The cecum has a vermiform appendix that performs a protective function. The appendix acts as a kind of "farm" and storage of microorganisms that make up a useful microflora. Inflammation of this appendage is the most common pathology of the digestive system, requiring immediate surgical intervention.
Appendicitis - causes
The exact factors provoking the disease in question are not yet established. The specialists only suggest why appendicitis arises - the causes are classified into 4 groups according to the probable pathogens of the inflammatory process:
- mechanical;
- infectious;
- cardiovascular;
- endocrine.
Causes of acute appendicitis
The main theory of development of the described disease is the occlusion (obturation) of the appendix. This leads to the accumulation of excess mucus and microorganisms in the appendix. It increases in size, the pressure inside grows and inflammation begins. Acute appendicitis can occur on the background of blockage of the appendix scab (copious stones), swallowed foreign bodies, helminths and a tumor (carcinoid).
Sometimes the inflammatory process makes its debut because of the organ's inflexion by cicatricial fusion due to other pathologies in the abdominal cavity:
- enteritis ;
- colitis;
- adnexitis;
- cholecystitis;
- peritiflita;
- the formation of adhesions.
According to the remaining theories of the appearance of appendicitis, it develops under the influence of such factors:
- infection of the vermiform appendage with pathogenic microbes;
- systemic vasculitis;
- excessive secretion of the hormone serotonin.
Chronic appendicitis - causes
This form of the disease is a slow inflammation of the appendix, without specific symptoms. Most doctors deny chronic appendicitis as a phenomenon. Some doctors establish such a diagnosis, classifying it into a primary and secondary type. The causes of the latent inflammatory process are:
- Sluggish infections in the subordinate organ;
- cicatricial changes after acute acute disease without removal of the appendix.
Signs of appendicitis
From the timely detection of the pathology in question, the success of its treatment depends. Each person must remember which signs of appendicitis are observed first. This will help immediately to suspect an inflammation and seek qualified help. Otherwise, there will be a complicated appendicitis - the symptoms of an acute form of the disease will increase and lead to dangerous consequences. The absence of medical intervention in such situations is fraught with extremely difficult conditions, sometimes even death is probable.
The first signs of appendicitis
A typical clinical picture of the disease begins with a feeling of discomfort in the area of the stomach, mainly in the evening or at night. The first sign of appendicitis is dull moderate pain resembling gastritis. Because of the low intensity of this manifestation, a person does not hurry to go to the clinic. There are other signs accompanying appendicitis - early symptoms:
- nausea;
- vomiting (1-2 times);
- weakness;
- malaise;
- dry mouth.
Signs of acute appendicitis
After the initial stage, the pathology progresses, and its clinical picture is maximally expressed. Pain with appendicitis becomes acute, pulsating or pressing. The discomfort is felt not only in the center, but also in the lower right abdomen. Appendicitis, symptoms, becomes more evident within the next few hours:
- increase in body temperature within 37-38 degrees;
- Absolute lack of appetite (anorexia);
- persistent severe nausea;
- heart palpitations (tachycardia), up to 90 beats per minute;
- bloating;
- white coating on the tongue.
Signs of chronic appendicitis
Clinical manifestations of a slow-burning form of inflammation are nonspecific, they may be characteristic of a variety of other diseases of the gastrointestinal tract. Symptoms of chronic appendicitis:
- stool disorders, like constipation, and diarrhea;
- nausea, especially after physical exertion and inaccuracies in the diet;
- weak appetite;
- irritability;
- periodic moderate abdominal pain.
How to determine appendicitis?
Only a qualified doctor can confirm the presence of an inflammatory process in the appendix. Even knowing which side of the appendix (right lower abdomen), and where to press for physical samples, will not help accurately diagnose the disease. In some people, the subordinate organ is located in an atypical place, and incorrect palpation often provokes damage or rupture of the walls of the appendix.
There are several professional techniques for recognizing appendicitis:
- Mendel's symptom. When tapping with the finger of the anterior abdominal wall, pain in the right ileal zone increases.
- Symptom Sitkovsky. Discomfort is more intense if a person turns over on the left side.
- Symptom of Pshevalsky. It is difficult for the patient to raise his right leg.
- Symptom of Shchetkin-Blumberg. Increased pain with sharp retraction after pressure.
- Symptom of irritation of the peritoneum. Severe discomfort during sneezing, laughing, coughing, walking and bouncing.
For final confirmation of the alleged diagnosis, a number of activities are carried out:
- a blood test (clinical, biochemical), feces, urine;
- coprogramme;
- ultrasonography;
- radiography;
- Irrigoscopy;
- CT scan;
- electrocardiogram.
First aid with appendicitis
If an inflammation of the appendix of the cecum is suspected, a medical team should be called immediately. On the phone it is important to report that the patient is supposed to have appendicitis - describe the symptoms in the most detail, to clarify the condition and well-being of a person. Before the arrival of specialists, no independent attempts at treatment should be undertaken.
Emergency help with appendicitis:
- Lay the victim on a horizontal surface.
- To provide the patient peace of mind.
- Do not give water, food, medicine.
- It is forbidden to put enemas, put warmers on the stomach.
Appendicitis - operation
The only way to treat the described pathology is to excise the inflamed organ. Surgical removal of the appendix is performed with the use of anesthesia and requires preliminary preparation of the patient. On the eve of the operation, the patient is injected with physiological saline and potent antibiotics. This is necessary to reduce the intensity of inflammation and prevent infection during and after surgery. Additionally, gastric lavage and intestinal cleansing are performed.
The standard version of the removal of the appendix is laparotopic appendectomy. It is performed mainly under general anesthesia and provides direct access to the subordinate organ by cutting the abdominal wall in the right lower part. Thanks to modern medical achievements, there is another, less traumatic, method of excision of the appendix.
Removal of appendix by laparoscopic method
This method of treatment provides less blood loss, prevents the formation of large scars and adhesions in the abdominal cavity. Laparoscopic removal of the appendix ensures minimal trauma to soft tissues and skin, shortens the duration of the recovery period. According to modern studies, this type of procedure rarely causes complications.
Such a surgical intervention is the introduction into the abdominal cavity of carbon dioxide (for the organization of sufficient space and free access to the body) and flexible instruments with a microscopic chamber through several small holes. The doctor sees the appendix from the inside on the computer monitor, and gently removes the inflamed process using manipulators. The excised organ is obtained through one of the holes made.
Rehabilitation after removal of the appendix
Within 1-2 days from the time of surgery recommended strict bed rest, getting out of bed is allowed only on the 3rd day. It is necessary that the seam after appendicitis does not disperse. The next 6 weeks, the muscles will fuse, against the background of which the risk of adhesions and hernias increases. To prevent complications, physical activity increases gradually, weight lifting, active sports and hard work are excluded. Speeding up the healing and preventing divergence of sutures is helped by wearing a special bandage.
In addition to limiting physical exertion, the patient needs:
- Regularly visit the therapist and surgeon for routine examinations.
- Monitor the state of postoperative wounds.
- To process seams, to go on dressings.
- After overgrowing damage, grease scars with prescribed topical preparations.
Diet after appendicitis
Independent consumption of food is allowed only from the 3rd day of the operation. Over the next 72 hours, the diet after removal of the appendix includes exclusively liquid and mushy foods. Allowed meals and drinks:
- vegetable, not strong chicken broth;
- milk jelly;
- puree from vegetables;
- juices diluted with water;
- semi-liquid porridge;
- broth of dogrose;
- herbal, weak black tea.
From the 6th day the menu expands, you can use:
- rubbed soups;
- dairy products with low fat content;
- lean varieties of meat or fish, steamed or boiled, in a crushed form;
- porridge on the water;
- vegetable and fruit purees;
- bananas;
- bread;
- jelly.
Within 2-4 months after appendicitis, it is important to follow the weight and follow the recommendations for the formulation of the ration:
- There are often and little by little.
- Use only warm food, not cold and not hot.
- Refuse any products that contribute to gassing in the intestines - legumes, cabbage, marinades, pickles, smoked products.
- Exclude "heavy" meals - fatty meat, fish, fried foods, strong soups and soups based on them.
- Do not drink alcohol, soda.
Return to the familiar menu for the person should be gradual and slow. Experts advise to continue to adhere to standards of proper nutrition, to maintain a full and balanced diet. This will help to strengthen the immune system and restore the balance of microflora in the intestines, which was affected by the inflammatory process.
Appendicitis - complications
Negative consequences arise against the background of neglected illness or lack of adequate medical care. Complications are often observed if appendicitis was detected late - symptoms ignored at an early stage of inflammation progress and provoke its spread. As a result, the pathological process passes to nearby organs and tissues, generalized infection can occur.
After removal of appendicitis the following dangerous consequences are likely:
- peritonitis (inflammation of the abdominal cavity);
- adhesive disease ;
- internal bleeding;
- periapendicular abscess of the abdominal cavity (limited inflammation in a capsule filled with pus);
- sepsis - penetration of pathogenic bacteria into the blood;
- rupture of the appendix with the outflow of its contents, including feces and exudate, into the abdominal space;
- inflammation of the portal vein of the liver, can be purulent (pylephlebitis);
- thromboembolism - clotting of a blood vessel with a thrombus;
- phlegmon of retroperitoneal space;
- Periapendicular infiltrate (fusion of the appendix and surrounding organs);
- thrombophlebitis of the veins of the small pelvis;
- suppuration of surgical wounds;
- seam divergence;
- sluggish or chronic appendicitis.