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The symptoms of appendicitis

Inflammation of the vermiform Appendix of the cecum is called the Appendix. The disease is characterized by the diversity and complexity of symptoms. The text contains information about what you need to know about appendicitis how to detect signs of appendicitis, what symptoms to pay attention to the physician in the differential diagnosis of the disease. The features of the symptoms of the Appendix in men, children, women, including pregnant women.

Contents:


What is appendicitis?

Human appendicitis is a common diagnosis in surgical pathology. Inflammation of the Appendix is diagnosed more often in women aged 20 to 40 years. The incidence of men of the same age, in two times lower. Aged 12 to 20 years more common in boys and young men.

The main method of treatment of the acute form of the disease – surgical removal of the Appendix (appendectomy).

! Annually in the country is more than a million such surgeries. Complications in the course of treatment identify approximately 5% of operated young patients and 30% of older patients. The main cause of complications of peritonitis.

If not to the active therapy, the peritonitis in acute form develops within one to two days.

Complications is often the result of a vague picture of a man warning signs of appendicitis, delay, time delay for seeking treatment, the presumption of a favorable outcome of pathology after the removal of unpleasant feelings.

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 when:

  • poisoning, poison;
  • infections, inflammations of the gastrointestinal tract;
  • infections, inflammation of the female, the male genital organs;
  • inflammation, infections of the kidneys, ureters, bladder;
  • painful female cycles, ectopic pregnancy, menopause;

  • obstruction of the duodenum;
  • rupture of the arteries of the abdominal cavity, other.

In medicine there is a term – "a syndrome of acute abdomen", which brings together the pathological States accompanied by pain in the abdomen, intoxication, fever.

The diversity of the syndrome of acute abdomen makes the diagnosis of appendicitis is a difficult medical task. In the period of diagnosis by the doctor, depending on gender, age of the patient should exclude signs of infection, urological, gynecological, obstetric, men, children, and other pathologies. The complexity adds to the unstable location of an organ in the abdominal cavity. Different people have Appendix define in different projections of the abdominal wall. Anatomical feature is manifested by the variety of outgoing points of pain.

Where is appendicitis?

Almost every adult, knows the location in the body internal organs – heart, liver, kidneys, lungs. Harder with determination of localization of 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 found in the crosshairs of two imaginary lines:

  • a horizontal navel and around the belly;
  • vertical, from the right breast nipple and down.

The abdomen, to the right of vertical and below horizontal line to the groin and the right leg is the right iliac fossa. Right modsdk considered the most likely location of the projection on the abdominal wall of the Appendix.

Unfortunately this is not the only localization of the Appendix. With its long mesentery, the Appendix may be displaced, by some distance, from the normal location. Prior to surgery using ultrasound, the doctor determines the location of the body and optimal access to it. The location of the body is important for the surgeon and is almost irrelevant to the patient.

Useful: How to determine the appendicitis?


Causes of appendicitis

There is still no unified view onthe causes of appendicitis. Why only some people suffer from inflammation of the vermiform Appendix? Proposed several theories of the causes of appendicitis.

The most common lies of the infectious factor. In acute appendicitis distinguish pathogenic strains of Escherichia coli, Staphylococcus aureus, Streptococcus, other pyogenic bacteria. In normal conditions, they are normal inhabitants of the intestines. Pathogens are a result of actions related to external or internal causes.

The main factors provoking the development of microflora in appendicitis:

  • a blockage (narrowing) of the lumen of the vermiform Appendix congenital anomalies (curves, narrowing), tumors, fecal stones, foreign bodies);
  • vascular responses, defects of the supply the intestinal wall of blood vessels, reducing blood flow to the wall causes blood stasis and further necrosis of the Appendix;
  • neurogenic reactions, slowing peristalsis of the intestine, accompanied by abundant sliseobrazutee, acute expansion of the lumen of the intestine.

Appendicitis usually develops in people suffering from: constipation, cardiovascular diseases, certain infectious diseases (intestinal form of tuberculosis, amoebiasis, other infections). In men appendicitis can be a sign of bad habits, hidden infections of the pelvis. It can be the result of gynecological inflammatory diseases. Children develop on the background of congenital narrowing of the lumen of the cecum, severe sore throat.

There are acute and chronic forms of appendicitis. The most common form of inflammation of the Appendix is acute. It is manifested pronounced symptoms. The chronic form is rare, the symptoms are erased.

The experiments in Spain have shown that in 40% of cases of acute appendicitis was caused by roasted sunflower seeds and chips. Usually affects children up to 14 years


The first symptoms of appendicitis

The symptoms of appendicitis are manifested primarily by abdominal pain. The usual pathogenesis of appendicitis manifests itself as consistently developing symptoms: pain, nausea, vomiting, fever, dyspepsia.

Detailed explanation of each symptom at the onset of the appendicitis.

  • Sudden pain in solar plexus or above the navel – the most typical first symptom of the acute formappendicitis. This period has also possible pain in the abdomen without a specific localization. It is characterized by pain of varying intensity (strong, weak) and type (permanent, intermittent). Then there is the shift of pain in the right pogwizdow, that is, to the topographic projection of the Appendix. The character of the pain, permanent, moderate intensity, increases with cough, movement, change of body position in space.

  • Nausea and vomiting. Vomit consist of previously ingested food with bile. Vomit with empty stomach in the form of liquid, mucus yellow. Vomiting in appendicitis develops as a reflex to the pain, accompanied by loss of appetite, often single.
  • Fever. Frequent companion of appendicitis – fever. It usually does not rise higher than febrile fever (37,0-38,00C).

  • Dyspepsia. The increase in toxicity is accompanied by a disorder of defecation – dyspepsia in the form of constipation or loose stool. Dyspepsia occurs on the background of frequent urination, the result of the involvement of the urinary bladder in pathogenesis. Urine color intense, dark.

Cunning appendicitis can manifest debut with the priority of other symptoms, lower pain response. In addition, the pain may subside, painkillers and medications, as well as necrosis of the wall of the Appendix.


Dangerous symptoms of appendicitis

Despite the obvious pain in the abdomen in appendicitis, the difficulty of diagnosis.

Dangerous symptoms for appendicitis

Dangerous appendicitis can be symptoms:

  • distracting from the underlying disease;
  • beginning peritonitis.

In women, the pain accompanies many inflammatory gynecologic pathology in children, intestinal infection, colic. Clinical signs, when a stomach ulcer, inflammation of the pancreas, gall bladder, and other abnormalities of the abdomen and pelvic organs, is also reminiscent of the symptoms of appendicitis.

With the help of diagnostic methods, the doctor can easily distinguish the source of pain. To facilitate the work of the doctor to inform him about previous diseases, unusual manifestations of the body during disease, including those not related to the basic pathogenesis, for example:

  • previously transferred sexual infection – possiblehidden microbial outbreak in the body – provocateur appendicitis or cause inflammation of the urinary organs;
  • prolonged absence of menstruation in women – a possible sign of an ectopic pregnancy;
  • black stool is a sign of stomach or intestinal bleeding, perforated ulcer;
  • belching, heartburn, flatulence, bulky stool – a sign of inflammation of the pancreas;

  • vomit without bile – a symptom of cholecystitis or obstruction of the gallbladder.

The danger of the mentioned symptoms is that they distract from the correct diagnosis and guide the physician down the wrong path of diagnosis, lengthen the time of its staging. Another group of symptoms indicates severe condition of the patient, peritonitis (inflammation of the abdominal wall) for appendicitis.

The most dangerous symptoms are:

The most dangerous symptoms are:

  • stasha for a few hours the pain may be associated with rupture of the walls of the Appendix inside the abdomen, followed by a sharp increase in pain intensity that defies relief – evidence of peritonitis;
  • constant retching and vomiting, not bringing relief to the patient;
  • a sharp increase in temperature above 390C, or Vice versa a quick drop to critically low values.

  • muscle tension, soreness at the moment of touching, tapping the skin of the abdomen;
  • altered consciousness (confusion, delirium, loss of reflexes).

Clinical study of appendicitis

Differential diagnosis of appendicitis is performed in a hospital. Used physical, instrumental, laboratory methods for diagnosis of appendicitis. The first phase involves a survey of patient and traditional research methods, palpation, feeling, tapping, pressure in the abdomen. Pay attention to pain, temperature, vomiting that most often accompanies appendicitis.

The pain of appendicitis

Despite the variety of symptoms, pain is the most consistent symptom of appendicitis, it is almost always accompanied by disease. Characteristics of pain is important in the differential diagnosis of appendicitis. The doctor finds outthe location, nature, duration, intensity, time of occurrence of pain.

In order to avoid distortion of the clinical picture not sick numb before the study doctor.

  1. Localization of pain. Many diseases are accompanied by unpleasant sensations as pain. According to its localization determine which organ is affected. Pain with a clear source pulse, if there is a body lying close to the wall of the peritoneum. Therefore, inflammation of the kidneys is often felt in the lumbar region, the heart – in the left side of the chest. In acute appendicitis surveyed usually can not show myself where the pain is localized. Another important diagnostic feature is the offset of the pain is unclear localization in 3-4 hours in the right iliac region.

  2. If the pain is immediately felt in the right poduszki means the Appendix is located in close projection. If the Appendix is in the abdominal cavity offset, use indirect methods. Diagnostic methods based on abnormal response pain response for weaker effect (touch, tap) to a certain point.

    In uncomplicated appendicitis the pain increases appear if the patient tries to suck in her stomach in the prone position, and if you press your fingers:

    • on the belly in the right poduszka;
    • at several points, to the right of the navel;
    • at several points along the diagonal line from the umbilicus to the right iliac tubercle (this is the bone protrusion of the pelvic bones at the front is determined in iliac region).

    In appendicitis the patient is experiencing pain during bowel movements in the anus, lifting of the right leg, right hand, deep breath, coughing. With the patient lying on her back – pain is felt in the right poduszki, change of position on the left side – the source of the pain moves to the navel;

    Danger signs of appendicitis is increased pain when gently pressing with your fingers in the navel, palpation of the abdomen are determined by muscles in the form of intense bands. In a laboratory study of the blood revealed an increase in the number of leukocytes higher than 14 thousand white blood cells – a marker of inflammation, almost always, in any acute process increases the number of leukocytes involved in immune defense of the organism. Low white blood cell count (leukopenia) indicates that the depletion of the immune system. These are signs of peritonitis – inflammation of the abdominal wall.

    Localization of the inflamed Appendix is always confirmed by instrumental studies (ultrasound) of the abdominal cavity

  3. Reflected pain. When you are diagnosed with appendicitis sometimes the painshown far from the inflamed organ. Radiating (reflected) pain is diagnosed when:

    • appendicitis – right foot, also pay attention to the emergence of a right-sided limp;
    • pelvic location of the Appendix – is given to men, boys into the scrotum, its location closer to the back is given ibid.;
  4. The nature of the pain. Distinguish between visceral and somatic pain. Visceral is formed in internal organs during a sudden increase in pressure in a hollow organ, stretching the walls of the body, the tension of the ligaments of the mesentery. Somatic pain is caused by abnormalities in the wall of the peritoneum surrounding the body and connected to her nerves. Of appendicitis can be a constant cramping and pain.

  5. The duration of pain. Characterized by one or two peaks of pain reactions. The first attack is associated with the inflammation of the Appendix. The second peak observed with the development of peritonitis, in severe cases. Pain in acute appendicitis lasts from several hours to several days. Long-lasting, persisting for a few days, weeks nagging pain is not typical for appendicitis.

  6. Within 1-2 days develops necrosis with high probability of rupture of the wall of the Appendix. In the first hours after spreading of purulent content into the abdominal cavity the pain disappears, comes imaginary recovery.

    A second wave of intense pain 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. In the treatment, the formation of adhesions of internal organs that cause constant pain.

  7. The intensity of the pain. Pain is a subjective sensation that depends not only on the strength of the traumatic factor, but individual to individual. For appendicitis is characterized by sudden intense pain. In some cases erased the picture of pain. The intensity of the 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, with the young people, often accompanied by forced postures, irritability, headaches.

Vomiting symptoms

An attack of acute appendicitis is accompanied by signs of nausea, then vomiting. Vomiting, if appendicitis has a reflex character, coincides with the peak of pain. Usually occurs in the first hours, and therefore, the symptoms of intoxication do not have this symptom significant effects. For appendicitis characterized by occasional vomiting. Recurring episodes of vomitingtypical for intoxication. This is an important feature for the prognosis of the disease, indicates the severity of the pathogenesis, threatening human life. Vomiting is accompanied by fever.

Hyperthermia

Fever febrile type (37-380C) characteristic symptom. Most appendicitis occurs on the background of moderate hyperthermia. The temperature in appendicitis is an important symptom for differentiation from other similar diseases. Intestinal, renal colic, the temperature in the normal range or below. Sometimes there is an interesting phenomenon, when the temperature measured by an ordinary mercury thermometer, with the right hand at 0.5-1.00With degree higher than the temperature determined in the left axilla. It is better to try to measure the temperature in the armpit, and then rectally. The differences are more evident.


Appendicitis in women and men

Appendicitis in men

The symptomatology of these patients is no different. At the age of twenty years, more common in young men and boys. It is noticed that the men more likely to be diagnosed ruptures and necrosis of the Appendix of the blind intestine.

Diagnostic methods to identify signs of appendicitis in boys and men, appear:

  • spontaneous pulling up right testicle on palpation of the abdomen in the right podscope, the cessation of feelings plot most painful – testicle descends, both testicles, the pressure on the abdomen;
  • pain right testicle with light stretching of the scrotum;

Appendicitis in women

At the age of twenty years, more common in women. The girls from twelve years and older, with clinical examination, be sure to consider gynecological status. Acute pain can be caused in teenagers painful periods. Women should exclude inflammation of the appendages, ovaries, ectopic pregnancy, miscarriage, kidney disease.


Appendicitis at children of younger age group

The child of younger age group does not allow to conduct the research, can not explain the abnormal sensations, pain is accompanied by a never-ending cry of fear. It is confusing to diagnose appendicitis.

The disease is manifested by acute debut. Pain in the right iliac region is determined by using a simple technique – right foot of the child to try to bend at the knee. A weak attempt, there was a strong reaction. Another diagnostic technique – after retracting hands exploring, pressing on your abdomen in the right iliac area there is a response of stronga pain response. When feeling the abdomen tight, but not distended due to gas formation.

The child refuses to get up, he prefers to lie and not to move. The pain increases with movement, running, jumping. When standing it is noted the forced position to alleviate pain on the right side of the body. Vomiting, in contrast to adult patients, occurs as a result of intoxication and not caused severe pain. The child has vomiting may be the first symptom of appendicitis precede the pain.

The final diagnosis can put a doctor on the basis of laboratory and instrumental methods of research.

In young children appendicitis often when say pulling up to his right leg. The symmetrical probing of the stomach is manifested in the rapid response to touching the right side. You can use other similar methods to determine the localization of the pain.

Clinical symptoms of appendicitis in children

High temperature 38-390C, a rapid pulse, tongue coated – like signs of infection. The complexity of the study adds to the diarrhea and vomiting. In the absence of signs of disorders of the intestines, gases depart freely. Sometimes the temperature is normal. In this case, one of the reasons for pain may be intussusception of the small intestine. Intussusception is the occurrence of ulcer in the intestine, occur in children. As a result of intussusception of the gut is formed cuff that causes severe pain, bloating and intestinal obstruction, vomiting. The success of diagnosis depends on the attentiveness of the doctor to details.

The infection may indicate enlarged lymph nodes, rash on the skin and mucous membranes. In severe cases, consultation with pediatric infectious diseases, rapid methods laboratory tests blood.

Related article: How to recognize appendicitis in children?

Appendicitis in a child 5 years of age and older

At about this age the child is able on a basic level describe the pathological feelings. The clinical picture is the same as the younger age group.

Initial signs of appendicitis in a child. The localization of the pain indicate the forced posture of the child, the tension of the abdominal wall at palpation on the right side of the abdomen in the region of poduszka. Sparing right side, gait, holding hands right iliac fossa. Do not attempt to remove the pain medication, applying a cold compress against the affected area.

Set by palpation soreness, tension of the abdomen on the right side. The differential diagnosis is carried out with the purpose of exception: scarlet fever, measles, tonsillitis, worm infestation,the invagination of the small intestine. Localization of pain is determined using indirect methods, which are used in the diagnosis of appendicitis in adults.

Attenuation of pain can be a terrible symptom of perforation of the Appendix. Vomiting is preceded by nausea, more often single.


Appendicitis in the elderly

Manifested a quiet debut. The General condition is satisfactory. Pain in the right iliac area, often diffuse, vague localization, not intense. The temperature is normal or slightly elevated.

Confusion in making a diagnosis of possible intestinal paresis. The intestinal paresis is a condition when the bowel stops functioning, manifested by symptoms of obstruction (vomiting, no defecation, abdominal distension). Vomiting in this case is every time after eating. Vomit contain undigested food. Diagnostic methods used to determine the localization of the pain is unclear.

Effacement of the signs of the disease does not mean easy pathogenesis. In persons of older age groups more frequently observed complications and fatal outcomes.


Appendicitis in pregnant women

In the first months of pregnancy the difficulty in the diagnosis at the usual level. Difficulties in diagnosis arise after the fourth month of gestation when the growing uterus displaces the bowel loops. Usually the Appendix is displaced towards the top, closer to the liver. Therefore, there is the difficulty of differentiating between appendicitis and inflammation of the bile ducts of the liver. Sometimes appendicitis during pregnancy radiates to the region of the right kidney. The abdomen is tense as a result of stretching of the uterus, so the feeling is not an effective diagnostic technique in pregnancy.

Diagnosis of appendicitis pregnant was difficult, characterized by many nuances.

Clinical methods for diagnosis of appendicitis in pregnant women manifested with pain:

  • in the position lying on his right side – the result of the pressure of the uterus on the inflammation;
  • in the supine position with pressure on the left edge;

During this period, it is preferable to use effective methods of instrumental diagnostics ultrasound, MRI, x-ray (introduction of contrast x-ray of pharmacological agents in the test cavity). When confirmation of acute appendicitis shows an urgent surgical intervention. The pregnancy in this case is irrelevant. Priority of operations – the continuation of the pregnancy.

More detailed information about appendicitis in pregnancy


andidate of medical Sciences Dmitry Volkov S., surgeon