Appendicitis

December 26, 2011

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Appendicitis   called inflammation in appendix . This hollow tube, closed at the end belonging to the cecum . Because of its similarity to the name of the worm " appendix "Literally means" an appendage, like a worm. " It is considered that the beginning of appendicitis is the obstruction of the openings between the cecum and the appendix.

This occurs either due to blockage inside the appendix mucus layers thick consistency, or because falling feces from the cecum. After a while the masses are very hard, and the hole plugged. The name of such stones of feces - coprolites . In some cases, blockage occurs because of swelling, so that inflames the inflammatory process.

There is another theory manifestations of appendicitis. The disease is caused by rupture of the appendix and the following after the spread bacteria . With the development of inflammation and infection in the thickness of the wall of the appendix can rupture. Once ruptured, continued spread of infection throughout the abdomen, but usually, this process occurs in a relatively small space near the appendix. Thus, a " periappendikulyarny abscess ".

In some cases, with the proviso that no infection and inflammation will spread, appendicitis cured alone, without the use of surgery. Thus over time the symptoms of appendicitis are lost. As a rule, such a phenomenon is observed in patients in the elderly as well as people receiving antibiotics . After a relatively long period of time to treat such patients with complaints of skill swelling   or infiltration   in the abdomen, in the right-hand side.

The symptoms of appendicitis

The first exhibit symptoms of appendicitis is abdominal pain. First, the person feels pain all over the abdomen, but they are particularly intense in the upper part. The patient is difficult to clearly determine where exactly was wrong with him and, consequently, on which side of appendicitis. Pain that is not concentrated in one specific point in medicine called clearly localized pain . Typically, when an attack of appendicitis patient after the request to specify where exactly was wrong with him, he points to the middle of the abdomen in a circular motion.

Subsequent symptoms of appendicitis are manifested more clearly. With an increase in inflammation of the appendix inflammation progresses further through the wall of the appendix to the outer shell. Then the inflammatory process involves the lining of the abdomen, the peritoneum. When inflammation of the peritoneum nature of pain varies greatly, and the pain has already determined in a small area. However, to break the infection of the appendix covers the entire abdominal cavity, and the pain again becomes widespread.

Sometimes there are symptoms of appendicitis and how vomiting   and nausea . As the body's response to the inflammatory process can dramatically raise the body temperature. However, in the absence of elevated body temperature appendicitis ruled out in any case it is impossible, because the disease can occur at normal temperature.

The forms of appendicitis

Acute appendicitis   It is an acute inflammatory disease necrotic appendix. Its appearance provokes obstruction of the lumen of the appendix. Acute appendicitis is a direct indication for immediate surgery.

Acute appendicitis can be divided into several subspecies. At weakly expressed appendicitis , Also known as appendicular colic, often show slack aching pain in the right iliac fossa. Several hours later, the pain goes away.

At simple (surface or catarrhal) appendicitis   once manifested vomiting, palpation there is pain in the right iliac fossa. In the blood, there is a moderate leukocytosis .

The destructive appendicitis usually divided into several subspecies. So, phlegmonous appendicitis It begins with a small rise in temperature, and wbc   shifted to the left. When phlegmonous appendicitis patient speeded up pulse, coated tongue. If a patient is suspected appendicitis abscess, then during palpation expert drew attention to the pain and muscle tension anterior abdominal wall. When phlegmonous change observed his appendix thickening, swelling, it covers fibropurulent plaque. The lumen mucosa have pus in the abdomen and in the presence of purulent exudate or muddy.

Gangrenous appendicitis   arises as a consequence thrombosis   and thrombophlebitis   vessels in the mesentery and in the wall portion defined process. As a rule, gangrenous appendicitis accompanied by local peritonitis Sometimes rolling in common with the perforation. Symptoms of gangrenous appendicitis similar to the symptoms of appendicitis abscess. But in this case is more pronounced total intoxication   organism. When you change the color of gangrenous appendix dirty-green color, it covers fibropurulent plaque, it has an unpleasant odor.

Also released complicated appendicitis In which there are all sorts of complications.

Appendicism   It is a fairly rare form of the disease. Usually, chronic appendicitis develops as a consequence of acute appendicitis. For this condition characterized by sclerotic and atrophic changes in the wall of the appendix. Chronic appendicitis is most likely to occur after treatment of an acute attack without surgery.

Diagnosing appendicitis

At the beginning of the diagnosis of appendicitis is important careful questioning of the patient and his inspection. In many cases, patients complain about the body heat, as well as varying the intensity of pain at the right side of the pressure-sensitive abdomen. When inflammation of the peritoneum manifest other symptoms of appendicitis. So, while pressing on the abdomen the patient feels so-called "rebound" tenderness. That is, when pressing on the abdomen, after which the doctor removes his hand very strongly manifested sudden brief pain.

When the diagnosis of a specialist is required to take into account the number of white blood cells. If the body develops the infectious process, the analysis shows an increased number of white blood cell . In the early days after the onset of illness the number of white blood cells may be normal, but a slight increase in their number, as a rule, takes place at the earliest stages of the disease. But it is important to note that this feature is characteristic for almost any infection that develops in the body. In view of this high blood levels of white blood cells is not considered as a direct evidence of the presence of appendicitis. In the process of diagnosis is also carried out a microscopic examination of the urine of the patient

In carrying out X-ray examination of the abdominal cavity as a cause detect appendicitis fecalith   (hardened piece of feces, which clogs the outlet of the appendix). This phenomenon often occurs in children.

In the process of ultrasound can detect the presence of an abscess or enlarged appendix. But in patients with appendicitis the appendix can not see only half of the cases. In view of the impossibility of considering the appendix at ultrasound does not exclude appendicitis. However, in this study it is possible to eliminate the pathology of the ovaries, uterus, fallopian tubes, there are a number of states that can simulate appendicitis.

During the CT area of ​​the appendix can diagnose appendicitis or an abscess periappendikulyarny. This prevents a number of diseases inside the abdomen and pelvis, which resemble the symptoms of appendicitis.

Also for the diagnosis "appendicitis" method is used laparoscopy . This surgical procedure is the introduction into the abdominal cavity of a thin tube with a camera through a small hole in the abdominal wall. In carrying out this procedure, you can see the appendix and a number of other bodies. A detection of appendicitis appendix removed immediately.

To date, only a laparoscopy allows you to accurately diagnose appendicitis. In view of this for suspected appendicitis studies are carried out in a complex surgery.

The diagnosis of appendicitis in some cases very difficult to carry out. After the appendix in the abdominal cavity can be in different positions. Sometimes the expert difficult to determine which side of appendicitis. Most often the appendix is ​​located in the lower abdomen on the right. However, it has mesentery   - Like a sheet of foil, through which the appendix attached to other structures in the abdomen. And if there is a long mesentery of the appendix sometimes moves to a different location. The length can be himself appendix. Therefore, this combination appendix may fall into the cavity of the pelvis, located behind the colon. In such a case, the symptoms of appendicitis can coincide with inflammatory symptoms of other organs. Because of such characteristics of the patient with suspected appendicitis observed a certain period of time to get ahead, you will manifest the signs of appendicitis or other illness.

In the process of diagnosing appendicitis is very important to bear in mind a number of other diseases with similar symptoms with appendicitis. So, there should be a differentiation of appendicitis Meckel's diverticulum   (protrusion of the bowel wall, which is located near the vermiform appendix) pelvic inflammatory disease . inflammatory processes in the upper right abdomen . right-sided diverticulitis . kidney disease .

Treatment for appendicitis

When the diagnosis "appendicitis" in most cases, carried out surgery to remove the appendix, called appendectomy . Taking antibiotics begins immediately after the diagnosis before surgery.

There are cases where appendicitis inflammation and infection is not very severe and, respectively, the abdominal cavity do not apply. Sometimes the body alone stops the inflammatory process. Patients in this case feel satisfactory, and after a few days their general condition is improved. Sometimes, after a certain time, the appendix is ​​removed. However, the main difficulty of such a state is the ability to distinguish between appendectomy is for the disease with a tendency to complications.

Often, patients are very long period of time do not go to the doctor, so that they formed diagnosed abscess . In the appendix perforation closed. With a small abscess being treated with antibiotics. But in most cases you need to drain the abscess. Drainage set using ultrasound or CT scan to determine the exact localization of the abscess. After a few weeks after the removal of an abscess performed surgery to remove the appendix. This method of treatment is called delayed appendectomy and apply it with a view to forestalling the recurrence of appendicitis attack.

Today, when you remove the appendix practice the use of two methods. The first - a common operation, which is carried out through the incision, the second - endoscopic surgery, carried out through a puncture with video control.

In normal operation of the area where the appendix is ​​located, the cut is carried out with a length of about 10 cm. After inspecting the appendix removed. In the presence of an abscess it was dried using drainages. After all the procedures, the incision was sutured.

When the operation is performed using a laparoscope and a puncture with a tube with a video camera at the end of the show appendicitis. Further, removal of the appendix is ​​performed by special instruments introduced through small holes. After such an operation, the patient feels significantly less postoperative pain, faster restores.

If the appendix has not been broken, the patient can leave the hospital the next day. If there is a gap, then the patient is in the hospital for about a week. In this case the patient administering intravenously administered antibiotics. This is especially important in the development of peritonitis.

Complications of appendicitis

As complications of appendicitis, which occurs most frequently, it should be noted rupture . If perforation of the appendix subsequently infected pus can accumulate and cause periappendikulyarny abscess   or diffuse peritonitis   (ie the process of infection throughout the abdomen). The most common cause of this complication is failure to identify signs of appendicitis and, as a consequence, not just started treatment.

Less as a complication of appendicitis occurs ileus . This condition is manifested by the fact that the inflammation around the appendix suspends the bowel muscles. Accordingly, the food can not move through the intestines normally. Sometimes the part of the intestine, which is located over the place with broken cross, going to liquids and gases. In such a case occurs abdominal distention In patients with nausea and vomiting.

The most dangerous complication of appendicitis is sepsis , i.e blood poisoning . In this case, the bacteria enter the blood and are carried along with the blood to other parts of the body. This is a very serious complication that even threaten the patient's life. However, it does not develop very often.

Complications appendectomy

The most frequent complication in this case is an infection of the surgical wound. It may appear a slight complication - redness, soreness. However, the case and the very heavy defeat, in which the mandatory application of surgical treatments. In some severe cases, the surgeon can not sew up the incision completely after surgery. This occurs with a very strong inflammation and infection, when the cut is contaminated immediately after the meeting. He was sewn up in a few days.

Also complication Appendectomy   It becomes an abscess in the appendix. After the surgery can also occur the development of adhesions.

To date, no exact information about the function of the appendix. But after removing health problems in humans mainly occurs.

Appendicitis in Pregnancy

Today, it is an acute appendicitis is the most common cause of surgery in pregnant women. According to statistics, appendicitis in pregnant women seen at a frequency of 1 in 700-2000 women.

Appendicitis in pregnancy appears sharp painful sensations in the abdomen, which later become aching in nature. It is also noted positive symptom Taranenko : Pain becomes stronger if the woman turns to the left side to the right. In this disease in pregnant women it is very difficult to make the correct diagnosis because of anatomical and physiological characteristics of an organism at pregnancy . Because of this, an appendicitis in pregnancy can have serious complications idazhe sometimes provokes abortion. Therefore, experts are usually used early appendectomy, which helps to prevent unwanted effects.

Prevention of appendicitis

The most important for the prevention of appendicitis eating mostly healthy foods. Do not abuse the meat products, preferably foods of plant origin. It is important that the chair was a regular and systematic, there should be no occurrence constipation . After all, as a result of stagnation in the intestine can occur fester.