spontaneous abortion or ovulation that has begun. To exclude problems of the reproductive system, it is necessary to undergo ultrasound imaging of the pelvic organs. The diagnosis of appendicitis is established after examination by a gynecologist.

Unfortunately, inflammation of the appendix is often found in pregnant women. Surgical intervention for this reason is the most common abdominal operation in expectant mothers. The first signs of appendicitis in pregnant women are subtle. Erased clinical picture often leads to late diagnosis of the disease. In addition, the difficulties in detecting appendicitis are associated with a change in the position of the appendix in pregnant women. After 20 weeks, the characteristic sharp pain is usually fixed in the right hypochondrium, and not in the iliac region. To detect inflammation of the appendix in expectant mothers, the symptoms of Michelson and Taranenko are checked.

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

Man appendicitis pain

At birth, every person has a process of the caecum - the appendix. This body is still a mystery to physicians. In the last century, it was customary to remove it “in advance” to prevent acute and less often chronic appendicitis, now doctors are calling for this practice to be abandoned for a number of many reasons. Inflammation of the appendix is a serious disease that is almost always treated with surgery. The chronic form is much less common. Any person needs to know where appendicitis is located, early signs of the disease.

What is appendicitis

The appendix of the rectum is present from birth in the body. Inflammation of this organ in many situations occurs spontaneously, without any obvious prerequisites, develops in the form of an acute disease. Appendicitis in women is often confused with gynecological diseases - acute inflammation of the ovary, ectopic pregnancy, so fast and adequate diagnosis is important.

The patient's condition after a few hours becomes critical and life-threatening. For this reason, since the invention of antibiotics in the thirties and forties of the last century and until the end of the century, doctors almost insisted: to remove preventively (measures taken before the onset of an unfavorable event) the appendix.

But now this medical opinion is considered obsolete. Despite the fact that appendicitis is still a serious and life-threatening condition, gastroenterologists do not recommend removing an uninflamed intestinal process. This is due to the fact that the organ has long been considered a rudiment, inherited from the ancestors of cavemen, but a person does not have “extra” organs.

The appendix is needed as:

Utilization of a part of substances "in reserve".
Symbiotic bacteria live in the appendix.
With the help of the appendix, the body is restored if the main colonies die.

Thus, the appendix serves as a protection against dysbacteriosis - a fairly common diagnosis in the modern world. However, surgery is still considered the only acceptable treatment option for acute appendicitis, a condition where inflammation of the appendix of the caecum occurs. In rare cases, a sluggish form of the disease is noted - the so-called chronic appendicitis, unlike acute, it is not an indication for immediate abdominal surgery.

Where is appendicitis

The location of the appendix to a person without medical education is difficult to determine. This is due to the fact that the intestine, in contrast to the “fixed” organs in their places - the heart, lungs, liver, is plastic, the loops can move inside the abdominal cavity.

The exact localization is influenced by such factors:

age;
growth;
physique - in thin people, the loops are distributed more freely, in full ones they lie “closer”;
individual characteristics.

The intestines are compactly distributed within the body. The fuller the person, the closer the loops lie to each other, respectively, the appendix will be higher. Also, this factor is affected by height - in children, short people have less physical space in the abdominal cavity and gender. Women also have a more “dense” anatomy of the intestinal loops, since there must be room in the abdominal cavity for the ovaries, uterus and other gynecological organs. Accordingly, in men, the loops lie somewhat more freely.

However, since the signs of appendicitis are quite characteristic, it is possible to independently determine the localization of the process of the caecum. Normally, this organ is not felt in any way, a person simply does not “know” about its existence. The need to know which side appendicitis is on is associated with a timely visit to a doctor; a person’s life may depend on preliminary self-diagnosis.

When pain occurs, the appendix is “looking for” like this:

Vertically - determine the localization on the right. This is the place on which side appendicitis is found most often.
Mentally divide the abdominal cavity into two horizontal parts. Place your hand below the navel on the right.
This is the approximate location of the process of the caecum, which provoke the disease known as appendicitis.

It must be understood that the size of the mesentery, the amount of visceral (internal) fat, and other factors significantly affect the displacement of the appendix. On the other hand, with inflammation, pain is not localized at one point, it can be significantly shifted. Therefore, any abdominal pain in a person who has not been operated on for acute appendicitis is always suspicious of this disease in the first place. Qualified diagnostics helps to accurately diagnose, but the symptoms.

The reasons

Inflammation of the appendix of the caecum occurs spontaneously. At the moment, no unambiguous cause is known that provokes an acute condition. The disease has been known to mankind for thousands of years, the first operations to remove the appendix, according to historians, were carried out back in the Stone Age. In ancient times, they became commonplace, although they were still life-threatening due to the lack of normal medicines known in our time.

Among the possible provoking factors, various gastroenterologists and surgeons mention the following:

infectious factor. This theory remains dominant in medical circles. It is associated with the pathological development of opportunistic microflora, its predominance over the beneficial one. Normally, “good” bacteria kill the “enemies” of the intestine, and the appendix is especially rich in symbiotic microorganisms. If this balance is disturbed, the pathological process starts.
Blockage of the gatekeeper. The blind process is separated from the rest of the intestine by the pylorus, although much less dense than the one that separates the stomach and the beginning of the loops. Thanks to the "gatekeeper", the bacteria can freely pass as needed. If this access is blocked, on the one hand, the death of useful ones begins, on the other hand, the uncontrolled reproduction of malicious ones begins.
Lack of food. Symbionts that live in the appendix exist at the expense of the resources of the human body. They are fed regularly, and the waste products travel further down the intestines to be eliminated from the body along with other toxins. Lack of food also causes mass death of symbionts.
Stagnation of blood in the vessels of the appendix. The blood stops circulating, resulting in tissue necrosis.

However, in the vast majority of cases, the causes remain unknown, and the disease is idiopathic - that is, it occurs “by itself”. An emergency cannot be missed, it is characterized by vivid symptoms that will surely attract the attention of the patient. Prevention comes down to maintaining proper bowel function, a reasonable no-frills diet, and timely treatment of internal infections.

Symptoms

All diseases of the stomach, intestines, liver and other internal organs can give similar symptoms. However, the signs of appendicitis are still quite characteristic, especially since from this point of view the disease has been studied very well. It is possible to determine the development of the pathological process in the appendix of the caecum starting from early signs.

You should carefully consider the following:

Strong pain. Do not forget that localization is not fundamental - appendicitis tends to "capture" the entire abdominal cavity, irradiate to other areas. Determining where the appendix is located is only optional.
The pain increases constantly and increases significantly with movement. The entire lower back, back, and sternum may be involved. For some, the pain radiates to the legs.
Symptom Sitkovsky - a popular diagnostic technique, is that with appendicitis, pain increases if you lie on your left side.
Mendel's symptom is another characteristic diagnostic criterion. If you press in the iliac region on the right, where the process is located, and then abruptly release, there is a strong attack of pain.
Nausea, diarrhea joins. It can be single, stools have a normal or yellowish appearance.
Frequent urination due to abdominal pain. The same symptom is characteristic of gynecological inflammation in women, so qualified diagnosis is needed.
Body temperature rises to 38-39 degrees.
The tongue is covered with a yellowish coating, a person has a putrid smell from the mouth.

Even one of these symptoms is a reason to immediately call an ambulance. In the early stages of inflammation, removal of the rectal process is a simple abdominal operation that almost never causes complications. On the other hand, if you hope for "it will pass by itself", then the pathological process develops. Within a few hours, the necrotic tissues can burst, which will cause a huge amount of pathogenic bacteria to enter the abdominal cavity. Peritonitis develops, which still often leads to death.

A rare type of disease is chronic appendicitis. It implies that the inflammation of the appendix is non-purulent, there is no obstruction, only partial dysfunctions of the functioning of this organ are observed. Doctors of the "old school" prefer to remove such appendixes - according to the principle, "there is no dangerous organ - there is no risk to the patient's life." However, modern doctors may recommend conservative treatment.

Treatment

The only possible treatment for the acute form of the disease is appendectomy, that is, the complete removal of the appendix. Despite the proven useful functions, the absence of this organ practically does not affect the quality of human life, does not force adherence to lifelong diets.

About the operation you need to know that:

the sooner the diagnosis is made and the patient is on the operating table, the better;
purulent and necrotic appendicitis is more dangerous than uncomplicated;
every hour of delay is fraught with peritonitis, since the process can break at any moment;
during the day after the operation it is forbidden to eat and drink;
The patient is kept in the hospital for about a week.

Modern methods of removal have made the operation as simple and non-traumatic as possible. It is carried out in mild cases under local anesthesia, general anesthesia is necessary only in severe forms, especially if there are adhesions or peritonitis has already begun to develop. The patient receives antibiotic therapy for 7-10 days after surgery, depending on the doctor's prescription.

For the vast majority of patients, the removal of the appendix becomes a brief episode in life, which people quickly forget about. The main principle at the slightest suspicion of inflammation of the appendix is to immediately call an ambulance, since the diagnosis is also quite simple for professionals.