Stomach ache. This kind of pain is almost the most common in the world. The causes of abdominal pain are a huge number of very different, ranging from a banal stomach upset, ending with serious health problems, such as acute appendicitis in children or adults. The main thing about what the doctors warn - in no case can you do self-medication and try to get rid of the abdominal pain yourself. If abdominal pain occurs, immediately call an ambulance or seek help from the nearest medical institution. Needless to say, there are a lot of vital organs in the abdominal cavity of man, as, indeed, in the entire human body. That is why abdominal pains cause quite serious anxiety and increased attention from physicians. Pain in the abdomen can not be a "nonsense", even if the abdomen hurts because of banal flatulence or stool disorder, it is necessary to take measures as soon as possible in order to minimize the negative impact on the general condition of the body. And if the reason for the onset of pain is some serious disease requiring surgical intervention, delay often can cost the sick person the most expensive thing that he has - his life. With abdominal pain, very often people admit several typical common errors. Below is described why they are dangerous not only for health, but for life:
- Admission of painkillers. Often, people tend to get rid of the pain in the abdomen as quickly as possible and for this take various painkillers. However, this is strictly not recommended, because doctors, in the absence of pain, will not be able to adequately assess the status and the degree of danger not only for health, but also for the life of a sick person. As a result, the doctor may not recognize serious illnesses in time, such as appendicitis, peritonitis, perforated ulcer and other complications.
- Applying heat to the stomach - a warm water bottle ordiapers. With pain in the abdomen, in no case should you try to warm your stomach. With a number of certain diseases, this action can lead to the most unfortunate consequences. On the contrary, if a sick person experiences significant pain, a much stronger effect will be made by the cold applied to the stomach. To do this, any tool available, for example, a bag of dumplings or frozen chicken, found in the freezer. Wrap them in two layers of any tissue and attach to the place that hurts the most, and immediately consult a doctor.
- Ignoring the pain. Unfortunately, our hope for "maybe carry" often plays with us very evil jokes. Do not expect that the abdominal pain will disappear by itself - it also increases the chances that the presence of serious illness will be missed. It is much more reasonable to see a doctor and hear that there is no reason for much concern than to miss a really serious illness.
So, as already mentioned above, the reasons causingpain in the abdominal cavity, there is a huge variety. To tell at once about all is not necessary - without a special medical education a common man in the street is difficult to understand independently all the details of various diseases. Therefore, in this article we will only talk about the most common disease - appendicitis. Appendicitis is the most common disease of the abdominal cavity organs, requiring immediate surgical intervention of surgeons. According to statistical data, by the age of 15, the percentage of children who have appendicitis has not exceeded 15 processes, in people who have reached the age of 20 this figure is already increasing to 23%, and by 30 years to 41%. As is clear from all of the above, the chances of encountering such a disease as appendicitis, there are almost every person. Appendicitis is a very interesting disease. On the one hand, it is not so difficult - for the time from the onset of the disease to recovery is only 7 days, with uncomplicated course of the disease. And on the other hand, non-intervention by surgeons will inevitably lead to a fatal outcome - the death of a sick person. That is why it is so important for any person to know all the symptoms of this disease so as not to leave him without attention and in time to seek medical help. First, let's look at what appendicitis is. Appendicitis is an inflammatory process affecting the appendix of the cecum. There are several different causes that can cause this most inflammation:
- Activation of pathogenic microflora, as a resultWhat happens is a mechanical occlusion of the luminal appendix of the appendix. This cause of appendicitis is most common in children.
- In adults, the occlusion of the lumen of the appendix is often caused by hyperplasia of the lymphoid follicles.
- No less often, the reason for the clogging of the vermiformof the process become stool stones. This kind of appendicitis is most often found in those people who face chronic constipation.
- A little less often, but still there are casesblockage of the appendix or foreign objects, parasites or tumors. As a result of their mechanical action, inflammation of the mucous membrane and, as a consequence, accumulation of mucus and clogging of the lumen of the appendix are formed.
Symptoms of appendicitis
As already mentioned, in order to be on timeto recognize the presence of appendicitis, it is necessary to know its symptoms. Acute appendicitis symptoms are different. One of the main symptoms, of course, is the person's pain syndrome. At the very beginning of the disease, the pain does not have a clear localization, the sick person can not accurately show exactly where his stomach hurts. But after about 6 to 7 hours of pain concentrates in a strictly defined area - usually in the right ileal part of the abdomen. However, doctors do not recommend the patient and they themselves never focus only on the place of localization of pain. This is due to the fact that the features of human anatomy are such that the appendix is often found in different places of the abdominal cavity and, accordingly, the localization of pain can also be different for different people. So, for example, with the classical location of the appendix, in the right lower abdomen, a person feels a pain syndrome in the right ileal region, and if the location of the process is high - the abdomen hurts almost under the ribs. There are also cases where the appendix is located in such a way that it is slightly bent back. In such cases, the pain is localized in the lower back. In addition to the pain syndrome, a sick person often has a feeling of nausea and vomiting. As a rule, vomiting is not wearisome - no more than two or three attacks per hour. The urge to vomit persists even if the sick person does not eat anything. In the event that a large amount of fluid begins to accumulate in the intestine due to an inflammation of the appendix, this can lead to the appearance of a loose stool (diarrhea) in a sick person. Examination of the language of a sick person, who is suspected of having appendicitis, can provide the doctor with some information. At the very beginning of the disease the tongue of the sick person is moist, however, very quickly it becomes dry and covered with a white coating. However, this symptom alone can not serve as a basis for diagnosing this disease, since it is not an independent clinical sign, but only goes along with the rest of the symptoms. Also, the doctor and the position of the sick person can tell a lot about it. As a rule, it takes the so-called "forced" position. "Forced" position is the position in which a person experiences the least pain and when changing, the pain immediately causes the person to return back. With appendicitis, the sick person is most often in a lying position, either on the right side or on the back. The slightest change in position can cause extremely intense pain that will make the sick person lie down again. Any physical action, even such at first glance, as insignificant as laughter or coughing and sneezing, most often in a person who has fallen ill with appendicitis, causes the strongest pain that causes the sick person to stop these undesirable actions. The algorithm of the normal respiratory process also changes slightly: the lower square of the abdominal wall during the inspiration lags considerably behind its entire surface. Often, relatives of a sick person, picking up some superficial information from a wide variety of sources, try to independently perform palpation, bend and unbend the leg that has fallen ill. All this is done for the purpose of trying to diagnose this disease. However, this can not be done - without special skills, it is possible to cause perforation (breakthrough) of the appendix with careless movements. Body temperature in a person who has fallen ill with appendicitis, is often slightly elevated to 37.5 - 38 degrees. However, the absence of temperature can not be a guarantee of the absence of appendicitis - sometimes the disease can occur without temperature. The temperature for doctors in diagnosing appendicitis is also just one of the various symptoms of the clinical manifestation of appendectomy. A very important, almost decisive role in the diagnosis of the inflammation of the appendix is a detailed blood test. As a rule, when a patient has a high content of leukocytes and high ESR, together with a pain syndrome, one can speak of an inflammation of the appendix. From the side of the urinary system, there are also certain changes - if a patient has appendicitis in his urine, a laboratory test will usually detect the presence of a protein that a healthy person should not simply have. Often, the sick person or his relatives require doctors to conduct an x-ray study. Nowadays this kind of diagnostics is practically not used. On an X-ray, you can see only the stool in adults, if it has closed the lumen and caused the inflammation of the appendix. However, this stool may not clog up the appendix, or, on the contrary, the vermiform appendix will not be inflamed due to stool. But since the inflammation in the picture can not be seen by the doctors, this method of diagnosis is simply not relevant. The most suitable for visual diagnosis of inflammation of the appendix is to use the ultrasound method. Using it, you can establish a diagnosis with almost 100% probability. In the event that the cause of the painful sensations in a person is not related to the inflammation of the appendix, it simply will not be visible. But in the event that the appendix is inflamed, it will be visualized in the form of a tube, approximately 5 mm. Around the process, the fluid accumulation typical of appendicitis is clearly visible. Another, the most modern means of diagnosing the disease is the computer tomography. This method of diagnosis allows you to get an image of not only the most inflamed vermiform appendage, but all the modified abdominal and intestinal tissues that have arisen as a result of the inflammatory process. This method is good for everyone, except for one - the equipment for carrying out a computer tomography is very, very expensive. And not all medical institutions of even a large city, not to mention small ones, can afford to purchase it. That is why computed tomography has not been so widely used for the diagnosis of appendicitis as other methods. Sometimes, in especially difficult and incomprehensible cases, doctors, for the correct diagnosis, resort to a method of research, such as laparoscopy. The essence of laparoscopy is the following - a sick person receives a certain anesthesia, after which the surgeon makes a small incision in the anterior abdominal wall. Through this incision a laparoscope is inserted into the abdominal cavity of the person. Laparoscope is a thin probe, ending with a video camera. This method of diagnosis is 100% reliable, since the surgeon sees with his own eyes what exactly happens in the abdominal cavity of his patient.
The difference between appendicitis and other diseases
Despite the fact that the diagnosis of acuteappendicitis in our time is not difficult, differential diagnosis of acute appendicitis still deserves a little attention. Although an experienced physician practically without difficulty practically "on the eye" unmistakably and without much difficulty diagnoses an ill person with appendicitis in any of its manifestations. So, there are a number of different diseases, from which it is necessary to correctly distinguish the inflammation of the appendix. Below are listed only the most common of them:
- Urolithiasis, especially renal colic. In this case, it is very important to conduct a laboratory study of the urine of a sick person.
- Acute adnexitis. As a rule, if the presence of appendicitis is suspected in a woman, a gynecological examination of the patient is mandatory.
- Perforated stomach ulcer. Often to exclude this disease, doctors are forced to previously resort to laparoscopy.
- Right-sided pneumonia. To exclude it, it is necessary to make a radiograph of the lung to a sick person, after which it is possible to exclude or confirm the presence of pneumonia.
Do not worry about this, since the surgeon will establish the correct diagnosis with a 95% probability.
Types of appendicitis
Doctors distinguish several varieties of appendicitis by various criteria. The first thing that they pay attention to is the degree of intensity of inflammation of the appendix in the appendix:
- Acute catarrhal appendicitis
Acute catarrhal appendicitis is the mostthe initial stage of the development of inflammation of the appendix. Operation at this stage of the disease is the simplest and most effective. However, unfortunately, often the patients simply do not pay much attention to the catarrhal form of appendicitis, since a pronounced pain syndrome is either weakly expressed or completely absent.
- Simple appendicitis
The simple appendicitis proceeds according to the classical scheme of the current of this disease. It accounts for up to 70% of all cases of appendicitis.
- Destructive appendicitis
In the event that a sick person is confronted with athe destructive form of appendicitis, all the symptoms are much more pronounced in him than with a simple form of the disease. He has a much stronger pain syndrome, the temperature is also significantly higher than the figures found with simple appendicitis. But the morphological changes taking place in the appendix, may often not correspond to those in the usual appendicitis. Predicting the development of destructive appendicitis is simply impossible - it's not for nothing that it is called "destructive." But the development of simple appendicitis is very predictable. In the event that a person with a simple form of appendicitis for some reason does not seek medical help in a timely manner, or if the disease has not been timely diagnosed, the complications of acute appendicitis will be unavoidable:
- Acute phlegmonous appendicitis
With the phlegmonous form of appendicitis in the patienta significant increase in the intensity of pain, body temperature increases. The vermiform appendix begins to fill with pus, as a result of which ulcers begin to appear on the walls of the appendage. Ulcers cause quite a lot of inflammation, not only the process itself, but also all nearby tissues, such as the walls of the peritoneum, muscles. A similar vermiform appendix is almost always possible to feel with normal palpation.
- Acute gangrenous appendicitis
If at this stage the sick person does not receivesurgical intervention, the phlegmonous form of appendicitis smoothly flows into a gangrenous, most severe form. At this stage, because of the pus-filled appendix, the whole abdominal cavity is subjected to the inflammatory process without exception. However, although this may seem strange at first glance, sick people note the fact that the painful feelings that have troubled them completely disappear. However, there is nothing strange about this - this is due to the fact that the final and irretrievable death of all the cells of the appendix takes place. But instead of pain, a person marks a significant and dramatic deterioration in overall well-being, resulting as a result of extensive inflammation of the entire peritoneum. The patient has the following changes:
- The disappearance of pain. We have already mentioned what is involved in this phenomenon.
- The heart rate reaches about 100 beats per minute.
- There is a pronounced pallor, and sometimes cyanosis, skin.
- Cold, sticky sweat.
- Severe bloating.
In addition to all of the above symptomsThere are also pronounced signs of the strongest intoxication of the body. There are also some changes in the central nervous system - a sick person can be confused consciousness, there is an uncaused euphoria. In the event that even at this stage the patient is not provided with medical assistance on time, it is possible to develop such a formidable complication as peritonitis. An inflamed vermiform appendix is perforated (breaks through), and the purulent contents pours into the abdominal cavity. This phenomenon is extremely dangerous due to the fact that the result of perforation is always the general infection of blood and, as a consequence, the death of a sick person, unless immediate surgical intervention in the human body follows.
Features of the course of acute appendicitis in different categories of patients
Despite the common features, the course of the disease in different categories of sick people is still different. It is also necessary to know and take into account. Below are the main differences and features:
- Signs of appendicitis in children, as well as signs of appendicitis in adolescents
Physiological feature of the child's organismis such that, because of the insufficient development of a large omentum, the progression of the inflammatory process occurs many times faster than in an adult. That is why it is so important to seek medical help at the child's first complaints about pain in the tummy. In children, often from the first complaints of abdominal pain before the development of peritonitis, several hours pass, whereas the first signs of appendicitis in adults appear several days before peritonitis. In addition, considerable complexity is the diagnosis of acute appendicitis at the very beginning of the disease. All the symptoms can be the same as when poisoning, and the pain does not become clearly localized, and remains spilled. This can often lead to erroneous diagnosis in the early stages of the disease.
- In elderly people
At them the course of the disease also has its ownspecificity. Due to the fact that the human body decreases its reactive reaction with age, the clinical manifestations of appendicitis are often extremely lubricated. Because of this, it is possible later to seek medical help and, as a consequence, a later diagnosis of the disease. In elderly people, the destructive form of acute appendicitis is much more frequent than in others.
- Pregnant women
Due to the fact that the enlarged uterus displaces the dome of the rectum, the pregnant woman has a significant change in the standard localization of pain.
Treatment of appendicitis
Conservative treatment of appendicitis is impossible -only operational. If there is a suspicion of inflammation of the appendix, the patient should be immediately hospitalized in the surgical department of the nearest hospital. Doctors - surgeons will conduct an additional examination, which either confirms or refutes the initially assumed diagnosis. In the event that the diagnosis is confirmed, the patient is shown an emergency operation called appendectomy. During this operation, the surgeon performs the removal of the inflamed vermiform appendage. Do not go into details and talk about all the features of the operation - a person without medical education, all these details are often uninteresting and incomprehensible. It is much more useful to know what to expect in a hospital. After the diagnosis is confirmed, the sick person begins to prepare for an emergency operation. Such training consists of several stages:
- Cleaning of the stomach
Since most anesthetists preferwork with patients who have not previously eaten anything, if the patient's condition allows, the stomach will be washed. This is done using a special probe. In the same case, if the patient has had multiple vomiting and the stomach is empty, this procedure does not purify the stomach.
- Cleaning of the intestine
In some cases, according to the doctor's testimony, a patient can be prescribed a bowel cleansing. For this, ordinary cleansing enemas are used.
- Preparation for anesthesia
Before the operation begins, with the patienta person or his relatives MUST have to talk to a doctor - an anesthesiologist, who will later, during the operation, be responsible for anesthetizing the patient. The doctor should learn about all the details of the health of the sick person, about all cases of anesthesia in his life, if any. Also, the doctor will definitely ask about the presence of individual intolerance of any pharmacological drugs in a patient. Type of anesthesia is determined by the doctor - anesthesiologist, taking into account the individual characteristics of the sick person in each specific case. After this, the doctor should briefly explain to the sick person or his relatives what type of anesthesia will be used, and what are his main principles of action. After that, the surgeon should do the same thing - briefly talk about the forthcoming operation. And only after when the patient or his relatives do not have questions and objections, it will be possible to sign consent for surgical intervention. Of course, all of the above is done only if the patient's condition is not critical and allows for a little time. In the same case, if a person entered the hospital in an extremely serious condition, which carries a threat to his life, all preoperative preparation is reduced to the possible minimum, in order to avoid the loss of precious time.
Postoperative period after removalAppendicitis in many respects determines the further state of health of a sick person. Despite the fact that the removal of appendicitis is an extremely simple operation, it is nevertheless nothing more than a surgical intervention in the body. Therefore, the postoperative period often largely determines the course of recovery. It is about him and will be discussed below. After the operation is completed, the doctor will tell you about her progress and the final result. The further course of recovery will largely depend on the sick person who must strictly follow all the doctor's recommendations: the regime of the day, physical activity, nutrition after removal of appendicitis. Speaking of such a thing as a diet after removal of appendicitis, I would like to remind the relatives of a sick person - the removal of appendicitis is as serious an operation as all the others. Therefore, the diet must be strictly adhered to. About that, and when you can eat a sick person, your doctor will tell you. Often, a sick person and his relatives scare the temperature after removal of appendicitis. If you encounter this phenomenon, immediately inform the medical staff. Sometimes the temperature, like pain, after removal of appendicitis, is a variation of the norm, and sometimes - serve as a signal of trouble in the body. In each specific case, a doctor must be examined. And in no case should you panic and get upset - appendicitis in our time does not pose any threat to life, or human health. To do this, it is enough to observe only one simple condition - to seek medical help on time. This will help protect the child from the threat to his life and health. After all, despite the fact that appendicitis in our time with success and without complications is removed, procrastination costs a sick person life. We advise you to read: