- Classical symptoms with appendicitis
- What can I judge when I see a patient?
- Diagnosis by nominal symptoms
- Symptoms of atypical appendicitis current
- Modern diagnostic methods for
- Features of symptoms in childhood
- Features of signs in elderly and senile age
- What diseases do appendicitis differ from?
- Video on topic
Clinical manifestations of acute appendicitis differ in variety, variants of the course, dependence on the form of inflammation, the position of the appendix. It is not easy for a practical doctor to diagnose correctly. Therefore, the error rate ranges from 12 to 31%.
To study the symptoms of appendicitis, many outstanding surgeons and scientists dedicated their research and left a trace in the history of medicine, as well as in the practical activities of surgeons by the names of the signs of the disease. Rapid development of complications is even more confusing manifestation of appendicitis.
Classic symptoms with appendicitis
A sensible person will think about appendicitis if he feels pain in his stomach or his loved ones complain. Do not try to diagnose, it is better to call an ambulance as soon as possible. For those who are interested in how appendicitis manifests, we will give a description of the most typical signs.
The main symptom of acute inflammation of the appendix is pain. It has a permanent character, but a different localization:
- is the most typical beginning from the right iliac region( in the lower abdomen on the right above the inguinal fold), while it does not have a typical irradiation;
- in half of cases - according to the symptom of Volkovitch-Kocher begins in epigastrium( substrate) or around the navel( according to Kummel), only after 1-3 hours passes into the right iliac fossa;
- less often the pain immediately diffuse nature and spreads throughout the stomach, this indicates a sign of violent inflammation with appendicitis.
Atypical pain syndrome is more often associated with the peculiarities of the topography of the appendix:
- when lowered into the pelvis - the pain is localized above the pubic joint or deep in the pelvic organs, the inflamed appendix in adults forms many adhesions with the intestine, bladder, in women - with the uterus and appendages, such symptoms are very similar to gynecological diseases;
- at retroperitoneal position - it should be expected in right iliac region, waist, irradiation to the right thigh, painful urination, there is no symptom of Shchetkin-Blumberg and tension of abdominal muscles;
- for the ascending position are typical pains in the hypochondrium on the right;
- in the retroileal( medial) position, they occupy the entire right half of the abdomen, extend in the direction of the right ureter, resemble the renal colic, in men they give in the testicle, and in women - in the labia.
In the photo, the person clearly has abdominal pain on the right, but are they caused by appendicitis yet to be proved
If the pain subsides, then one should think about the necrosis of the appendix wall, the death of nerve endings, which is a symptom of gangrenous inflammation of the appendix. A sudden sharp increase in intensity may serve as a sign of perforation of the process( if the wall "bursts"), threats of peritonitis and other complications.
Sometimes surgeons find an appendix in the left side of the abdomen. This is possible with too long mesentery of the cecum or mirror arrangement of the organs. Then it is difficult to guess in advance which side and localization of the pain syndrome is considered a symptom of inflammation.
The second most significant symptom in the diagnosis of suspected appendicitis is vomiting and constant nausea. It is available in 75% of patients. Figuratively, vomiting is called a "shadow of pain."In adult patients occurs 1-2 times. It is caused by a reflex reaction in case of inflammation of a limited area of the peritoneum.
The secondary symptoms of appendicitis in adults are not typical for the defeat of the appendix, but reflect general disorders of the intestinal functions. These include:
- loss of appetite;
- stool disorders( diarrhea or constipation).
Severe weakness and decreased ability to work - early signs of
pathology What can be judged upon examination of the patient?
The first symptoms in appendicitis that can be detected when examining a patient are moderately expressed signs of general malaise:
- the position of the patient can not be attributed to a forced posture, the patients calmly lie on their backs or on their right sides, excitation is absent;
- body temperature within 37-38 degrees, the appearance of chills indicates the development of purulent inflammation;
- manifests a small tachycardia, the increase in heart rate increases with increasing temperature, it is associated with destructive processes, increased intoxication and local peritoneal phenomena, their mismatch( tachycardia against the background of normal temperature or bradycardia when it rises) - this is a symptom of the patient's severe condition;
- color of the skin does not change, paleness is observed in cases of complication with peritonitis;
- examination of the tongue draws attention to the deposition with white coating, dryness indicates the processes of intoxication, local or diffuse peritonitis;
- examination of the abdomen shows shining of the right divisions during breathing due to limited mobility of the abdominal wall, often occurs with phlegmonous or gangrenous form of appendicitis.
Diagnosis by nominal symptoms
The symptoms of appendicitis by authors who found them and suggested taking into account appendicitis and its differential diagnosis with other diseases remain valid until now. They are checked by surgeons even if there are opportunities for ultrasound and laboratory tests. In such cases, a conservative approach, based on years of experience, is justified.
The testing of the Shchetkin-Blumberg symptom is carried out with any suspicions of involvement of the peritoneum
. The methods only emphasize that once doctors could rely only on themselves, their knowledge and observations. Here are a few symptoms that, according to the authors, point to acute appendicitis.
- Szczektina-Blumberg - it is necessary to press down easily and gradually on the abdominal wall, then abruptly pull back the hand, peritoneal inflammation is characterized by the manifestation of soreness at the time of pressure release, and not by palpation.
- Resurrection - located to the right of the patient, the doctor should use his left hand to pull the shirt over his lower edge, and the right one to hold a sharp sliding movement along the tissue over the abdomen from top to bottom, to stop in the ileum. A positive symptom is manifested by increased pain at the time of slippage.
- Rovsinga - with one hand pressed to the left of the descending bowel area, another - produce a short push, while in patients with appendicitis the pain appears on the right.
- Razdolsky - the author used percussion of the abdomen, the method gave a positive result to increase pain over the projection of the appendage.
- Ortner-Sitkovsky - the patient is offered to turn to the left side, and he has painful pains in his right side.
- Obraztsova - increased pain in palpation in the right side area against the background of a raised straight leg in the knee.
- Michelson - helps in the diagnosis of inflammation of the appendix in pregnant women, the author noted an increase in pain in the position of the woman on the right side, due to the pressure of the enlarged uterus on the inflammatory focus.
- Pasternatsky - effleurage in the lumbar region causes pain in the abdomen, is used not only to diagnose kidney disease, but also to identify the retroperitoneal position of the inflamed appendix.
- Volkovich - the author indicated that in patients with chronic appendicitis the stomach looks sunk in the right lateral and hypochondrium due to the softer abdominal wall.
- Lanza - the disease point is determined, characteristic for the disease, in mind, it is necessary to connect the protruding upper ends of the iliac bones by a line, the point lies on the junction of the outer and middle third on the right.
Symptom Obraztsova helps in differential diagnosis of
Symptoms of atypical appendicitis current
The main reason for the lack of classical appendicitis flow are the variants of the position of the appendix in the appendix relative to the nearby organs and the peritoneum. Pelvic and retrocecal forms are accompanied by the most severe course, gangrenous and perforating types of inflammation often occur. It depends on the mistaken and belated diagnosis. Let us dwell on the recognition of these forms.
Pelvic position of the inflamed appendix
Instead of the most clear symptoms, the patient has dysuric disorders:
- frequent urination;
- rubs and pains over the pubis.
Signs of bowel damage:
- liquid stools frequent;
- sometimes a false urge to defecate( tenesmus).
The tension of the abdominal muscles is weak. In the diagnosis it is important to conduct a rectal examination to identify the infiltrate around the appendix. Women should be consulted with a gynecologist.
Distinguished by severe symptoms of general intoxication( fever, vomiting, nausea, headache) with minor local signs. It is recommended to palpate the patient in position on the left side with both hands, pushing from the side of the waist and the right side of the abdomen.
If the doctor is unsure of the absence of appendicitis, an operation should be performed and the diagnosis should be resolved during the intervention. Obstruction of observation is dangerous for the patient's life.
Modern diagnostic methods for
The first signs of appendicitis are evident from the results of laboratory studies. In the analysis of blood leukocytosis is observed with a shift of the formula to the left, changes allow us to judge the nature of the severity of the inflammatory process:
- in simple forms - moderate leukocyte growth( from 8 x 109 to 10 x 109 / L);
- for destructive and complicated - from 14 x 109 to 20 x 109 / l.
The more pronounced the shift of the leukocyte formula to the left, the more pronounced the degree of destruction of
. However, it should be remembered that in 4% of cases of acute appendicitis the blood test remains normal, and that a small leukocytosis with a significant shift indicates a severe process in the peritoneum.
Deviations in the composition of the urine sediment in the form of a small pyuria, the appearance of a protein, red blood cells occurs with the pelvic and retrocytic position of the inflamed process. Caused by the involvement of the urinary system. For the purpose of clarification, urgent additional studies of the condition of the kidneys and the bladder are needed.
Conducting an ultrasound study for emergency indications helps to solve the problem of diagnosis. The ultrasound probe is placed in the epicenter of pain, if it is unclear, then the examination begins with the right ileal region. It is necessary to press it more densely to the abdominal wall and try to force out gases from the intestine.
Signs of appendicitis on ultrasound are:
- an increase in the diameter of the process to 7 mm or more;
- revealing a rounded diameter without changing its shape under pressure;
- presence of reactive effusion around the process;
- no gas appendix;
- increased blood flow on the color Doppler;
- increase in regional lymph nodes;
- definition of stool in the lumen of the shoot.
The most reliable method of diagnosis is laparoscopy. Inspection of the intestinal loops and the appendix and the surrounding peritoneum allows you to make a diagnosis with confidence, and then remove the appendix.
Features of symptoms in childhood
Acute appendicitis is affected by children of any age. In the period of the newborn and up to two years is very rare. Prevalence reaches a maximum by 9-12 years.
The clinical course is caused by:
- reduced peritoneum resistance to any infection;
- small packing;
- more active reactivity of the body.
Small patients, unfortunately, are more likely to suffer from destructive and complicated forms of
. The pain syndrome is difficult to localize due to complaints. The child has:
- high fever;
- frequent vomiting;
- signs of intoxication( anxiety or retardation, symptoms of meningism);
- disturbances of water-electrolyte balance towards dehydration( dryness of mucous membranes, exacerbation of facial features).
Palpation of the abdomen is hampered by the child's violent reaction. In older children, it is possible to determine the positive symptoms of appendicitis, the tension of the abdominal muscles in the right side.
Characteristics of signs in the elderly and senile age
In elderly people, the features of appendicitis flow depend:
- from a decrease in the reserve capacity of immunity to protect against infection;
- the presence of concomitant vascular disease with an atherosclerotic process;
- chronic diseases.
The onset of the disease is less severe than in the young, the pain is moderate even in destructive forms. In patients:
- , there is nausea, vomiting, constipation with a difficult passage of gases;
- the temperature rises rarely;
- tension of the abdominal muscles is weak or absent;
- in the blood test moderate leukocytosis without a shift in the formula. What diseases do appendicitis have to distinguish from?
Differential diagnosis of acute appendicitis needs careful comparison with the clinic of diseases concealed under the mask of "acute abdomen", taking into account atypical flow, unclear and mild symptoms.
The most common pathology, from which it is necessary to distinguish appendicitis, are:
- peptic ulcer of the stomach and duodenum in the stage of perforation - pain "dagger", a picture of shock, a previous ulcerative anamnesis;
- acute cholecystitis - maximum pain in the right hypochondrium, bitterness in the mouth, frenicus-symptom, high fever;
- intestinal obstruction - intestinal atony, absence of gases;
- Crohn's disease - a link with heredity;
- acute pancreatitis - "girdling" pain;
- enterocolitis of different etiology - the connection with poor-quality products, frequent diarrhea, vomiting;
- ectopic pregnancy, adnexitis on the right, rupture of ovarian cyst in women - menstrual cycle disorder, painful formation during manual examination;
- right-sided renal colic in urolithiasis - irradiation in the groin, external genitalia, lower back, blood in the urine;
- right-sided croupous pneumonia - absence of respiration in the lower parts of the lungs, shortness of breath, unilateral lag of the chest;
- Acute myocardial infarction - vaginal pain localization, association with physical activity or stress, decrease from Nitroglycerin, pressure drop.
Patient with suspicion of acute appendicitis must be hospitalized in the surgical hospital
For observation, specialist consultations and emergency examination, no more than 3-5 hours are allowed. When you save or weight symptoms, the operation is shown. The doctor is responsible for the timely diagnosis of appendicitis.
Often, patients in the hospital are examined by several surgeons in order to develop a common opinion. Modern requirements set the task of training physicians for primary ultrasound diagnosis and independent application of this technique when examining a patient. This capability is designed to reduce the number of diagnostic errors and improve the prognosis of treatment.