Langerhans cells. melanocytes. The immune system of the skin in infectious and non-infectious lesions
Acute appendicitis is an acute inflammation of the appendix (vermiform appendix of the cecum), requiring urgent surgical treatment, one of the most common inflammatory diseases of the abdominal organs.
What is an "appendix" and why does it become inflamed?
The appendix arises from the lower end of the caecum (the initial part of the large intestine). It is believed that the appendix is one of the links of the immune system, since the mucous membrane of the appendix is rich in lymphoid tissue. It is generally accepted that inflammation of the appendix may occur due to blockage of the appendix lumen by enlarged lymphoid tissue, fecal stones (hard stools resulting from chronic constipation), a foreign body, and sometimes helminths. Blockage leads to expansion of the appendix cavity, the rapid development of infection and inflammation. However, the exact cause of this common disease is not clear.
Symptoms of acute appendicitis
Manifestations depend on the location of the appendix, the time elapsed from the onset of the disease, the severity of the inflammatory process in the appendix and the involvement of nearby organs and peritoneum, as well as the age of the patient and the presence of concomitant diseases.
Since the appendix is a mobile organ, its inflammation can mimic almost any disease. In some cases, doctors have difficulty in making a diagnosis, since the main symptom of appendicitis - pain - can occur not only in the right lower abdomen, where it should be located according to the anatomy of the caecum, but also in the navel, in the groin, above the pubis , in the lower back, in the right hypochondrium and disguised as diseases of the liver, kidneys, female genital organs.
As a rule, the disease begins with the appearance of pain in the upper abdomen, which gradually increases, moves to the right iliac region (right lower quadrant of the abdomen). The pain is aggravated by coughing and movement. Usually there is a subfebrile body temperature of 37.2-37.5 ° C. Examination of the abdomen reveals involuntary tension of the muscles of the anterior abdominal wall and pain in the right iliac region. The pain is constant and may be accompanied by nausea and sometimes vomiting. There is often loss of appetite and refusal to eat, as well as stool retention caused by restriction of intestinal motility due to inflammation spreading through the peritoneum.
Unfortunately, these classic signs of appendicitis are seen in just over half of patients with acute appendicitis. The pain may not have a clear localization, especially in children under 3 years of age. In elderly and senile patients, reduced reactivity of the body, connective tissue replacement of all layers of the appendix wall and its blood vessels contribute to poor symptoms of acute appendicitis and a large number of complicated forms. In pregnant women in the second and third trimesters, a uterine appendix may cause an atypical clinical picture. Therefore, so often patients with acute appendicitis come to the emergency surgery department already with complications (perforation of the appendix, peritonitis).
What is "phlegmonous" and "gangrenous" appendicitis?
If the patient's symptoms of appendicitis are mild, but, nevertheless, the inflammatory process develops (the pain is not very strong, there is no nausea and vomiting), he is in no hurry to seek medical help, and then catarrhal appendicitis becomes phlegmonous. The appendix fills with pus and ulcerates. Inflammation begins to spread to the surrounding tissues: the walls of the intestine, the peritoneum. The pain becomes more pronounced, aggravated by the tension of the abdominal muscles; in thin people, the inflamed process can be felt as a dense roller.
Phlegmonous appendicitis can turn into a gangrenous form, when the inflammatory process develops already in the abdominal cavity. With gangrenous appendicitis, there is a decrease or complete absence of pain associated with the death of the nerve endings of the appendix, but signs of general intoxication come to replace, worsening of the general condition: weakness, pallor , bloating. If at this stage the patient is not helped, the patient's life is at risk due to the development of peritonitis.
How is appendicitis diagnosed?
If acute appendicitis is suspected, emergency hospitalization of the patient in a surgical hospital is necessary. In the EMC Surgical Clinic, emergency operations are performed around the clock for acute appendicitis and its complications.
At the stage before hospitalization, even in the presence of a pronounced pain syndrome, painkillers should not be taken, as this can make it difficult to diagnose the disease. You should also not use antibiotics, as this can blur the picture with the further development of complications (perforation of the process, diffuse peritonitis).
Diagnosis begins with a thorough questioning and examination, as well as taking a blood test (a complete blood count usually reflects a picture of inflammation - the number of leukocytes increases, leukocytosis occurs). In the classic course of acute appendicitis (high temperature and pain in the right iliac region from tolerable to very strong), the diagnosis is not difficult. For patients with questionable or unclear symptoms, doctors may order an abdominal and pelvic ultrasound and/or computed tomography when admitted to the hospital.
In some cases, diagnostic Laparoscopy can be performed, a diagnostic procedure in which a thin fiber optic tube with a camera is inserted into the abdominal cavity through a small hole in the abdominal wall. Laparoscopy allows you to see the appendix and other organs of the abdominal cavity and pelvis and assess their condition.
Emergency care for acute appendicitis
Surgery to remove an appendix (inflamed appendix) is called an "appendectomy" in which the inflamed appendix is removed.
In the presence of perforation (rupture) of the appendix, surgical intervention becomes technically more difficult to perform. There is a need for a thorough "washing" of the abdominal cavity from pus. Consequently, both the operation itself and recovery can be delayed.
Removal of the appendix is preceded by intravenous antibiotics to prevent complications. If there is a perforation of the appendix, antibiotic treatment continues until the blood tests normalize (approximately 5-7 days). The question of the abolition of antibiotics is decided by the attending physician.
Laparoscopic appendectomy
As a rule, in EMC, most of the surgical interventions for acute appendicitis, even in the case of severe forms of the disease, are performed by laparoscopic access, which guarantees a minimum of pain and a shorter recovery period. In uncomplicated appendicitis, if the appendix has not been perforated, the patient is usually discharged the next day. Patients with a perforated appendix may stay in the clinic longer (up to 7 days), especially if peritonitis has developed.
However, there are a number of cases where traditional open surgery (open appendectomy) is preferred.
With timely surgical intervention, recovery occurs quickly.
The main symptom of appendicitis is pain, which is of a varied nature. It can occur suddenly, be observed in the lower back, in the right lower abdomen and epigastric region. The pain in most cases appears sharp, less often pulling and cramping. It also increases with tension of the anterior abdominal wall during walking and lifting. There are discomfort mainly in the morning and late in the evening.
Common Symptoms of Appendicitis
Lack of appetite, loose stools, nausea, vomiting - all of these are among the most common causes of appendicitis. Often they can be accompanied by painful and frequent urination. This is due to the fact that the disease progresses. Inflammation began to cross the bladder and ureter.
In order to reduce pain, you can take an antispasmodic drug. However, you can not drink more than 2 tablets. Only one-time use is allowed. It is impossible to reduce pain with cold compresses on the abdomen and use heating pads. All this will only lead to increased inflammation.
The increase in weakness and malaise is also appendicitis. They are noted by patients when strong inflammatory processes are observed in the appendix. Along with these symptoms, high fever with chills may be present. As a rule, it is not possible to bring it down with conventional medicines.
Wrong gait is also a symptom of appendicitis. When walking, patients bend to the right side, and hold their stomach with their hands, thereby protecting it from concussions and reducing pain. With a deep breath, they note sharp pains in the suprapubic region, which are of a short duration.
Discoloration of the skin is another main symptom of appendicitis. Along with this, the patient may have a weak pulse and low blood pressure. When pressing on the abdomen with a finger, localized soreness occurs, and the muscles tense up strongly.
What to do when you find yourself experiencing symptoms?
If you have one or more of the symptoms of appendicitis, see your doctor as soon as possible. It is necessary to undergo a thorough examination in order to confirm the presence of such a disease. Based on its results, it will be clear whether surgery is required, or the reason lies not in the presence of appendicitis, but in something else.
Thank you for your feedback.
Your application is accepted.
Our specialist will contact you shortly
The cause of appendicitis is a blockage of the opening between the appendix and the caecum or a rupture of the appendix.
The most common complication of appendicitis is perforation. Perforation (perforation) of the appendix can lead to a periappendicular abscess (collection of infected pus) or diffuse peritonitis (infection of the entire abdominal cavity).
A dangerous complication of appendicitis is sepsis (blood poisoning), a condition in which bacteria enter the bloodstream and are carried to other parts of the body. This is a very serious, life-threatening complication.