Appendicitis: diagnosis, treatment. Differential diagnosis of acute appendicitis

Inflammation of the appendix is a disease that many of us know only by hearsay. Among the symptoms that are all heard - acute pain in the abdomen. However, one symptom of the disease is not limited to one. And in cases where appendicitis occurs in an elderly person, there can be practically no pain. It is very important to pay attention in time to other symptoms of appendicitis in yourself or a loved one and immediately consult a doctor and provide timely qualified help. Appendicitis, diagnosed with a number of studies, can lead to peritonitis, which, in turn, can be the cause of death.

Causes of appendicitis

Doctors can not give an exact answer, why some people have an appendix inflamed. However, there is an opinion that the development of the disease is triggered by problems with the intestines, stool stones, helminthic invasions, constipation, pregnancy and abnormalities of the process. Malnutrition can also provoke inflammation of the appendix of the cecum. No wonder in childhood we were told that dirty seeds can lead to an operation to remove appendicitis.

In any case, it is impossible to protect yourself from appendicitis. With a terrible diagnosis, the hospital gets into the hospital, like newborn infants, both retired and healthy young people. Appendicitis, whose diagnosis consists in differentiating the disease from a number of other health problems, requires immediate surgical intervention.

Stages of appendicitis development

Inflammation of the appendix has its beginning and logical conclusion. Acute appendicitis, the diagnosis of which includes a number of measures to identify the problem and differentiation of the disease, passes several stages, each of which smoothly passes into the next. It:

• Appendicitis is catarrhal. At this stage, the inflammatory process affects only the vermicular appendix.
• The superficial stage is characterized by progressive inflammation with primary damage to the mucous membrane. During this period, leucocytes and blood are found in the lumen of the appendage.
• At the phlegmonous stage, the entire appendix is inflamed, including the outer shell of the appendage.
• The phlegmonous-ulcerative stage is characterized by the appearance of ulcers on the mucosa of the appendix.
• The last stage is gangrenous, characterized by necrosis of the appendix walls and breakthrough of its contents into the cavity of the peritoneum.

Given that from the onset of inflammation to the stage of peritonitis occurs only two to four days, it is worthwhile to see a doctor who will use all methods of diagnosing appendicitis if the first symptoms of the disease are found.

Common symptoms of acute appendicitis in adults

Like any other disease, the inflammation of the appendix of the cecum has its own symptomatology. The general symptoms of acute appendicitis depend on the stage of inflammation, the location of the process and even the age of the patient. At the first stage of acute appendicitis development there is nausea, single or multiple vomiting, which, unlike food poisoning, does not bring any relief. The person begins to complain of a strong weakness and a feeling of malaise, loss of appetite and some problems with defecation. Diagnosis of appendicitis in adults at this stage is almost impossible, because such disorders are typical for a number of acute and chronic diseases.

The next stage is a tongue-wrapped tongue, first wet, then dry. The temperature of the patient rises to 38 degrees, and rectal above the body temperature is not by 1, but by several degrees. Pelvic location of the process leads to the appearance of a loose stool; The appendix, located in close proximity to the bladder, causes urination disorders. Loss of appetite, including anorexia, is noted in 90% of cases of inflammation of the process of the cecum. If the patient continues to eat normally, then, most likely, differential diagnosis of acute appendicitis is required, which will allow to detect another disease with similar symptoms.

Local Symptoms

Given that the common symptoms are characteristic of a number of other diseases, it is very difficult to make an accurate diagnosis in the first hours. However, after 4 hours, the local symptoms join the general symptoms, allowing differentiation of the inflammation of the appendix and providing the necessary medical care to the patient. It:

• Aching is a dull pain. And the pain becomes palpable before the development of symptoms of a general nature. It is localized either over the entire abdomen, or in the peri-ocular or right iliac region. In the pelvic position of the appendage, pain occurs over the bosom, and in the prehepatic - in the hypochondrium. But more often doctors face the so-called Kocher's symptom, when the painful sensations in a few hours from the epigastric region move to the right iliac region.
• Gradually the pain progresses and from the aching becomes acute, sometimes giving back to the genital area, the lower back or the right thigh. Especially bright the patients feel unpleasant sensations during movement or coughing. Often, doctors ask the patient to cough to determine exactly the nature and location of pain localization.
• Has the pain abruptly receded? This is also one of the symptoms of the disease, which indicates the necrosis of nerve cells in the process. And the symptom is really formidable, preceding the worsening of the patient's condition and peritonitis.
• The peritonitis is also indicated by the tension of the muscles of the abdominal wall (in the case of the retrocecal location of the process, the muscles of the loin are strained). When you touch the abdomen, the muscles contract reflexively, demonstrating that the inflammation has reached the visceral peritoneum.
• There is hypertension of the skin in the right iliac region.
• The muscles of the right side of the abdomen seem to lag behind when breathing, which indicates muscle tension.
• In thin patients, the navel is slightly shifted to the right side.
• Diagnosis of appendicitis at home involves palpation. It is enough to press on the iliac region and sharply tear off the brush - the pain will immediately increase.
• Rectal examination with appendicitis reveals the soreness of the rectum. More precisely, its front wall.

Additional diagnostic methods at home

To identify pathological reflexes and differentiate the disease, such methods are also used:

• The symptom of Dubois is a painful sensation when pressing on the occipital points of the vagus nerve.
• The symptom of Moscow is the dilated right pupil.
• Also, there are points in the abdomen, pressing on which causes an attack of pain in appendicitis. But their exact location is known only by a doctor, so it is worth waiting for the arrival of an ambulance team.

Appendicitis in children

The difficulty in diagnosing appendicitis in children is that they can not tell about their feelings because of their age. In this case, the younger the child, the more rapidly the disease progresses. Almost all the symptoms of children's appendicitis are common, which is why for any of them it is necessary to contact a specialist. At first the child changes his habitual behavior, ceases to actively move, becomes listless and apathetic. Later, other symptoms appear, which make it possible to differentiate the disease.

Newborn babies abandon the breast or bottle, the fontanel sinks, the tongue becomes dry. There must be strong tension in the iliac region. Diagnosis of acute appendicitis in children is also in monitoring the position of the child. Usually babies lie on the right side with bent knees. Older children can sit, leaning forward.

When palpation by a doctor of the right iliac region, the child instinctively pulls the right leg to the abdomen and pushes the doctor's hand away from him. Diagnosis of appendicitis in preschool and schoolchildren always includes the question "where exactly does it hurt?". Traditionally, the child shows the navel area. With the course of the disease, pain can move to the area of the inflammatory process. Lethargy, nausea, vomiting, constipation preceding the onset of pain, tachycardia and fever are also symptoms of inflammation of the appendix.

Acute appendicitis in expectant mothers

Pregnant women are not immune from such an unpleasant disease as appendicitis. Diagnosis is complicated by the fact that common symptoms, such as abdominal pain, nausea and vomiting, are characteristic of toxicosis in the initial stages of pregnancy. With the growth of the uterus, the development of the symptoms of the disease becomes more difficult. Some methods of diagnosing acute appendicitis in the second and third trimesters can not give a result. For example, the symptoms of irritation of the peritoneum are not determined, the pains are localized not in the right ileal region, but above, palpation is ineffective due to the covering uterus of the growing uterus. Because of this aching, dull or cramping pain can be mistaken for the symptoms of an impending miscarriage.

Given the difficulty in diagnosing appendicitis in pregnant women, it is necessary to immediately go to an in-patient examination and pass all the necessary tests to accurately determine the nature of the problem, without harming neither the future mother, nor her baby. Suspicion of appendicitis? Differential diagnosis will help to make sure the diagnosis is correct or to refute it. Modern medicine allows you to remove the appendix during pregnancy without harm to health. The main condition for success is timely diagnosis and prevention of complications such as peritonitis. Unfortunately, in the case of phlegmonous or gangrenous appendicitis , caesarean section is required. Only after that it is possible to remove the appendix, clean the abdominal cavity and save the woman.

Appendicitis in old age

Appendicitis, which occurs in elderly people, is most dangerous. This is due to the erasure of almost all the symptoms of the disease. The pain syndrome is poorly expressed, there are practically no dysuric and diarrheal disorders, the temperature remains normal. Do not notice in older people and characteristic for attacks of acute appendicitis tachycardia, an increase in ESR and leukocytosis. Because of the age flabbiness of the abdominal wall, there is no protective reaction from the muscles of the abdomen. This is why older patients should respond as quickly as possible to any changes in their condition. At the slightest suspicion of inflammation of the appendix, it is necessary to call a doctor who will be able to conduct a complete examination of the patient.

Complications of appendicitis

The acute form of the disease can lead to destruction of the appendix or its spontaneous amputation. In this case, purulent masses go beyond the process, which leads to local or diffuse inflammation of the peritoneum. With a reflux form, it is possible to develop an empyema, a purulent lesion that spills over the peritoneum, rectum and adjacent tissues. It forms purulent foci, reaching fatty tissue.

No less serious consequences are thrombophlebitis of the appendix, which provokes the development of septic thrombophlebitis of the portal vein and branches. This leads to a blockage of the veins of the liver and the development of purulent specific inflammations. Given such complications, appendicitis should be treated immediately, without delaying "for tomorrow" and not hoping for "maybe it will pass."

Appendicitis chronic

There is such a thing as chronic and not acute appendicitis. The clinic, diagnosis and treatment of the disease differ from the picture of acute inflammation of the appendix. As a matter of fact the chronic form is a consequence of the transferred or carried acute inflammation. In the appendix are dystrophic and sclerotic processes, accompanied by destruction of tissues. Inflammations occur and heal, forming scars and adhesions, possibly the appearance of ulcers and infiltrates. In some cases, chronic appendicitis leads to the fact that the process is transformed into a cyst, the breakthrough of which is no less dangerous than the breakthrough of the appendix itself. It is worth noting that the chronic form - an extremely rare phenomenon, observed only in 1 of 100 cases. Do you suspect chronic appendicitis? Diagnosis, treatment and subsequent drug support occurs in a hospital.

Diagnostics

Diagnosis of appendicitis at home should be as accurate as possible, since a mistake and subsequent medication, for example, from poisoning, can lead to unfortunate consequences. This will not only complicate the diagnosis, but also worsen the patient's condition. Appendicitis, whose differential diagnosis is to some extent possible at home, does not tolerate self-medication. Before the arrival of doctors, you should not take any medications or apply a warmer to the sore spot, trying to calm down unpleasant sensations. Such "care" about the patient can lead to premature peritonitis and other possible complications.

You were taken to the hospital with a preliminary diagnosis of appendicitis? US-diagnostics of appendicitis will allow to differentiate the disease and take timely measures to get rid of the problem. Also, in diagnosis, radiography of the abdominal cavity, computed tomography, irrigoscopy is used. After surgical intervention, the morphological form of the disease is specified and a histological examination is performed .

Treatment of appendicitis

Traditionally, the appendage of the cecum is relieved by surgical intervention. The most commonly used method is laparotomic appendectomy, in which the inflamed process is removed through a dissected site of the abdominal wall. With this operation, thanks to the small holes, there is practically no postoperative scars, and the use of a telescopic tube allows the surgical intervention to be as precise as possible. The duration of the postoperative period decreases, the possibility of adhesions and the development of the chronic form of the disease is minimized.

Antibiotic therapy after surgery is prescribed if there is an inflammatory effusion in the pelvis. At the catarrhal form antibiotics are not applied. The peculiar scar remaining after the operation makes it possible to accurately determine that the appendix is removed, in case of getting into a hospital with similar symptoms in the foreseeable future. This is why, during other operations in the ileum, appendicitis are always removed, even if it is not inflamed, so as not to disorient the other specialist. Appendicitis, which should be diagnosed and treated as soon as possible, is a "one-time" disease. That is why in case of repeated symptoms it is necessary to consult specialists who will be able to determine the disease with similar symptoms.