Appendicitis Acute

Acute appendicitis

Nonspecific inflammation of the appendix of the cecum.

Symptoms, course. Clinical manifestations of acute appendicitis depend on the nature of the morphological changes in the appendix, its location, the age of the patients, and the nature of the associated complications.

The initial symptom of the disease is a sudden dull pain without clear localization in the upper abdomen or navel area. After 4-6 hours (with fluctuations from 1 to 12 hours), the pain moves to the right iliac region (Kocher's symptom). A change in the localization of pain with the appearance of soreness in the right iliac region indicates the alarming appearance of somatic pain caused by irritation of the visceral peritoneum (i.e., inflammation has captured all layers of the wall of the appendix).

The localization of pain depends on the location of the appendix: in a typical position the patient feels pain in the right iliac region, in a high position - almost in the right hypochondrium, in a retrocecal position - on the lateral surface of the abdomen or in the lumbar region, in a pelvic position - above the pubis.

Nausea is a common symptom of acute appendicitis; sometimes, especially at the beginning of the disease, vomiting is possible. In most cases, the stool is not disturbed. When the appendage is located near the rectum or among the loops of the small intestine, inflammation can spread to the intestinal wall, leading to intestinal irritation, fluid accumulation in the intestinal lumen, and diarrhea.

At the beginning of the disease, the tongue is moist and often covered with a white coating. The patient lies on his back or right side; changes in body position, coughing, laughing, sneezing sharply increase abdominal pain. When examining the abdomen, there may be a lag in the right lower quadrant of the abdominal wall during breathing.

On palpation, muscle tension and sharp pain in the right iliac region are detected. Positive symptoms of peritoneal irritation (Shchetkin-Blumberg, Razdolsky, Voskresensky symptom) can also be detected here. There are no pathognomonic symptoms of acute appendicitis; all symptoms are caused by local peritonitis.

The pain, as a rule, intensifies when the patient is positioned on the left side (Sitkovsky's symptom), especially with palpation (Barthomier-Michelson's symptom). With a retrocecal location of the process, there may be a positive Obraztsov’s sign—increased pain when raising the straightened right leg. The temperature is often elevated to low-grade levels.

In the blood - leukocytosis with a shift to the left. During a digital examination of the rectum or vaginal examination, pain is noted on palpation of the right wall of the pelvis (especially when the appendage is in the pelvic position). The presence of red blood cells and white blood cells in the urine does not exclude acute appendicitis.

In the case of emapyema of the appendix with scant local symptoms (no symptoms of peritoneal irritation), pronounced general phenomena are observed (high temperature, chills, high leukocytosis).

The diagnosis of acute appendicitis in typical cases is simple, but the atypical location and peculiarities of the course of the inflammatory process sometimes make diagnosing the disease extremely difficult. Differential diagnosis is carried out with pyelitis, renal colic, acute adnexitis, ectopic pregnancy, acute enteritis, mesadenitis, diverticulitis, acute cholecystitis, acute pancreatitis, perforated gastric and duodenal ulcers, right-sided pneumonia, herpes zoster, etc.

There are acute simple and destructive appendicitis. In the latter case, the symptoms of acute appendicitis are more pronounced: pain is stronger, symptoms of peritoneal irritation are more clear, leukocytosis and temperature are higher. However, complete correspondence of the clinical picture of the disease with the nature of the detected morphological changes in the appendix is ​​still not observed. The course of acute appendicitis in children, elderly patients and pregnant women has its own characteristics.

In children, underdevelopment of the greater omentum and