The appendix, or vermiform appendix, is an unpaired organ located in the abdominal cavity, which has a tubular shape, ranging in size from 2 to 17 cm or more, with its base flowing into the dome of the cecum. The appendix has the same layers as the cecum: serous, muscular, submucosal, mucous. In one of them there are lymphoid follicles (specific tissue that is similar in function to the tonsils in the throat), which play a huge role in the formation inflammatory changes appendix walls.
The blood supply to the appendix is carried out by an artery that arises from the mesenteric vessels supplying the small intestine. The vessels of the appendix can have branches, and always pass through the mesentery, which consists of adipose tissue and gives the appendix mobility.
Innervation of the process (supply of organs and tissues nerve cells) is carried out by sympathetic and parasympathetic nerve fibers. One important fact for doctors is that nerve fibers sympathetic system, feeding the appendix, exit the solar plexus. This anatomical feature noted by the famous surgeon Kocher, who described the displacement of pain from upper sections abdomen to the right iliac region, with acute inflammation appendix.
On which side does a person have appendicitis?
Human abdominal cavity The human abdominal cavity is divided into 9 conventional areas, which are limited by lines drawn through anatomical structures. In particular, the projection of the appendix onto the anterior abdominal wall is in the right iliac region, which is approximately located below and to the right of the navel, not reaching the right hip, i.e. we can say that appendicitis is located on the right side of a person below the navel.
Typically, the appendix arises from the posterior segment of the dome of the cecum, 2-3 cm below the ileocecal angle (the junction of the small intestine with the large intestine). There are five positions of the appendix relative to the cecum:
- Descending (40-50%) - located in the pelvis;
- Lateral (25%) - placed closer to the lateral abdominal wall;
- Internal (medial) (17-20%) - that is, closer to the small intestine;
- Posterior (retrocecal, dorsal) (9-15%) - in this case, it can be located behind the dome of the cecum intraperitoneally or extraperitoneally, which significantly complicates the diagnosis of acute appendicitis;
- Anterior (ventral) (8-15%) - adjacent to the anterior abdominal wall.
Depending on the location of the process, the clinical picture of the disease in people can be different and imitate diseases of various organs.
For example, the posterior location of the appendix can simulate the symptoms of renal colic with lower back pain, difficulty urinating and mild abdominal pain. Another option is internal placement, in which the patient complains of diarrhea, pain throughout the abdomen, which in turn can lead the patient and even the doctor to think about a banal intestinal infection.
Inflammation of the appendix - acute appendicitis
Inflamed appendix The term “acute appendicitis” implies acute nonspecific inflammation of the layers of the appendix. Depending on the spread of the reaction, it is possible to damage only the mucous membrane, or all layers of the organ, up to the occurrence of perforation (the appearance of a hole) in its wall. Classification of acute appendicitis:
- catarrhal - inflammation of the mucous membrane only;
- phlegmonous - damage to the mucous, submucosal and muscular membranes;
- gangrenous - damage to all layers of the organ;
- gangrenous-perforated - also damage to all layers, but with the presence of a pathological hole in the wall of the appendix (perforation).
Causes of acute appendicitis
Doesn't exist today the only theory development of the disease. However, even in the last century, surgeons attached great value some of them, which still exist:
Experience shows that timely removal of the inflamed appendix stops or even stops the development of inflammatory process in the abdominal cavity.
The first symptoms of appendicitis
There are a few things to remember simple symptoms that will help determine appendicitis at home:
- abdominal pain;
- muscle tension abdominal wall;
- nausea, sometimes vomiting;
- general weakness, malaise.
So, let's take a closer look at each of them.
Migration of pain is the main symptom of appendicitis Abdominal pain. This is perhaps the most main feature the presence of pathology in the abdominal cavity. You need to remember the main symptom of acute appendicitis - the Volkovich-Kocher symptom. It is characterized by migration of pain from the upper abdomen (sometimes patients say “stomach hurts”) or the entire abdomen to the right iliac region for 3-8 hours. I emphasize that this symptom is fundamental in making a diagnosis of acute appendicitis. Although in in rare cases this sign It may not appear, for example, when the patient overslept it at night, or did not pay attention to it, since he periodically has problems with the gastrointestinal tract. Further, the pain is debilitating and localized mainly in the right iliac region.
Abdominal wall muscle tension. This important symptom also occurs in most patients with acute appendicitis. It occurs when the patient wants to cough or perform any physical activity, and pain and tension in the muscles of the abdominal wall in the right iliac region occur. If the patient himself tries to touch this area, he will be able to feel his muscles tense.
This symptom of appendicitis is more informative for the doctor who examines the patient, but if a sick person discovers this symptom, he should definitely consult a specialist.
Nausea, sometimes vomiting. There are many dyspeptic symptoms in the presence of inflammation in the organs digestive tract, but these two together create a picture of a disease in which you definitely need to see a doctor. Vomiting and nausea are not specific symptoms acute appendicitis, but often accompany this disease. Nausea may be constant, and vomiting may be sporadic.
General weakness, malaise, increased body temperature. Fever, general weakness appear when affecting the body toxic substances, which enter the blood in the presence of an inflammatory focus, which may be an inflamed appendix.
Symptoms of appendicitis in adult women and men
In adults, the symptoms of appendicitis are practically no different, however differential diagnosis may pose some difficulties for the doctor. I will present a list of diseases that may have a similar clinical picture with acute appendicitis and occur equally in men and women: inflammation of Meckel’s diverticulum, Crohn’s disease, enterocolitis, renal colic, colon cancer, etc.
In women, the symptoms of appendicitis are similar to the signs of the following pathologies: inflammation of the uterine appendages (adnexitis, salpingitis, tubo-ovarian abscess), disrupted ectopic pregnancy, rupture of an ovarian cyst, ovarian syndrome, ovarian apoplexy. Main point, which everyone needs to learn - all of the listed diseases need qualified treatment in the clinic, or at least consultation with a doctor.
Symptoms of appendicitis during pregnancy
Pregnant women have a blurred picture of the disease, which can be misleading when initial examination women. It is necessary to pay attention to the period of pregnancy, because later the fetus enlarges and thereby expands the uterine cavity, which displaces the appendix upward. In this case, the pain may be located in the right hypochondrium, be not intense and intensify when the pregnant woman turns right side, due to the pressure of the uterus on the inflamed appendix. Otherwise, the symptoms are similar - there may also be vomiting, nausea, elevated temperature body, weakness.
The safest and most reliable method for diagnosing appendicitis in pregnant women is abdominal ultrasound. If the diagnosis of acute appendicitis is confirmed, it is necessary to urgently perform surgery– remove the inflamed appendix.
Signs of appendicitis in children
In children, there is a certain structural feature of the appendix and abdominal organs:
- a wide and short appendix up to the age of 3-4 years, with no accumulation or stagnation of contents in the lumen of the appendix;
- a relatively large area of the peritoneum, which can contribute to the rapid absorption of toxic substances and the development of a fatal complication of acute appendicitis - sepsis;
- the presence of a short greater omentum (this organ consists mainly of fatty tissue and should cover all organs of the abdominal cavity, but in children it is not able to do this, which can lead to generalization purulent inflammation in the abdominal cavity).
Acute appendicitis mainly develops in children over 5 years of age, but this fact does not prevent the presence of appendicitis in newborns or under 5 years of age. Acute appendicitis occurs very violently and with pronounced general symptoms. In children younger age signs of appendicitis may be: fever, temperature up to 39 C, vomiting, sometimes diarrhea, general weakness, drowsiness, lack of physical activity.
When examining the child, pain and muscle tension are noted in the iliac region on the right, positive symptoms peritoneal irritation. The signs of appendicitis in older children, as well as the course of the disease itself, are identical to adults.
Signs of appendicitis in older people
In older people, an attack of appendicitis may begin with pain in the stomach, which gradually moves to the right iliac region. However, the problem of diagnosing appendicitis in this group of the population often lies in the patient’s late visit to the doctor, the uncertainty of abdominal pain, sclerotic changes in the nervous system (the patient may not remember when the pain began, how long he has been sick, and cannot show the exact location of the pain) . The first place is taken by general weakness, elevated body temperature up to 38 C, bloating, constipation.It must be remembered that any pain that lasts more than a day should cause concern. Ultrasound and CT scan of the abdominal cavity help in diagnosing acute appendicitis. Treatment of appendicitis in elderly people is identical to all categories of the population - surgical removal inflamed appendix.
First aid for suspected acute appendicitis
First of all, if there is a suspicion of acute appendicitis you cannot take painkillers, since they can erase the clinical picture of the disease. If you recognize symptoms of appendicitis, you should consult a doctor immediately. Before the doctor arrives, you can allow yourself to take a Drotaverine tablet (no-spa) or take intramuscular injection antispasmodics (drotaverine or papaverine).
Diagnosis of acute appendicitis
To confirm the diagnosis of acute appendicitis in medical institution The following diagnostic methods are used:
- general analysis blood (leukocytosis with a shift of the formula to the left is observed);
- general urinalysis (often without pathological changes);
- biochemical blood test (at the first stage inflammatory reaction in acute appendicitis, the level of bilirubin, urea, creatinine, total protein are within normal limits, but as complications develop, these indicators increase);
- Ultrasound (in our time has a very high percentage of accurate diagnosis, while the diagnostician can indicate the size of the appendix, its location, the presence or absence of free fluid in the abdominal cavity);
- computed tomography of the abdominal cavity (is the gold standard in the diagnosis of acute appendicitis).
Treatment
Treatment of appendicitis without surgery, surgical intervention, is impossible, therefore all patients with suspected acute appendicitis are admitted immediately to surgical department. The surgeon has only 2 hours to make a diagnosis. Delay in this case is impossible.
Over the course of 2 hours you can spend conservative therapy(antispasmodics, antibiotics, infusion therapy) and dynamic observation. If combined with clinical picture and worsening results additional methods After examination, the surgeon diagnosed acute appendicitis, then the patient needs urgent surgery.
Surgical access for early stages The disease is performed in the right iliac region, in an oblique direction, 7-10 cm long. If there are signs of peritonitis, a median laparotomy is performed, that is, an incision from the navel to the pubis. This access allows you to thoroughly sanitize the abdominal cavity, get rid of accumulated exudate and cure the patient.
Medicine does not stand still, so appendicitis can be removed laparoscopic method, through just three small incisions on the abdominal wall, which will subsequently significantly reduce the duration of postoperative recovery.
Postoperative period
The duration of the operation can vary from 40 minutes to several hours, depending on the duration of the disease, the presence of complications and the location of the inflamed appendix in the abdominal cavity.
IN postoperative period the patient receives appropriate drug therapy:
- antibiotics for 5-7 days;
- infusion therapy (a treatment method based on the introduction into the bloodstream various solutions a certain volume and concentration, in order to correct pathological losses of the body or prevent them.);
- painkillers.
On the first day after the operation, eating and drinking are prohibited, since the patient receives everything he needs along with the infusion, but, in the absence of complications, he can already move independently. On the second day after surgery you can drink mineral water, compote with dried fruits, eat light soup, baked apples. From the moment intestinal peristalsis starts, you can expand your diet.
The patient undergoes wound dressings daily to ensure tissue healing and the absence of wound complications.
Length of hospital stay after surgical treatment acute appendicitis depends on the timeliness of the operation and its method. With a typical access and no complications, 6-8 days, and with laparoscopy only 3-4 days.
Contraindicated after surgery to remove the appendix. physical activity for at least 2 months.
Possible complications
There have been and will be complications in surgery, but a lot depends on the patient, who should not self-medicate, and at the first suspicious symptoms, immediately consult a doctor.
I will give examples of some complications of acute appendicitis.
Appendiceal infiltrate
Occurs when a patient presents to the hospital late for acute appendicitis and accounts for 4% of cases. Usually at home, people with abdominal pain take painkillers and antibiotics without a doctor’s prescription, which leads to the development of infiltration.
This complication consists in delimiting the inflamed appendix from the abdominal cavity with the help of organs adjacent to it, such as small intestine, big oil seal, cecum, abdominal wall. These organs create a barrier against the spread of purulent inflammation from the appendix into the abdominal cavity.
Treatment of infiltration is only conservative, in no case surgical. Antibiotics are used wide range actions, detoxification and anti-inflammatory therapy for 8-10 days, until signs of infiltration disappear.
Periappendicular abscess
This complication is the next stage in the development of infiltration, when appropriate treatment is not performed. In this case, purulent melting of the appendix develops with the formation in its place of a purulent focus, which is delimited by nearby organs.
The main complaints will be: abdominal pain, fever with a temperature of up to 40 C, weakness, malaise, and sometimes vomiting.
Treatment is only surgical, and it is necessary to open the abscess not transperitoneally, so as not to infect the abdominal cavity.
Peritonitis
Peritonitis is an inflammation of the peritoneum, which covers all organs of the abdominal cavity. A terrible complication that indicates advanced case acute appendicitis, characterized by pain throughout the abdomen, fever, intoxication, low blood pressure.
Upon admission of a patient with such a diagnosis, you must first carry out preoperative preparation in the form infusion therapy, and then perform a laparotomy, sanitize the abdominal cavity and remove the inflamed appendix.
The postoperative period in this case is significantly extended, irreparable consequences cannot be ruled out. Therefore, you should always contact a qualified doctor who will promptly suspect the diagnosis of acute appendicitis, which will prevent serious complications.
Pylephlebitis
A life-threatening complication characterized by portal vein thrombosis, leading to liver failure. The condition is manifested by fever, loss of consciousness, jaundice and acute hepatic-renal failure.
This is very rare complication, practically it cannot be foreseen, but it can be prevented by consulting a doctor in time.
Appendicitis- This is an inflammation of the appendix - the vermiform appendix of the cecum. The main cause of the disease is excessive consumption of protein foods (meat, fish), this leads to overload gastrointestinal tract. Appendicitis can also be caused by severe cold and general weakening of the body.
There are two types of appendicitis: acute and chronic.
Symptoms of appendicitis
- Most often, acute appendicitis occurs with sharp pain in the lower abdomen on the right, in the navel area or throughout the abdomen; after a few hours the pain is concentrated in the right lower abdomen.
- Appendicitis is characterized by pain that increases over several hours, intensifying with movement or coughing.
- Nausea and vomiting may occur.
- As a rule, body temperature increases to 37.5-38.5 ° C, sometimes the temperature may remain normal.
- Stool and gas are retained, and the disease can also cause diarrhea.
First aid
If you suspect appendicitis, you should immediately put the patient to bed, then put ice on the stomach and call a doctor or go to the hospital, since acute appendicitis requires urgent surgery.
In such a situation, you cannot give a laxative (as a last resort, you can give an enema from warm water to drain feces from the cecum), you should not give painkillers and place a heating pad on your stomach, because heat will only intensify the development of the inflammatory process, and painkillers will only give a temporary improvement.
If, after acute appendicitis, the patient was not operated on for some reason but the symptoms of the disease subsided, they may recur, and repeated attacks most often occur more severely and often cause complications. This type of appendicitis is called chronic. Complications from appendicitis are very serious and require mandatory surgical intervention.
Sometimes the inflammatory process is limited only to the mucous membrane, and if the contents of the appendix spill into the cecum, the pain may go away. But one should not hope for this, since even a doctor cannot always determine the severity and nature of the inflammatory process in the appendix, and unfavorable changes in it (for example, gangrene) cause serious complications, they sometimes appear very quickly. Therefore, it is imperative to remove the appendix immediately; The earlier the operation is performed, the safer it is and the more reliably it prevents the most dangerous complications.
Usually pain appears suddenly in the epigastric region (on initial stage development of the disease, it is often mistaken for stomach pain). After this, for several hours (usually 6-8, sometimes 12 hours or more), the pain intensifies and moves to the right, localizing in the iliac region (under the right costal arch). If the patient has not received assistance by this point, the pain becomes diffuse and it becomes difficult to determine its location. This migration of pain - specific sign inflammation of the appendix.
The appendix may be located in the abdominal cavity higher than usual, then the pain will be concentrated almost. With other abnormal locations of the appendix, the pain may be localized closer to the navel or in the lumbar region.
Appendicitis in pregnant women is characterized by non-standard localization pain due to displacement of internal organs.
When the pain is felt constantly, but it can weaken or intensify for some time.
When moving, coughing or changing body position, the pain becomes stronger, so patients often move around holding their right hand bottom part abdomen, or lie motionless on the right side. When you try to roll over or lie on your left side, the pain intensifies significantly.
If the pain suddenly disappears, this is a very ominous sign, indicating the beginning of pain, accompanied by the death of nerve endings.
When palpating the abdomen, the pain does not become stronger, but it increases sharply if you stop pressing on the palpated area.
Other signs of appendicitis
In addition to pain, inflammation of the appendix can be accompanied by tension in the abdominal wall, nausea and vomiting, and possible disturbances in bowel movements and frequent urination. The patient feels weak, loses appetite, the temperature usually rises to low-grade levels, and sometimes headache and increased blood pressure.
In appendicitis, the malaise is usually less pronounced than in appendicitis, and the main symptom of the disease is abdominal pain. Children suffer more, including from pain, they vomit more often, and their temperature rises.
In elderly people with appendicitis pain syndrome may be mild, which often leads to late recognition of the disease and untimely seeking help.
Is it possible to relieve the pain?
Appendicitis requires treatment surgical hospital. It is impossible to manage in case of an acute emergency, and any delay in bringing the patient to the doctor threatens with serious complications. You must call without delay ambulance.
You should not try to relieve pain on your own. Taking antispasmodics (no-spa, papaverine) or painkillers blurs the symptoms and complicates diagnosis, causing you to waste valuable time; in addition, the effectiveness of these drugs for appendicitis is usually low.
Under no circumstances should heat or cold be applied to the patient’s abdomen. A warm heating pad will cause inflammation to spread. You should not try to palpate the patient’s abdomen on your own - it is inflamed due to careless movement.
Appendicitis often progresses to more severe forms, and diabetes actively contributes to this. The first signs of appendicitis are conditions familiar to diabetics, so people with this diagnosis often seek medical care It's too late. This leads to fatal consequences. But if the operation was successful, then diabetes can worsen the patient’s well-being and delay recovery.
What is appendicitis?
Appendicitis involves inflammation of the appendix, that is, the vestigial extension of the cecum (the first segment of the large intestine).
The appendix is filled with foreign topics ( feces, not processed food), which leads to the inflammatory process beginning. More often, husks from seeds or grains accumulate. Inflammation sometimes begins due to an infection. This only happens if immune system weakened. Scientists have not yet been able to understand the exact cause of appendicitis.
Risk group
At risk of appendicitis are people aged 15 to 35 years with obesity, and this is often typical for diabetics. Pregnant women, as well as children from 3 to 5 years of age, are at risk. In diabetes mellitus, appendicitis is common due to the fact that the immune system is weakened. Moreover, people who are sick diabetes mellitus more difficult to bear recovery period after surgery. This is due to the fact that many medications are contraindicated.
Symptoms of appendicitis
One of the symptoms of inflammation of the appendix may be abdominal pain. The following symptoms of appendicitis are distinguished:
- sharp pain in the abdomen;
- elevated temperature (37.5-38.0 °C);
- muscle tension;
- nausea, vomiting, sometimes diarrhea;
- dry mouth;
- Shchetkin-Blumberg syndrome.
Shchetkin-Blumberg syndrome is considered a reliable symptom of appendicitis. All other symptoms may indicate any inflammatory disease abdominal cavity. The meaning of the syndrome is that if you gently press on the stomach in the place where it hurts, and then quickly remove your hand, the pain will be much stronger than from pressing. If the patient discovers this syndrome, then it is necessary to immediately contact a medical institution.
Treatment of appendicitis in diabetes
First aid
If the patient has abdominal pain, he can take 2 painkiller tablets (No-shpa or Buscopan) at a time, but if these drugs are ineffective and secondary symptoms symptoms that do not go away for more than 6 hours, you need to consult a doctor. Under no circumstances should you take stronger painkillers. During the initial examination, the doctor must see the full picture. Under no circumstances should heat be applied to the abdomen, as this will increase the inflammatory process. Before the doctor arrives, you should not eat or drink water.
Diagnosis of the disease in a hospital
To make a diagnosis, the surgeon must examine the patient. After the patient is admitted to the hospital, a general urine and blood test is taken from him (in this case, they will be ready in half an hour). After this, he is examined by a surgeon, to whom the patient must tell all his symptoms, as well as chronic diseases. If the surgeon finds symptoms of appendicitis, he will send you for an ultrasound of the abdomen. Women are referred for examination to a gynecologist to rule out diseases of the uterus.
