Appendicitis acute

Appendicitis acute - nonspecific inflammation of the appendix of the cecum.

Symptoms, course. The clinical manifestations of acute appendicitis depend on the nature of the morphological changes in the process, its location, the age of the patients, the nature of the complications that have joined. The initial symptom of the disease is a sudden dull pain without a clear localization in the upper half of the abdomen or the navel area. After A-6 h (with fluctuations from 1 to 12 h) the pain moves to the right iliac region. Changing the localization of pain with the appearance of pain in the right iliac region indicates the alarming appearance of somatic pains caused by irritation of the visceral peritoneum (ie, inflammation captured all layers of the appendix wall). The localization of pain depends on the location of the appendix: in a typical position, the patient feels pain in the right iliac region, in a high position - almost in the right upper quadrant, in a retrotic position - on the side of the abdomen or in the lumbar region, at the pelvic position - above the pubis. Nausea is a common symptom of acute appendicitis, sometimes, especially at the onset of the disease, vomiting is possible. In most cases the stool is not broken. When the process is located next to the blind or rectum or among the loops of the small intestine, the inflammation can spread to the intestinal wall, which leads to the accumulation of fluid in the lumen of the gut and diarrhea.

The tongue at the beginning of the disease is moist, often covered with white print. Freely lies on the back or right side; Changes in the position of the body, coughing, laughing, sneezing dramatically increase pain in the abdomen. When examining the abdomen, lagging of the right lower quadrant of the abdominal wall may be noted during breathing. When palpation, muscle tension and sharp soreness in the right ileal region are detected. Here, positive symptoms of irritation of the peritoneum (symptom of Schetkin-Blumberg, Razdolsky, Voskresensky) can be determined. There are no pathognomonic symptoms of acute appendicitis, all symptoms are caused by local peritonitis. Pain usually increases when the patient is on the left side (Sitkovsky's symptom), especially when palpation (the Bartome-Michelson symptom). With retrocalculus, the process may have a positive Obraztsov symptom-a painful enhancement when lifting a straightened right leg. This symptom should be checked very carefully, because with rough pressure on the abdominal wall, perforation of the appendix is ​​possible. The temperature is often increased to subfebrile digits. In the blood-leukocytosis with a shift of the formula to the left. When finger examination of the rectum or vaginal examination, pain is noted when palpation of the right pelvic wall (especially in the pelvic position of the shoot). The presence of erythrocytes and leukocytes in the urine does not exclude acute appendicitis.

The diagnosis of acute appendicitis is typical in typical cases, but atypical location and features of the inflammatory process sometimes make it extremely difficult to diagnose the disease. Differential diagnosis is carried out with pyelitis, renal colic (see Urolithiasis), acute adnexitis, ectopic pregnancy, acute enteritis, mesadenitis, diverticulitis, acute cholecystitis, acute pancreatitis, perforated ulcer of the stomach and duodenum, right-sided pneumonia, shingles, etc.

There are acute simple and destructive appendicitis. In the latter case, the symptomatology of acute appendicitis is more pronounced: pain is stronger, the symptoms of irritation of the peritoneum are more distinct, the leukocytosis and temperature are higher. However, the clinical picture of the disease does not completely correspond to the character of the detected morphological changes in the process.

The course of acute appendicitis in children, the elderly and pregnant women has its own characteristics. In children, underdevelopment of a large omentum and hyperergic reaction of the body lead to a rapid progression of the inflammatory process and the development of peritonitis. Diagnosis of acute appendicitis in children in the initial stage of the disease is difficult: nausea, repeated vomiting, high fever, diffuse abdominal pain, and therefore often allowed diagnostic errors. In the elderly, a decrease in the reactivity of the organism causes the erasure of the clinical symptoms of the disease, which may be the cause for delayed diagnosis and hospitalization. Hence the prevalence of destructive forms of acute appendicitis and, quite often, appendicular infiltrates. In pregnant women, the displacement of the dome of the cecum and the appendix in the womb leads to a change in the typical localization of pain, and the location of the appendage behind the uterus reduces the severity of peritoneal symptoms.

Treatment operative. The operation is shown not only in every case that is clear from the diagnostic point of view, but also with a reasonable suspicion of acute appendicitis, if it is impossible to exclude acute inflammation of the process on the basis of clinical signs and special research methods (including laparoscopy). With pronounced signs of peritonitis, it is advisable to introduce antibiotics (aminoglycosides) and metronidazole before the operation. In lean patients of a young age, appendectomy is usually performed under local anesthesia with 0.25-0.5% solution of novocaine. In severe pain in patients with unstable psyche, children, pregnant women, elderly and senile patients, general anesthesia should be preferred.