Appendicitis - Causes, Symptoms and Treatment .MF .
Acute appendicitis - the most frequent surgical disease
contains a lot of paradoxes.
Rusakov VI 1975
Appendicitis - is an inflammation of the appendix (appendectomy) cecum.Appendix - a hollow body length of 7-11 cm, which departs from the dome of the cecum.Inflammation of the appendix may be acute or chronic.Therefore, in medicine emit acute and chronic appendicitis.Currently, chronic appendicitis is very rare.Such diagnosis put patients after an attack of acute appendicitis in which the appendix can not be removed because of complications (appendiceal dense infiltrate of it will be discussed below).
Causes of acute appendicitis
Acute appendicitis - the most common surgical disease.And, as paradoxical as it sounds, but to date, clear and plausible theory of its origin is not offered.There are about 17 major hypotheses to explain the development of an attack of acute appendicitis.Among the possible causes of the disease following:
• infection - the bacteria can penetrate the wall of the appendi
• Violation of the evacuation of feces, or blockage of the mouth of the appendix fecal stones, which can lead to stagnation of the content and inflammation;
• Violation diet - people who constantly consume large amounts of meat, according to some scientists, appendicitis sick more often, and with the other hand during the famine of the number of cases of appendicitis disease is sharply reduced;
• Individual features of the anatomy of the appendix - the presence of bends, the considerable length of the appendix may also cause stagnation of its contents;
• Thrombosis of the arteries supplying the appendix in humans suffering from atherosclerosis and heart disease in violation of the heart rate;
• Hereditary predisposition proven in people - carriers of certain antigens;
• Also important is the overall reduced resistance of the human body as a result of stress, alcohol, smoking.
• In women, inflammation can go to near the appendix of the uterus, so regular checkups gynecologist, prevention and treatment of gynecological diseases can reduce the risk of developing appendicitis.
patient survey with symptoms of appendicitis
diagnosis of acute appendicitis, despite the prevailing impression of lightness, is quite complex and requires professional skills.Acute appendicitis can occur in any person, regardless of gender and age, it occurs most severely in infants and the elderly.Appendicitis is called "monkey all diseases" because it can masquerade as any pathology in the abdomen.So often so difficult to make a correct diagnosis.Very similar to the symptoms of acute appendicitis following diseases: renal colic, acute cholecystitis, right-adnexitis, enterocolitis, gastric ulcer and duodenal ulcer (especially in ulcer perforation, when an opening is formed in the wall of the stomach or intestine), strangulated inguinal, femoral and umbilical hernia, inflammation of the Meckel diverticulum.In children, abdominal pain may also occur in infectious diseases.
symptoms of appendicitis
In order to enable you to promptly find at this pathology and refer to a specialist in time, consider the basic signs of the disease.
attack of appendicitis is often late at night or in the morning.In the classical course of the disease is the first sign of his pain.Initially, pain occurs in the stomach, or around the navel or around the abdomen.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 a constant, a stronger, enhanced with walking, lying on his left side.
A couple of hours after the onset of pain nausea and vomiting.Vomiting is not abundant, often single, not bringing relief.There is an intestinal disorder: constipation, diarrhea, or vice versa.
After 2-4 hours after the onset of fever appears pain.The higher the temperature, the more pronounced inflammation.
Remember: severe pain caused stomach and do not pass on their own within 6 hours - a sure sign of surgical disease and require inspection by the surgeon!
First aid for signs of appendicitis
When pain you can take antispasmodic drugs , such as no-spa, Buscopan, once no more than 2 tablets.If their inefficiency is necessary to address to the surgeon.
With the sudden appearance of abdominal pain on the background of well-being can not be taken painkillers, especially such a strong analgesics as nonsteroidal anti-inflammatory drugs.These include analginum and analginsoderzhaschie drugs (baralgin et al.), Ketorol, ketanof, ketorolac, nimesulide, indomethacin and others. They can lubricate the picture of the disease that your doctor will not give the correct diagnosis.
unacceptable use of heaters, compresses on her stomach - this will only increase inflammation.It is impossible for suspected acute appendicitis treated folk remedies or apply antibiotics.The latter also distort the clinical picture of the disease.
Do you have these symptoms, which are not held for 6 hours?It is necessary to cause a brigade ambulance, which will take you to the nearest surgical hospital where you will be examined by a surgeon.Eating before a doctor can not inspection.
Treatment of acute appendicitis
What will I do in the hospital?For a start will have to pass a general analysis of blood and urine, which will be ready in 15-30 minutes.After inspection of the surgeon, you will need to tell your complaints, history of the disease, it is necessary to undergo abdominal ultrasound (US).Girls and women are usually sent for consultation to the gynecologist to rule out adnexal disease.
Note: at this stage the most reliable method of diagnosis - a survey of the surgeon, but it may be suspected appendicitis.The rest of the diagnostic methods are complementary, even the US does not always give an opportunity to see the appendix.
After the examination, if the doctor had the suspicion of appendicitis, hospitalization in a surgical ward.If the picture is fuzzy disease, you may remain under observation, as well as perform a laparoscopy.Laparoscopy - a diagnostic method, and when the puncture is introduced therethrough into the navel region under local anesthesia in the abdominal cavity of the apparatus - a laparoscope, which makes it possible to visually inspect the appendix.
Surgical treatment of appendicitis
If the picture of the disease is not in doubt, it is necessary to perform an operation - appendectomy (removal of the appendix).It is the only treatment for appendicitis.The operation for acute appendicitis is performed under general anesthesia.You can remove the appendix through a laparotomy when performing a classical incision in the right iliac region, and laparoscopically through three small incisions.The latter method is preferable, since rehabilitation (recovery) period after surgery is much shorter.
After surgery in the absence of complications the first 12 hours you need to comply with bed rest and not eat.Over the next 12 hours it is possible to turn the bed and sit in drinking water with lemon small portions every 2 hours if no nausea.On the second day after surgery in consultation with your doctor, you can get up and walk.Active motor mode - the key to a speedy recovery and prevention of blood clots in the veins of the lower extremities.The possibility of eating too need to ask your doctor.Remember that for you to receive the main indicator of food is hunger, lack of nausea, carminative and the appearance of the chair.These signs indicate recovery of bowel function.
On the second day after the operation should take liquid food (1% yogurt, juices, oatmeal, low-fat cottage cheese, baby food) in small portions, up to 6 times a day, focusing on their own feelings.On the third day after surgery, you can take in food boiled chicken meat, low-fat soup broth, meatballs steamed in small portions at a normal state of health.With 8 days, you can eat normally.
sutures are removed 7-8 days after surgery.
After 1.5-3 months after the operation, you can play sports (swimming, running, jumping, riding, sport dances, exercises on the crossbar, and others.).From heavy exercise (weightlifting) should be avoided for 3-6 months.These restrictions are necessary for the formation of dense scar in order to avoid the formation of hernias at the incision site.Connective tissue, which consists of a scar, acquires the necessary strength for 3-6 months.
disability terms vary depending on the nature of the inflammation process, and complications from 16 to 40 days.
Possible complications of appendicitis
Do not underestimate the severity of acute appendicitis.Until now, there are cases of fatal disease.Inflammation of the appendix is dangerous for its complications.After 12 hours from the onset of the disease the inflammation encompasses the entire thickness of the wall of the appendix, and 24-48 hours is its destruction and rupture of the intestinal contents into the free abdominal cavity.If this happens, it is possible to develop the following consequences.
• Periappendikulyarny abscess, and abscesses in the abdominal cavity - formation of abscesses around the process, between the loops of intestines, in the pelvis, under the diaphragm, accompanied by high fever and chills.
• Peritonitis - inflammation of the peritoneum (the most thin skin covering the outside of all organs and the inner surface of the abdominal wall), which can lead to the development of sepsis (blood poisoning) and death.
• Appendiceal infiltration - an attempt to isolate the organism sore body from the abdominal cavity.This formation around the appendix, consisting of soldered thereto bowel loops and strands of the greater omentum.It may be rocky density.Remove the appendix of this dense conglomerate impossible.Prescribe antibiotics, physiotherapy, due to which infiltrate or dissipates, or turns into an abscess.When resorption of infiltration is a routine appendectomy in 4-6 months.With the development of an abscess drained him or under ultrasound guidance under local anesthesia or standard incision in the right iliac region is under general anesthesia.
• pylephlebitis - an inflammation of the main (portal) vein of the liver due to getting into the emboli with microorganisms from the veins of the appendix, which leads to disruption of the liver and death.This is the most severe complication of acute appendicitis recovery cases is not known by him.
The only way to prevent these complications of acute appendicitis is the earliest reference to the surgeon within the first 6-12 hours after the onset of pain!
As the great Russian surgeon and diagnostician Ivan Grekov: "Acute appendicitis is not found where the thought of him, and find out where the existence of it do not even know."So take care of your health, do not treat it carelessly.It is better to overestimate the severity of your symptoms, rather than later, seek medical attention.
Surgeon Thews DS