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Appendicitis call inflammatory process in a worm-shaped shoot. It is the hollow tube closed at the end, belonging to a caecum. In view of its similarity with a worm the name "appendix" literally means: "appendage similar to a worm". It is considered to be that as the beginning of appendicitis serves obstruction of an opening between a caecum and a worm-shaped shoot.
Similar obstruction comes or owing to stratification in an appendix of slime of a dense consistence, or in view of hit of fecal masses from a caecum. After a while this masses becomes very firm, and the opening is corked. The name of such stones from a calla – coprolites. In certain cases obstruction happens because of swelling owing to what inflammatory process runs high.
There is one more theory of display of appendicitis. The illness arises owing to a rupture of a worm-shaped shoot and the distribution of bacteria following after it. At development of inflammatory process and an infection in the thickness of a wall the worm-shaped shoot can become torn. After there was a gap, distribution of an infection continues on an abdominal cavity, but, as a rule, this process happens on rather small space near a worm-shaped shoot. Thus, "periappendikulyarny abscess" forms.
In certain cases, provided that the infection and an inflammation will not extend, appendicitis recovers independently, without use of a surgery. At the same time through certain time symptoms of appendicitis vanish. As a rule, the similar phenomenon is observed at patients at advanced age, and also at the people receiving antibiotics. Through rather long span such patients address specialists with complaints to a swelling or infiltrate in the bottom of a stomach, in its right part.
The first shown symptom of appendicitis is the abdominal pain. At first feels pain of people in all stomach, but they are especially intensive in its upper part. It is difficult for patient to define accurately, where exactly hurts him and, respectively, from what party appendicitis. Pain which does not concentrate in one specific point in medicine is called indistinctly localized pain. As a rule, at an attack of appendicitis sick after a request to specify where specifically hurts it, points to the middle of a stomach by a roundabout.
The subsequent symptoms of appendicitis are shown more accurately. At increase of inflammatory process of a worm-shaped shoot further the inflammation moves ahead through a shoot wall to its outside cover. Then inflammatory process takes a stomach vystilka, a peritoneum. At a peritoneum inflammation character of pain sharply changes, and pain is already defined on a small site. However at a rupture of a worm-shaped shoot the infection takes all abdominal cavity, and pain passes into widespread again.
Sometimes there are also such symptoms of appendicitis as vomiting and nausea. As reaction of an organism to inflammatory process body temperature can sharply rise. However in the absence of the increased body temperature appendicitis cannot be excluded at all, the illness can proceed at a normal temperature.
The acute appendicitis is an acute inflammatory and necrotic disease of a worm-shaped shoot. Its emergence is provoked by obturation of a gleam of a worm-shaped shoot. The acute appendicitis is the direct indication to immediate carrying out a surgery.
The acute appendicitis can be divided into several subspecies. At poorly expressed appendicitis which is also called appendicular colic the weak aching pains in the right ileal area are often shown. Several hours later pain passes.
At simple (superficial or catarral) appendicitis vomiting is once shown, at a palpation there is pain at the right ileal area. In blood the moderate leukocytosis is observed.
Destructive appendicitis can be subdivided into several subspecies. So, phlegmonous appendicitis begins with small temperature increase, and the leukocytic formula moves to the left. At phlegmonous appendicitis at the patient pulse is speeded up, language is laid over. If the patient has a suspicion on phlegmonous appendicitis, then when carrying out a palpation the specialist pays attention to pain and a muscle tension of a front abdominal wall. At phlegmonous change of a worm-shaped shoot its thickening, hypostasis is observed, it is covered by a fibrinopurulent plaque. In a gleam mucous there is a pus, and in an abdominal cavity available a muddy or purulent exudate.
Gangrenous appendicitis arises as a result of thrombosis and thrombophlebitis of vessels in a mesentery or in a certain site of a wall of a shoot. As a rule, gangrenous appendicitis accompanies the local peritonitis sometimes passing in extended at perforation. Symptoms at gangrenous appendicitis are similar to symptoms of phlegmonous appendicitis. But in this case the general intoxication of an organism is more expressed. At gangrenous change color of a worm-shaped shoot dirty-green color, covers it a fibrinopurulent plaque, it has an unpleasant smell.
Also the complicated appendicitis at which any complications are observed is allocated.
The appendicism is rather rare form of this disease. As a rule, the appendicism develops as a result of an acute appendicitis. Sclerous and atrophic changes in a wall of a worm-shaped shoot are characteristic of this state. The appendicism most often arises after treatment of a bad attack without surgery.
Diagnosis of appendicitis
At the very beginning of diagnosis of appendicitis careful poll of the patient and his survey is important. In many cases patients complain of high temperature of a body, and also of pain of different intensity when pressing in the right part of a bottom of a stomach. At inflammatory process of a peritoneum other symptoms of appendicitis are shown. So, during pressing on a stomach the patient feels so-called "ricochet" morbidity. That is when pressing on a stomach after which the doctor very sharply takes away a hand sudden short pain is shown.
At statement of the diagnosis the specialist surely considers quantity of white blood cells. If in an organism infectious process develops, then the analysis shows the increased number of white blood cells. At first after developing of an illness the number of white blood cells can remain normal, however small increase of their quantity, as a rule, takes place already at the earliest stages of an illness. But at the same time it is important to consider that the similar sign is characteristic practically of any infectious process which develops in an organism. So high content in blood of white blood cells is not considered as the direct certificate on existence of appendicitis. In the course of diagnosis also microscopic examination of urine of the patient is conducted
When carrying out a X-ray analysis of an abdominal cavity reveal as the appendicitis reason a coprolite (the hardened piece a calla which corks an exit from a worm-shaped shoot). The similar phenomenon most often takes place at children.
In the course of carrying out ultrasonic research it is possible to find existence of abscess or the increased worm-shaped shoot. But at patients with appendicitis the worm-shaped shoot manages to be seen only in half of cases. So the impossibility of consideration of a worm-shaped shoot during ultrasonography does not exclude appendicitis. However when carrying out this research there is an opportunity to exclude pathology of ovaries, a uterus, fallopiyevy pipes, that is a number of states which could simulate appendicitis.
During a computer tomography of area of a worm-shaped shoot it is possible to diagnose appendicitis or periappendikulyarny abscess. At the same time a number of diseases in an abdominal cavity and a basin which symptoms remind appendicitis is excluded.
Also "appendicitis" is applied to establishment of the diagnosis a laparoscopy method. It is surgical procedure with introduction to an abdominal cavity of a thin tube with the camera through a small opening in a stomach wall. When carrying out this procedure it is possible to see a worm-shaped shoot and some other bodies. And at detection of appendicitis the worm-shaped shoot at once is removed.
Today only the laparoscopy allows to diagnose appendicitis precisely. So at suspicion on appendicitis researches in a complex are conducted or the surgery is carried out.
In certain cases to carry out diagnosis of appendicitis very difficult. The worm-shaped shoot in an abdominal cavity can stay in different provisions. Sometimes it is difficult for specialist to define from what party appendicitis. The most often worm-shaped shoot is in the bottom of a stomach on the right. However it has a mesentery – the film reminding a leaf by means of which the worm-shaped shoot fastens to other structures in an abdominal cavity. And in the presence of a long mesentery the worm-shaped shoot sometimes moves to other place. At the same time the worm-shaped shoot can be long also. Therefore at such combination the worm-shaped shoot can fall to a pelvic cavity, be located behind a colon. In that case symptoms of appendicitis can match symptoms of an inflammation of other bodies. In view of such features of the patient with suspicion on appendicitis observe a certain span to outstrip whether symptoms of appendicitis or other illness will be shown.
In the course of diagnosis of appendicitis it is very important to remember some other the diseases having symptoms, similar to appendicitis. So, it is necessary to carry out differentiation of appendicitis with Mekkel's diverticulum (protrusion of a wall of a gut which is located near a worm-shaped shoot), an inflammation of pelvic bodies, inflammatory processes in upper right part of a stomach, a right-hand diverticulitis, diseases of kidneys.
Treatment of appendicitis
At statement of the diagnosis "appendicitis" is in most cases performed the surgery on removal of a worm-shaped shoot called by appendectomy. Reception of antibiotics begins at once after installation of the diagnosis, before operation.
There are cases when at appendicitis inflammatory process and development of an infection are not strongly expressed and, respectively, on an abdominal cavity do not extend. Sometimes the organism independently stops inflammatory process. Patients in this case feel well, and several days later their general state improves. Sometimes through certain time the worm-shaped shoot is deleted. However the main difficulty of such state is an opportunity to distinguish such course of appendicitis from a disease with tendency to complications.
Quite often patients very long time do not address the doctor owing to what the created abscess is diagnosed for them. At the same time in a worm-shaped shoot perforation is closed. At small abscess treatment is carried out by antibiotics. But in most cases abscess needs to be drained. The drainage is established with use of ultrasonic research or a computer tomography for exact definition of localization of abscess. After several weeks after elimination of abscess operation on removal of a worm-shaped shoot is performed. The similar method of treatment is called the delayed appendectomy and apply it for the purpose of anticipation of repetition of an attack of appendicitis.
Today during removal of a worm-shaped shoot practice use of two techniques. The first – usual operation which is performed through a section, the second — the endoscopic operation performed through a puncture with video control.
At usual operation over area where the worm-shaped shoot is located, the section which length makes about 10 cm is carried out. After survey the worm-shaped shoot is deleted. In the presence of abscess it is dried up with use of drainages. After all procedures the section is sewn up.
At operation with use of a laparoskop carry out a puncture and by means of a tube with a video camera on the end find appendicitis. Further removal of a worm-shaped shoot is carried out by the special tools entered through small openings. After such operation the patient feels considerably smaller postoperative pains, is quicker recovered.
If the worm-shaped shoot was not broken off, the patient can leave a hospital already next day. If the gap took place, then the patient is in a hospital about a week. In this case to the patient appoint introduction intravenously of antibiotics. Especially it is important at development of peritonitis.
Complications of appendicitis
As complication of appendicitis which meets most often, it should be noted perforation. At perforation of a worm-shaped shoot the infected pus can collect afterwards and arise periappendikulyarny abscess or diffuse peritonitis (that is process of infection of all abdominal cavity). Untimely identification of symptoms of appendicitis and, as a result, at the wrong time the begun treatment is the most common cause of this complication.
Less often as complication of appendicitis there is an intestinal impassability. This state is shown because inflammatory process about a worm-shaped shoot suspends intestines muscles. Respectively, the food cannot move on intestines, as usual. Sometimes in that part of a gut which is over the place with the broken passability liquid and gases gathers. In that case there is abdominal distention, the patient has a nausea and vomiting.
Especially dangerous complication of appendicitis is sepsis, that is blood poisoning. At the same time bacteria get to blood and together with blood are carried to other parts of an organism. This very serious complication which even threatens the patient's life. However, it develops not especially often.
The most frequent complication in this case is the infection of an operational wound. Easy complication – redness, morbidity can be shown. However there are also very severe defeats at which use of surgical ways of treatment is obligatory. In separate hard cases the surgeon can not sew up a section completely after operation. It occurs at very strong inflammation and infection when the section becomes soiled at once after carrying out. It is sewn up in several days.
Also abscess in the field of a worm-shaped shoot becomes complication of appendectomy. After operation there can also be a development of commissural process.
Till today there are no exact data on functions of a worm-shaped shoot. But after its removal of problems with health at the person generally does not arise.
Appendicitis at pregnancy
Today acute appendicitis is the most frequent reason of surgeries at pregnant women. According to statistical data, appendicitis at pregnant women is shown with a frequency of 1 a case on 700 — 2000 women.
Appendicitis at pregnant women is shown by acute pain in a stomach which gains the aching character later. Also the positive symptom of Taranenko is noted: pain becomes more severe if the woman turns from the left side on right. At this disease at pregnant women it is very difficult to carry out the correct diagnosis in view of anatomo-physiological features of an organism at pregnancy. Because of it appendicitis at pregnant women can sometimes have serious complications to an idazha provokes abortion. Therefore specialists, as a rule, apply early appendectomy that allows to warn undesirable effects.
Prevention of appendicitis
Most important for prevention of appendicitis the use in food of mainly useful products. It is not necessary to abuse meat products, the food of a plant origin is more preferable. It is important that the chair was regular and systematic, it is not necessary to allow emergence of locks. Owing to stagnation in intestines suppuration can be shown.