Appendicitis

Symptoms

The onset of the disease is sudden. In some cases, before the appearance of the first clinical manifestations, general well-being worsens, appetite decreases, weakness and fatigue appear.
The main symptom of appendicitis is abdominal pain. Most often, it occurs in the navel area, and then shifts lower and increases with the development of inflammation. Appendicitis pain gets worse when you cough or sneeze, make sudden movements, or change position while you sleep.
Although the appendix is located in the lower right side of the abdomen in most people, it can also have an atypical location: in the left side of the abdominal cavity, the right lumbar region, or in the small pelvis. This means that pain can also be localized in other parts of the abdomen.
Severe abdominal pain is a reason to immediately consult a doctor. Timely diagnosis of appendicitis reduces the likelihood of dangerous complications.

Common symptoms and signs of appendicitis :
•    Abdominal pain;
•    Lack of appetite;
•    Nausea or vomiting following a sharp pain in the abdomen;
•    Bloating;
•    Gradual increase in body temperature.
Rarer symptoms of appendicitis :
•    Sharp or dull back pain
•    Pain when urinating
•    Severe abdominal cramps
•    Constipation or diarrhea.
If you suspect appendicitis, you should not eat or drink, take heartburn medications or laxatives. You cannot use local heat (apply a heating pad to the stomach). Do not take painkillers without the permission of a doctor.

Causes

The exact causes of acute appendicitis have not been definitively established. The main route of infection is enterogenic (infection occurs through the lumen of the appendix).
Factors that are believed to be capable of causing the development of acute inflammation of the appendix include:
•    Infectious diseases (Amebiasis, Yersiniosis, typhoid fever, intestinal tuberculosis, etc.);

•    Activation of the intestinal microflora against the background of congenital anomalies of development or blockage of its lumen (foreign bodies, fecal stones, parasites, neoplasms, etc.);
•    The presence in the appendix of cells of the diffuse endocrine system that produce inflammatory mediators;

•    Diseases, a component of which is inflammation of the walls of blood vessels;

•    Poor nutrition;

•    Violation of the innervation of the intestine;

•    Immunological disorders, including allergies;

•    Intestinal dysbacteriosis;

•    Bad habits;

•    Abdominal trauma.
The risk of developing acute appendicitis is increased in pregnant women due to the enlargement of the uterus, which leads to displacement of the appendix and caecum. In addition, the development of the pathological process during pregnancy is facilitated by changes in the blood supply to the pelvic organs, constipation, restructuring of the endocrine and immune systems.

Treatment

When symptoms of acute appendicitis appear at the stage of pre-hospital care, the patient is shown bed rest, applying an ice pack to the stomach, and refusing to eat. It is strictly contraindicated to apply a heating pad to the stomach, as this can lead to the development of complications of acute appendicitis. Seek medical attention even if the acute pain spontaneously subsided. Before the diagnosis is made, the patient should not take painkillers, antispasmodics or any other drugs, as this may complicate the diagnosis of the disease.

The method of surgical treatment of acute appendicitis is the operation of appendectomy, which can be performed in two versions:

1) Classical appendectomy involves laparotomy through an oblique variable incision (McBurney) in the right iliac region, removal of the dome of the caecum along with the appendix into the wound, ligation and cutting off from the process of its mesentery with the vessels passing through it, applying a ligature to the base of the process and cutting it off. The stump of the appendix is usually immersed in the dome of the cecum with a purse-string suture. But more and more surgeons consider this manipulation unnecessary. If it is impossible to remove the dome of the caecum into the wound, with a strong fixation of the tip of the process in the depths of the abdominal cavity with adhesions, the so-called "retrograde" appendectomy is possible. In this case, first, in the depth of the wound, the place of attachment of the appendix to the caecum is found, at the base of the process, its mesentery is pierced and a ligature is applied to it, followed by cutting off the base of the appendix from the caecum. And then gradually, in the direction from the base of the process to its top, the appendix is separated from its mesentery and adhesions.
2) Laparoscopic appendectomy is performed from 3 punctures of the abdominal wall. The mesentery of the appendix is either coagulated with a power tool, or clips are applied to the vessels of the mesentery. The process itself, after applying a ligature to its base, is cut off. The stump of the appendix during laparoscopic appendectomy is not immersed in the dome of the caecum.
Postoperative complications develop in 5-10% of patients with acute appendicitis, mortality is 0.1-0.3%.
In catarrhal acute appendicitis, antibiotic therapy is not required. Antibacterial drugs are prescribed, as a rule, in the presence of an inflammatory effusion in the small pelvis, as well as in the phlegmonous form of the disease. When the course of acute appendicitis is complicated by diffuse peritonitis, antibiotics are used at the stage of preoperative preparation and in the postoperative period.
 

Tests Required for Diagnosis

When collecting a history, information about previous or existing diseases that can mimic the symptoms of acute appendicitis is important.
Diagnosis is usually made during a physical examination. In acute appendicitis, a number of abdominal symptoms are noted:
The Shchetkin-Blumberg symptom is that with the rapid removal of the fingertips that press on the abdominal wall, pain arises.
Rovsing's symptom is associated with the appearance of pain in the right iliac region with jerky tremors of the abdominal wall in the left iliac region.
Laboratory and surgical examination :
•    Complete Blood Count
•    Urine Test
•    Ultrasound
•    MRI
•    Diagnostic laparoscopy

Differential diagnosis:
Diseases such as gastritis, peptic ulcer of the stomach and duodenum, pancreatitis, acute cholecystitis, cholelithiasis, acute cystitis, renal colic, acute orchiepididymitis, neoplasms, ectopic pregnancy and others that can lead to the development of an acute abdomen. Differential diagnosis may require vaginal and/or rectal examination. It is possible to exclude neoplasms of the caecum through colonoscopy. In pregnant women, acute appendicitis must be differentiated from spontaneous abortion, as well as from premature birth.