Appendicitis - Causes, symptoms and treatment. MF.
Acute appendicitis is the most common
surgical disease,
containing a lot of paradoxes.
Rusakov VI, 1975
Appendicitis is an inflammation of the appendix of the cecum. The appendix is a hollow organ 7-11 cm long, which extends from the dome of the cecum. Inflammation of the appendix may be acute or chronic. Therefore, in medicine, acute and chronic appendicitis is isolated. Currently, chronic appendicitis is extremely rare. Such a diagnosis is made by patients who have had an attack of acute appendicitis, in which the appendix can not be removed because of the development of complications( a dense appendicular infiltration, which will be discussed below).
Causes of acute appendicitis
Acute appendicitis is the most common surgical disease. And, paradoxically, this sounds, but to date a clear and plausible theory of its origin has not been proposed. There are about 17 main hypotheses explaining the development of an attack of acute appendicitis. Among the possible causes of the development of the disease are the following:
• Infection - bacteria can penetrate the wall of the appendix from its lumen or can be brought by a current of blood from another focus( eg, tonsils);
• Disturbance of the evacuation of stool or blockage of the mouth of the appendix with a calcified stone, which can lead to stagnation of the contents and inflammation;
• Dysfunction of the diet - people who regularly consume large amounts of meat, according to some scientists, suffer from appendicitis more often, and on the other hand, during the famine, the number of cases of appendicitis decreases sharply;
• Individual features of the anatomy of the appendix - the presence of bends, a significant length of the appendix may also cause stasis of its contents;
• Thrombosis of the artery feeding the appendix in people suffering from atherosclerosis and heart diseases with heart rate abnormalities;
• Hereditary predisposition is proved in persons - carriers of certain antigens;
• It is important to reduce the overall resistance of the human body as a result of stress, alcohol abuse, smoking.
• In women, inflammation can pass from the appendages of the uterus located next to the appendix, so regular gynecological examinations, prevention and treatment of gynecological diseases can reduce the risk of developing appendicitis.
Examination of a patient with signs of appendicitis
Diagnosis of acute appendicitis, despite the prevailing opinion about ease, is complex and requires professional skills. Acute appendicitis can occur in any person, regardless of sex and age, most severely it occurs in infants and elderly people. Appendicitis is called the "monkey of all diseases", as it can be masked for any pathology in the abdomen. Therefore, it is often difficult to correctly diagnose. The following diseases are very similar in symptoms to acute appendicitis: renal colic, acute cholecystitis, right adnexitis, enterocolitis, stomach and duodenal ulcer disease( especially with perforation of the ulcer when an opening is formed in the wall of the stomach or intestine), strangulated inguinal, femoral and umbilical hernia, inflammation of the diverticulum of Meckel. In children, abdominal pain can also occur with infectious diseases.
Symptoms of appendicitis
In order for you to be able to detect this pathology in time and to consult a specialist in time, let's consider the main signs of the disease.
Attack of appendicitis often occurs late at night or in the morning. With the classical course of the disease, the first sign of it will be pain. At first, pain occurs in the spoon, or around the navel, or around the stomach. It has a fuzzy bursting, pulling character. After 3-4 hours the pain shifts to the right iliac region, where it remains. Now it becomes permanent, stronger, strengthens with walking, lying on the left side.
A couple of hours after the onset of pain, nausea and vomiting occur. Vomiting is not copious, often single, not bringing relief. There is an intestinal disorder: constipation or vice versa liquid stool.
After 2-4 hours after the onset of pain, fever occurs. The higher the temperature, the more pronounced inflammation.
Remember: severe pains that have arisen in the abdomen and do not pass independently for 6 hours are a sure sign of a surgical disease and require a surgeon's examination!
First aid for signs of appendicitis
When you have pain, you can take antispasmodic drugs , such as no-shpa, buscopan, once no more than 2 tablets .If they are ineffective, you should consult a surgeon.
With the sudden appearance of abdominal pain on the background of the full well-being of , it is not possible to take painkillers, especially strong analgesics such as non-steroidal anti-inflammatory drugs. These include analgin and analgin-containing drugs( baralgin, etc.), ketorol, ketanol, ketorolac, nimesulide, indomethacin, etc. They can lubricate the picture of the disease, which prevents the doctor from correctly diagnosing.
It is inadmissible to use heaters or compresses on the stomach of - this will only increase inflammation. It is impossible to be treated with folk remedies or to use antibiotics if you suspect a sharp appendicitis. The latter will also distort the clinical picture of the disease.
Do you have any of these symptoms that did not go away within 6 hours? It is necessary to call an ambulance team that will take you to the nearest surgical hospital where you will be examined by a surgeon. Take food before examination by a doctor can not.
Treatment of acute appendicitis
What will the hospital do? For the beginning it is necessary to hand over the general analysis of a blood and urine which will be ready in 15-30 minutes. After examining the surgeon, to whom you will need to tell your complaints, the history of the disease, you need to undergo ultrasound examination of the abdomen( ultrasound).Girls and women are usually referred for advice to a gynecologist to exclude the disease of the uterine appendages.
Remember: at this stage the most correct method of diagnosing is an examination of the surgeon, only he can suspect appendicitis. The remaining methods of diagnosis are of an auxiliary nature, even ultrasound does not always provide an opportunity to see the appendix.
After the examination, if the doctor has a suspicion of appendicitis, hospitalization in the surgical department is indicated. If the picture of the disease is not clear, you may be left under observation, and also perform laparoscopy. Laparoscopy is a method of diagnosis when a puncture is performed under local anesthesia and a laparoscope is inserted into the abdominal cavity, which makes it possible to visually inspect the appendix.
Surgical treatment of appendicitis
If the picture of the disease is not in doubt, then it is necessary to perform an operation - appendectomy( removal of the appendix).This is the only method for treating appendicitis. Operation with acute appendicitis is performed under general anesthesia. You can remove the appendix through laparotomy access when performing a classic incision in the right ileal region, and laparoscopically through 3 small incisions. The latter method is preferable, since the rehabilitation( recovery) period after surgery is much shorter.
After operation
After the operation, in the absence of complications, the first 12 hours must be followed by bed rest and not to eat. During the next 12 hours you can turn and sit in bed, drink water with lemon in small portions every 2 hours, if there is no nausea. On the second day after the operation, in consultation with the doctor, you can get up and walk. Active motor regimen is the key to an early recovery and prevention of blood clots in the veins of the lower limbs. On the possibility of eating, you must also ask the attending physician. Remember that for you the main indicator for eating is hunger, lack of nausea, gas leakage and the appearance of stools. These signs indicate a restoration of bowel function.
On the second day after the operation, you should take liquid food( 1% kefir, juices, oatmeal, low-fat cottage cheese, baby food) in small portions, up to 6 times a day, focusing on your own feelings. On the third day after the operation, you can eat boiled chicken meat, soup on low-fat broth, cutlets for a couple small portions with normal health. From 8 days you can eat as usual.
Sutures are removed for 7-8 days after the operation.
After 1,5-3 months after the operation, you can go in for sports( swimming, running, jumping, riding, sports dancing, bar exercises, etc.).From severe physical exertion( weightlifting), you should abstain for 3-6 months. These restrictions are necessary for the formation of a dense scar in order to avoid the formation of hernias at the site of the incision. The connective tissue from which the scar is made acquires the necessary strength for 3-6 months.
The period of incapacity for work varies depending on the nature of the inflammation of the process and the presence of complications from 16 to 40 days.
Possible complications of appendicitis
Do not underestimate the severity of acute appendicitis. Until now, there are lethal cases of the disease. Inflammation of the appendix is dangerous due to its complications. After 12 hours from the onset of the disease, the inflammation covers the entire thickness of the appendix wall, and after 24-48 hours, it breaks down and spills the contents of the intestine into the free abdominal cavity. If this happens, the following consequences may develop.
• Periappendicular abscess and abscesses in the abdominal cavity - formation of abscesses around the process, between the loops of the intestines, in the small pelvis, under the diaphragm, accompanied by high fever and chills.
• Peritonitis is an inflammation of the peritoneum( a very thin membrane that covers all organs and the inner surface of the abdominal wall from the outside), which can lead to the development of sepsis( infection of blood) and death.
• Appendicular infiltration is an attempt by the body to fence the inflamed organ from the abdominal cavity. This formation is around the appendix, consisting of the intestinal loops stuck to it and the strands of a large omentum. It can have a stony density. It is impossible to remove the appendix from such a dense conglomerate. Assign antibiotics, fizioprotsedury, due to which the infiltrate either resolves, or turns into an abscess. With resorption of the infiltrate, scheduled appendectomy is shown after 4-6 months. With the development of an abscess, it is drained either under ultrasound under local anesthesia, or by a standard incision in the right ileal region under general anesthesia.
• Pilephlebitis - inflammation of the main( portal) vein of the liver due to ingestion of emboli with microorganisms from the veins of the appendix, which leads to impaired liver function and death. This is the most serious complication of acute appendicitis, there are no cases of recovery from it.
Prevention of appendicitis
The only way to prevent listed complications of acute appendicitis is an early call to the surgeon during the first 6-12 hours from the onset of pain!
As the great Russian surgeon and diagnostician Ivan Ivanovich Grekov said: "Acute appendicitis is not found there, where people think of it, and find it where they do not even suspect it exists."Therefore, take care of your health, do not treat it negligently. It is better to overestimate the severity of your symptoms than it is too late to seek medical help.
Surgeon-physician Tevs DS