Acute appendicitis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms of acute appendicitis
- Features of the course of acute appendicitis in children
- Diagnostics of the acute appendicitis
- Treatment of acute appendicitis
- Possible complications of acute appendicitis and consequences
- Forecast
- Prevention
Acute appendicitis is an acute inflammation of the appendix (appendix) of the cecum, which is one of the most common surgical pathologies of the abdominal cavity, accounting for about 90%. Acute appendicitis can occur in patients of all age groups. Most often, the disease is diagnosed at the age of 20-40, while women are more susceptible to it.
The appendix is an appendage of the cecum and is a tubular, blind-ended formation. It is located in the right iliac region (sometimes behind the cecum, can reach the liver), its length is usually 5-15 cm. The appendix has its own mesentery, which holds it and provides relative mobility.
Acute inflammation of the appendix
Causes and risk factors
The exact causes of acute appendicitis have not been conclusively established. The main route of infection is enterogenic (the ingress of an infectious agent occurs through the lumen of the appendix).
Factors presumably capable of causing the development of acute inflammation of the appendix include:
- infectious diseases (amebiasis, yersiniosis, typhoid fever, intestinal tuberculosis, etc.);
- activation of intestinal microflora against the background of congenital anomalies of development or blockage of its lumen (foreign bodies, fecal stones, parasites, neoplasms, etc.);
- the presence in the appendix of cells of a diffuse endocrine system that produce inflammatory mediators;
- diseases, the component of which is inflammation of the walls of blood vessels;
- poor nutrition;
- violation of the intestinal innervation;
- immunological disorders, including allergies;
- intestinal dysbiosis;
- bad habits;
- abdominal trauma.
The risk of developing acute appendicitis is increased in pregnant women due to the enlargement of the uterus, which leads to a displacement of the appendix and cecum. In addition, changes in the blood supply to the pelvic organs, constipation, and restructuring of the endocrine and immune systems contribute to the development of the pathological process during pregnancy.
Forms of the disease
According to the clinical and morphological classification according to V. I. Kolesov, the following forms of acute appendicitis are distinguished:
- simple (catarrhal, superficial);
- destructive (phlegmonous, perforated, gangrenous);
- complicated (with appendicular infiltrate, with appendicular abscess, with diffuse peritonitis, with other complications).
Stages of acute appendicitis
Symptoms of acute appendicitis
The onset of the disease is sudden. In some cases, before the appearance of the first clinical manifestations, general health worsens, appetite decreases, weakness, and rapid fatigue appear.
The most characteristic early symptom of acute appendicitis is abdominal pain, which is initially localized near the navel or epigastric region and then moves to the right iliac region. However, appendicitis can also occur atypically: in some cases, abdominal pain manifests itself in other places (when the appendix is located behind the cecum, pain occurs in the lumbar region, in the case of the subhepatic position of the appendix - in the right hypochondrium, with the pelvic position - in the suprapubic region.), or has no specific localization at all. The intensity of painful sensations rapidly increases, their nature can be different (sharp, stabbing, dull), the pain can be constant or intermittent. Most often it radiates to the lower back, groin area,however, the area of irradiation may vary depending on the location of the appendix. The painful sensations increase with coughing, sneezing, sudden movements. With a rupture of the walls of the appendix, the pain subsides, but after a few hours it increases sharply and does not stop, this is a formidable sign indicating the possible development of peritonitis.
Possible localization sites for pain in acute appendicitis
In addition to abdominal pain, dyspeptic disorders are characteristic of acute appendicitis: nausea, vomiting with an admixture of bile, which does not bring relief (usually a single one), flatulence, and defecation disorders.
As the pathological process develops, the pain becomes constant, signs of general intoxication join and grow. Tachycardia appears, urination disorders, body temperature rises (in severe cases, the body temperature of patients can drop sharply to critical values). The dark color of the stool may indicate gastric or intestinal bleeding.
In some patients, especially in pregnant women, the elderly, people with atypical localization of the appendix, an atypical course of acute appendicitis is often observed, as well as erased forms of the disease.
Features of the course of acute appendicitis in children
Acute appendicitis in children under two years of age develops relatively rarely due to the anatomical features of the appendix at this age, as well as nutritional characteristics. In children, the appendix is often infected by the hematogenous and lymphogenous pathways, since in many cases there is a connection between the development of the inflammatory process in the appendix and acute respiratory viral infections, sinusitis, otitis media, measles and other infectious diseases.
The clinical manifestations of acute appendicitis in children vary depending on the child's age, localization of the appendix and a number of other factors, but in general, children are characterized by a rapid development of the inflammatory process. Young children are usually dominated by nonspecific symptoms that can be observed in many other diseases - fever up to febrile numbers, refusal to eat, lethargy, anxiety, crying. Delayed bowel movements, vomiting are often observed. Repeated vomiting can lead to dehydration. When the appendix is in the pelvic position, children urinate more often. Young children pull their legs up to their belly and resist examination.
In children, acute appendicitis may be accompanied by fever and repeated vomiting.
Differential diagnosis of acute appendicitis with childhood infections, coprostasis, pathologies of the gastrointestinal tract and urinary system is required. Thorough examination of the skin and throat in children with suspected acute appendicitis eliminates hemorrhagic vasculitis, rheumatism, influenza, measles, scarlet fever.
Diagnostics of the acute appendicitis
When collecting anamnesis, it is important to know about past or existing diseases that can mimic the symptoms of acute appendicitis.
The diagnosis is usually made with a physical examination. In acute appendicitis, a number of abdominal symptoms are noted:
- Ivanov's symptom - the distance between the right upper front spine and the navel is less than between the left upper front spine and the navel (the reason is muscle contraction on the right);
- Sitkovsky's symptom - in the position of the patient on the left side, pain in the right iliac region increases;
- Razdolsky's symptom - soreness with percussion in the right iliac region;
- Widner's symptom - the temperature readings in the right armpit are higher than those obtained in the left armpit;
- Dolinov's symptom - when the abdomen is drawn in, the pain in the right iliac region increases; and etc.
Ultrasound makes it possible to detect the presence of free fluid, the absence of peristalsis, blockage of the lumen of the appendix, its expansion, as well as signs of peritonitis. Young children may additionally require anterior abdominal wall electromyography.
Ultrasound is one of the stages in the diagnosis of acute appendicitis
In case of insufficient information content, they resort to X-ray of the abdominal cavity, magnetic resonance imaging.
In the general analysis of the blood of patients with acute appendicitis, nonspecific inflammatory changes are revealed.
In diagnostically difficult cases, they resort to diagnostic laparoscopy, which, upon confirmation of acute inflammation in the appendix, is transferred to a therapeutic one (i.e., when a diagnosis is made, an appendectomy is performed during the same procedure). Determination of the etiological factor that caused the disease is possible when conducting a histological diagnosis of the removed appendix.
Differential diagnosis of acute appendicitis is carried out with diseases such as gastritis, gastric ulcer and duodenal ulcer, pancreatitis, acute cholecystitis, cholelithiasis, acute cystitis, renal colic, acute epididymitis orchitis, neoplasms, ectopic pregnancy and others. For differential diagnosis, vaginal and / or rectal examination may be necessary. It is possible to exclude neoplasms of the cecum through colonoscopy. In pregnant women, acute appendicitis must be differentiated from spontaneous abortion, as well as from premature birth.
Treatment of acute appendicitis
When symptoms of acute appendicitis appear at the stage of prehospital care, the patient is shown bed rest, applying an ice pack on his stomach, and refusing to eat. It is categorically contraindicated to apply a heating pad to the abdomen, as this can lead to the development of complications of acute appendicitis. Seek medical attention even if the acute pain subsides spontaneously. Before a diagnosis is made, the patient should not take pain relievers, antispasmodics, or any other medication, as this can complicate the diagnosis of the disease.
After the diagnosis of acute appendicitis is made, an urgent surgical intervention is performed - appendectomy (removal of the appendix). Surgical treatment of acute appendicitis can be performed by an open (laparotomy) or closed (laparoscopy) method. In an uncomplicated course of the disease, the method of laparoscopic appendectomy is usually used. A laparoscope is inserted through a small hole in the abdominal wall, to ensure the operative space, the abdominal cavity is filled with carbon dioxide (pneumoperitoneum), after which the appendix is removed under visual control (the laparoscope is equipped with a cold light source and a microcamera that transmits a scaled image of the operative field to the monitor in the operating room). This method allows you to avoid unnecessary trauma and blood loss,The advantages of laparoscopic appendectomy also include a shorter postoperative period and a good cosmetic effect.
In acute appendicitis, surgery is indicated - appendectomy
In case of development of complications of general appendicitis, in particular, diffuse peritonitis, laparotomy is performed with a thorough revision of the abdominal organs. In this case, access to the appendix is usually used according to Volkovich-Dyakonov (an incision in the right iliac fossa is made parallel to the inguinal ligament).
With catarrhal acute appendicitis, antibiotic therapy is not required. Antibacterial drugs are usually prescribed in the presence of an inflammatory effusion in the small pelvis, as well as in the phlegmonous form of the disease. When the course of acute appendicitis is complicated by diffuse peritonitis, antibiotics are used at the stage of preoperative preparation and in the postoperative period.
Possible complications of acute appendicitis and consequences
Possible complications of acute appendicitis can be local or diffuse peritonitis, appendicular infiltrate, abscesses of the abdominal cavity, phlegmon of the retroperitoneal space, thrombophlebitis of the pelvic veins, sepsis, intestinal obstruction. All of these conditions are potentially life threatening.
Forecast
With timely treatment of the patient for medical care, timely and adequate treatment, the prognosis is favorable. It gets worse if complications develop. Postoperative complications develop in 5–10% of patients with acute appendicitis, mortality is 0.1–0.3%.
Prevention
There is no specific prevention of acute appendicitis.
In order to prevent the onset of the disease, it is recommended:
- rational balanced nutrition;
- rejection of bad habits;
- strengthening the body's defenses.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
