Symptoms of appendicitis
Inflammation of the appendix of the cecum is called appendicitis. The disease is characterized by a variety and complexity of symptoms. The text contains information about what you need to know about appendicitis, how to independently determine the signs of appendicitis, what symptoms the doctor pays attention to in the differential diagnosis of the disease. The features of appendix symptoms in men, children, women, including pregnant women are shown.
- What is appendicitis?
- Where is appendicitis located?
- Causes of appendicitis
- The first symptoms of appendicitis
- The most dangerous symptoms
- Clinical study of appendicitis
- Appendicitis in women and men
- Appendicitis in children
- Appendicitis in the elderly
- Appendicitis in pregnant women
What is appendicitis?
Appendicitis is a common diagnosis of surgical pathologies. Inflammation of the appendix is more often diagnosed in women between the ages of 20 and 40. The incidence of men of the same age is two times lower. Between the ages of 12 and 20, boys and young men are more likely to get sick.
The main method of treatment for the acute form of the disease is surgical removal of the appendix (appendectomy).
! More than a million such surgeries are performed in the country every year. Complications at the stages of treatment are detected in about 5% of operated young people and 30% of elderly patients. The main cause of complications is peritonitis.
If you do not carry out active therapy, peritonitis in the acute form develops within one to two days.
Complications are, often, the result of a person's vague idea of dangerous signs of appendicitis, delay, delay in the time to see a doctor, arrogance for a favorable outcome of pathology after removing unpleasant sensations.
Appendicitis is an insidious disease
It is manifested by pain in the abdomen, high fever, nausea, vomiting, bowel disorder (diarrhea or constipation). Similar symptoms are observed with:
- intoxications, poisoning;
- infections, inflammation of the gastrointestinal tract;
- infections, inflammation of the female, male genital organs;
- inflammation, infections of the kidneys, ureters, bladder;
- painful female cycles, ectopic pregnancy, menopause;
- obstruction of the duodenum;
- ruptures of the arteries of the abdominal cavity, others.
In medicine, there is a term - `` acute abdomen syndrome '', which combines pathological conditions accompanied by pain in the abdominal cavity, intoxication, and an increase in body temperature.
The variety of acute abdomen syndrome makes the diagnosis of appendicitis a difficult medical task. During the period of diagnosis, the doctor, depending on the gender, age of the patient, must exclude signs of infectious, urological, gynecological, obstetric, male, children's, and other pathologies. The unstable location of the organ in the abdominal cavity adds complexity. In different people, the appendix is determined in different projections of the abdominal wall. The anatomical feature is manifested by a variety of outgoing pain points.
Where is appendicitis located?
Almost every adult knows the location of internal organs in the body - heart, liver, kidneys, lungs. It is more difficult to determine the localization of the parts of the gastrointestinal tract. The total length of the human intestine, compactly located in the abdominal cavity, is 4-5 meters. Topographic landmarks of the projection of the appendix are found inside the crosshairs of two imaginary lines:
- horizontal, from the navel and around the abdomen;
- vertical, from the right breast nipple and down.
The area of the abdomen to the right of the vertical and below the horizontal line to the groin and right leg is the right iliac region. The right iliac breath is considered the most likely place of projection onto the abdominal wall of the appendix.
Unfortunately, this is not the only location for the appendix. Due to the long mesentery, the appendix can be displaced, some distance, from its normal position. Before the operation, using ultrasound, the doctor determines the location of the organ and the optimal access to it. The location of the organ is important to the surgeon and almost irrelevant to the patient.
Useful: How to identify appendicitis in yourself?
Causes of appendicitis
Until now, there is no common understanding of the causes of appendicitis. Why does only a part of people suffer from inflammation of the appendix? Several theories have been proposed for the causes of appendicitis.
The most common is an infectious factor. In acute appendicitis, pathogenic strains of Escherichia coli, Staphylococcus aureus, Streptococcus, and other pyogenic bacteria are isolated. Under normal conditions, they are normal intestinal dwellers. They become pathogenic as a result of the action of concomitant external or internal causes.
The main factors provoking the development of microflora with appendicitis:
- blockage (narrowing) of the lumen of the appendix - congenital anomalies (bends, narrowings), neoplasms, fecal stones, foreign bodies);
- vascular reactions, defects in the blood vessels feeding the intestinal wall, which reduce the blood supply to the walls, causes blood stagnation and further necrosis of the appendix;
- neurogenic reactions, slowing of the peristalsis of the intestinal walls, accompanied by abundant mucus formation, acute expansion of the intestinal lumen.
Appendicitis develops more often in people suffering from: constipation, diseases of the cardiovascular system, some infectious diseases (intestinal forms of tuberculosis, amebiasis, other infections). In men, appendicitis may be evidence of bad habits, latent pelvic infections. It can be the result of gynecological inflammatory diseases in women. In children, it develops against the background of congenital narrowing of the lumen of the cecum, severe tonsillitis.
Distinguish between acute and chronic forms of appendicitis. The most common form of inflammation of the appendix is acute. It manifests itself with pronounced symptoms. The chronic form is rare, the symptoms are erased.
Experiments in Spain have shown that 40% of cases of acute appendicitis were caused by fried seeds and chips. As a rule, children under 14 suffer
The first symptoms of appendicitis
The symptoms of appendicitis are manifested mainly by severe abdominal pain. The usual pathogenesis of appendicitis is manifested by the following sequentially developing symptoms: pain, nausea, vomiting, fever, dyspepsia.
Details about each symptom in the debut of appendicitis.
- Sudden pain in the solar plexus area or above the navel is the most common first symptom of acute appendicitis. During this period, pain in the abdomen is also possible without a specific localization. It is characterized by pains of varying intensity (strong, weak) and character (constant, intermittent). Further, there is a shift in the accent of pain to the right sigh, that is, to the area of the topographic projection of the appendix. The nature of the pain, constant, moderate intensity, aggravated by coughing, movement, change in body position in space.
- Nausea and vomiting. Vomit consists of previously eaten food mixed with bile. Vomit with an empty stomach in the form of liquid, yellow mucus. Vomiting with appendicitis develops as a reflex to pain, accompanied by a decrease in appetite, more often once.
Fever. A frequent companion of appendicitis is an increase in body temperature. Usually it does not rise above the indicators of febrile fever (37.0-38.0 0 C).
- Dyspepsia. The increase in intoxication is accompanied by a disorder of the act of defecation - dyspepsia in the form of constipation or loose stools. Dyspepsia occurs against the background of frequent urination, the result of the involvement of the bladder in pathogenesis. The color of the urine is intense, dark.
The insidiousness of appendicitis can manifest itself as a debut with a priority of other symptoms, against the background of a weak pain reaction. In addition, the pain can subside under the action of pain medications, as well as with necrosis of the wall of the appendix.
Dangerous symptoms of appendicitis
Despite the obviousness of pain in the abdomen with appendicitis, difficulties arise with the diagnosis.
Dangerous symptoms with appendicitis
Dangerous, with appendicitis, symptoms can be:
- distracting from the underlying disease;
- beginning peritonitis.
In women, pain accompanies many inflammatory gynecological pathologies, in children - intestinal infections, colic. Clinical signs, with stomach ulcers, inflammation of the pancreas, gallbladder, and other pathologies of the abdominal cavity and pelvic organs, also resemble the symptoms of appendicitis.
With the help of diagnostic methods, the doctor can easily distinguish the source of the pain. To facilitate the doctor's work, inform him about previous illnesses, unusual manifestations of the body during the period of the disease, including those not related to the main pathogenesis, for example:
- previously transferred genital infections - a possible hidden microbial focus in the body - an appendicitis provocateur or a source of inflammation of the genitourinary organs;
- prolonged absence of menstruation in a woman is a possible sign of an ectopic pregnancy;
- black feces - a sign of gastric or intestinal bleeding of a perforated ulcer;
- belching, heartburn, gas, bulky feces - a sign of inflammation of the pancreas;
- vomit without bile is a sign of cholecystitis or gallbladder blockage.
The danger of these symptoms is that they distract from the correct diagnosis, direct the doctor down the wrong path of diagnosis, and lengthen the time of diagnosis. Another group of symptoms indicates a serious condition of the patient - peritonitis (inflammation of the abdominal wall) with appendicitis.
The most dangerous symptoms are:
The most dangerous symptoms are:
- pain that subsided for several hours - may be associated with a rupture of the walls of the appendix inside the abdominal cavity, a subsequent sharp increase in the intensity of pain, cannot be stopped - evidence of peritonitis;
- constant vomiting, and vomiting itself does not bring relief to the patient;
a sharp increase in temperature above 39 0 С, or vice versa, a rapid drop to critically low values;
- muscle tension, soreness at the time of touching, tapping the skin of the abdomen;
- altered consciousness (confusion, delirium, fading reflexes).
Clinical study of appendicitis
Pain with appendicitis
Despite the variety of symptoms, pain is the most stable sign of appendicitis, it almost always accompanies the disease. The characteristic of pain is important in the differential diagnosis of appendicitis. The doctor finds out the location, nature, duration, intensity, time of onset of pain.
To avoid distortion of the clinical picture, it is impossible to anesthetize the sick person before examining the doctor.
- Localization of pain. Many diseases are accompanied by unpleasant sensations in the form of pain. By its localization, it is determined which organ is affected. Pain with a clear source of impulses, if the organ is close to the peritoneal wall. Therefore, kidney inflammation is more often felt in the lumbar region, heart - in the left side of the chest. In acute appendicitis, the examinee, as a rule, cannot show himself where the pain is localized. Another important diagnostic sign is the displacement of pain of unclear localization in 3-4 hours to the right iliac region.
If pain is immediately felt in the right iliac sigh, then the appendix is located in a close projection. If the appendix in the abdominal cavity is displaced, indirect methods are used. Diagnostic techniques are based on identifying an excessive pain response to a weak effect (touch, tapping) of a certain point.
With uncomplicated appendicitis, increased pain appears if the patient tries to suck in the stomach while lying down, and also if you press with your fingers:
- on the stomach in the area of the right ilia;
- at several points, to the right of the navel;
- at several points along a diagonal line from the umbilicus to the right iliac tubercle (this is the bony protrusion of the pelvic bones defined in front in the iliac region).
With appendicitis, the patient experiences pain during bowel movements in the anus, raising the right leg, right arm, taking a deep breath, and coughing. In the position of the patient lying on his back - pain is felt in the right sigh, a change in position to the left side - the source of pain shifts to the navel;
Dangerous signs of appendicitis are increased soreness with light pressure with fingers in the navel, palpation of the abdomen is determined by muscles in the form of tense cords. In a laboratory study of blood, an increase in the number of leukocytes above 14 thousand is revealed. Leukocytes are a marker of inflammation, almost always, with any acute process, the number of leukocytes participating in the body's immune defense increases. A low white blood cell count (leukopenia) is a sign of a depleted immune system. These are signs of peritonitis - inflammation of the abdominal wall.
Localization of inflamed appendicitis is always confirmed by instrumental studies (ultrasound) of the abdominal cavity
Reflected pain. With appendicitis, pain is sometimes diagnosed that is manifested far from the inflamed organ. Irradiating (reflected) pain is diagnosed when:
- appendicitis - in the right leg, also pay attention to the appearance of right-sided lameness;
- pelvic appendicitis - given in men, boys to the scrotum, its location closer to the back - given in the same place;
Within 1-2 days, necrosis develops with a high probability of rupture of the wall of the appendix. In the first hours after the spread of purulent contents into the abdominal cavity, the pain disappears, and an imaginary recovery occurs.
The second wave of pain is intense and is associated with the development of inflammation of the peritoneum. Peritonitis, without treatment, lasts seven to ten days, often ends with the death of the patient. During treatment, adhesions of internal organs may form, which cause constant pain.
- The intensity of the pain. Pain is a subjective sensation that depends not only on the strength of the traumatic factor, but also on the individual characteristics of a person. Appendicitis is characterized by sudden, intense pain. In some cases, an erased picture of pain is possible. The intensity of pain cannot serve as a criterion for appendicitis. More important is the combination of pain with other symptoms, high fever, nausea, vomiting, dyspepsia. The intensity of pain is high, in young people, it is often accompanied by forced postures, irritability, headaches.
- spontaneous pulling up of the right testicle with palpation of the abdomen in the right iliacus, cessation of feeling the area of greatest pain - the testicle descends, both testicles with pressure on the abdomen;
- pain in the right testicle with slight pulling of the scrotum;
- in the lying position on the right side - a consequence of the pressure of the uterus on the focus of inflammation;
- in the supine position with pressure on the left rib;
An attack of acute appendicitis is accompanied by signs of nausea, then vomiting. Vomiting, with appendicitis, has a reflex nature, coincides with the peak of pain. As a rule, it occurs in the first hours, therefore, the phenomena of intoxication do not have a significant effect on this symptom. For appendicitis, single vomiting is characteristic. Recurrent bouts of vomiting are characteristic of the body intoxication. This is an important sign for the prognosis of the disease, indicating the severity of the pathogenesis that threatens human life. Vomiting is accompanied by an increase in body temperature.
Febrile type fever (37-38 ° C) is a characteristic symptom. More often appendicitis occurs against a background of moderate hyperthermia. Fever with appendicitis is an important symptom for differentiating from other similar diseases. With intestinal, renal colic, the temperature is within normal limits or below. Sometimes an interesting phenomenon is observed when the temperature measured with an ordinary mercury thermometer on the right side is 0.5-1.0 0 C degrees higher than the temperature determined in the left armpit. It is better to try to measure the temperature in the armpit and immediately afterwards - rectally. The differences are clearer.
Appendicitis in women and men
Appendicitis in men
The symptomatology of this category of patients does not differ. Under the age of twenty, young men and boys are more likely to get sick. It has been noticed that ruptures and necrosis of the caecum of the intestine are more often diagnosed in men.
Diagnostic techniques for detecting signs of appendicitis in boys and men are manifested:
Appendicitis in women
Women over the age of twenty are more likely to get sick. In girls twelve years of age and older, during clinical examination, it is imperative to take into account the gynecological status. Acute pain can be caused by painful periods in adolescent girls. In women, inflammation of the appendages, ovaries, ectopic pregnancy, miscarriage, and kidney disease should be excluded.
Appendicitis in children of the younger age group
A child of the younger age group does not allow research, cannot explain pathological sensations, pain is accompanied by continuous crying and fear. This confuses the diagnosis of appendicitis.
The disease manifests itself as an acute onset. Pain in the right iliac zone is determined using a simple technique - try to bend the child's right leg at the knee. A weak attempt, manifested by a strong reaction. Another diagnostic technique is that after removing the examiner's hand pressing on the abdomen, a strong painful response occurs in the right iliac zone. When palpating, the abdomen is tense, but not swollen due to gas formation.
The child refuses to get up, prefers to lie down and move less. The pain increases with movement, running, jumping. When standing, a forced posture is noted in order to relieve pain on the right side of the body. Vomiting, unlike in adult patients, occurs as a result of intoxication, and is not caused by severe pain. In a child, vomiting may be the first symptom of appendicitis, preceded by pain.
The final diagnosis can be made by a doctor based on instrumental and laboratory research methods.
In small children, when appendicitis is often noted, pulling the right leg towards itself is noted. Symmetrical palpation of the abdomen is manifested by a violent reaction to touch on the right side. You can apply other similar methods for determining the location of pain.
Clinical symptoms of appendicitis in children
The high temperature is 38-39 0 С, the pulse is quickened, the tongue is coated - they resemble signs of infection. Diarrhea and vomiting add complexity to the study. In the absence of signs of intestinal upset, gases pass freely. Sometimes the temperature is normal. In this case, one of the causes of pain may be intussusception of the small intestine. Intussusception is the entry of the intestine into the intestine, found in children. As a result of intussusception, a cuff forms on the intestines, causing severe pain, bloating, obstruction, and vomiting. The success of the diagnosis depends on the doctor's attention to detail.
Infection may be indicated by enlarged lymph nodes and a rash on the skin and mucous membranes. In severe cases, consultation of a pediatric infectious disease specialist, express methods of laboratory blood tests are required.
Related article: How to recognize appendicitis in children?
Appendicitis in a child 5 years and older
From about this age, the child is able to describe pathological sensations at a primitive level. The clinical picture is the same as in children of the younger age group.
The initial signs of appendicitis in a child. The localization of pain is indicated by the forced postures of the child, the tension of the abdominal wall when palpating on the right side of the abdomen in the iliac region. Gentle, right side, gait, holding the right iliac region with the hands. Do not try to relieve pain with medication by applying a cold compress to the affected area.
By palpation, soreness, tension of the abdominal wall on the right side is established. Differential diagnosis is carried out in order to exclude: scarlet fever, measles, tonsillitis, helminthic invasions, invaginations of the small intestine. The localization of pain is determined using indirect methods that are used in the diagnosis of appendicitis in adults.
Attenuation of pain can be a formidable symptom of perforation of the appendix. Vomiting precedes nausea, more often it is single.
Appendicitis in the elderly
It manifests itself as a calm debut. The general condition is satisfactory. Pain in the right iliac zone, often diffuse, of unclear localization, not intense. The temperature is normal or slightly increased.
Possible intestinal paresis introduces confusion in the diagnosis. Intestinal paresis is a condition when the intestines cease to function, manifested by the phenomena of obstruction (vomiting, absence of defecation, intestinal distention). Vomiting in this case occurs every time after eating. Vomit contains undigested food. The diagnostic methods used to locate pain are unclear.
The blurring of the signs of the disease does not mean an easy pathogenesis. In older age groups, complications and deaths are more common.
Appendicitis in pregnant women
In the first months of pregnancy, the difficulty in diagnosis is at the usual level. Diagnostic difficulties arise after the fourth month of gestation, when the enlarging uterus displaces the intestinal loops. Usually the appendix is displaced to the top, closer to the liver. Therefore, it becomes difficult to differentiate appendicitis and inflammation of the biliary tract of the liver. Sometimes appendicitis during pregnancy radiates to the area of the right kidney. The abdominal wall is tense as a result of the stretching of the uterus, therefore, palpation is not an effective diagnostic technique during pregnancy.
Diagnosis of appendicitis in a pregnant woman is a difficult task, characterized by many nuances.
Clinical methods for diagnosing appendicitis in pregnant women are manifested by pain:
During this period, it is preferable to use effective methods of instrumental diagnostics of ultrasound, MRI, radiography (introduction of contrasting pharmacological agents for X-rays into the cavity under study). When the acute form of appendicitis is confirmed, urgent surgery is indicated. The gestational age in this case does not matter. The priority in the operation is preserving pregnancy.
More information on appendicitis in pregnancy
List of used literature
Source: "Acute appendicitis" - Evgeny Achkasov 2018
Source: "Clinic and treatment of acute appendicitis" - Vasily Kolesov, 2012
Source: "Diagnostic and tactical errors in acute appendicitis" - Igor Rotkov, 1988
Source: "Guide to Emergency Abdominal Surgery. A Guide for Physicians" - Victor Savelyev, 2014
Source: "Fundamentals of pathology of diseases according to Robbins and Cotran. In 3 volumes." - Vinay Kumar, Aboul K. Abbas, Nelson Fausto, John C. Astaire, 2016
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.