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What is an Appendix?
The location of the Appendix Vermiform Appendix (lat. processus vermiformis) as a separate entity begins to form in the third month of embryonic development. The first descriptions and sketches of the authority date back to 1472 and belong to Leonardo da Vinci.
The Appendix, or vermiform Appendix, is unpaired organ located in the abdominal cavity, which has a tubular shape, in sizes from 2 to 17 cm or more, its base flows into the dome of the cecum. In the Appendix there are the same layers as that of the blind intestine: serous, muscular, submucous, and mucous. In one of them there are lymphoid follicles (specific fabric, which is similar in function to the tonsils in the throat), which play a huge role in the formation of inflammatory changes in the wall of the Appendix.
The blood supply to the bone is the artery which goes from the mesenteric vessels that supply the small intestine. Vessels of the Appendix can have ramifications, and are always in the mesentery, which consists of fatty tissue and makes the process of mobility.
The innervation of the Appendix (the provision of organs and tissues nerve cells) are the sympathetic and parasympathetic nerve fibers. One of the most important for physicians is the fact that nerve fibers of the sympathetic system supplying the Appendix, out of the solar plexus. This anatomical feature is marked by the famous surgeon Kocher, who described the displacement of pain from the upper abdomen to the right iliac region, acute inflammation of the Appendix.
What side is the Appendix in humans?
A person’s peritoneal cavity Abdominal cavity of the person is divided into 9 conventional areas, which are limited by lines drawn through the anatomical structure.
In particular, the projection of the Appendix on the abdominal wall located in the right iliac region, which is roughly below and to the right of the navel, not reaching to the right hip, i.e. we can say that appendicitis is the man on the right side below the navel.
As a rule, the Appendix moves away from the posterior segment of the dome of the cecum, at 2-3 cm below the ileocecal angle (junction of the small intestine for the colon). There are five provisions of the Appendix relative to the cecum:
- Descending (40-50%) — located in the pelvis;
- Side (lateral) (25%) is placed closer to the lateral abdominal wall;
- Internal (medial) (17-20%) is closer to the small intestine;
- Rear (retrocecal, dorsal) (9-15 %), while it can be placed outside the dome of the cecum is intraperitoneal or extraperitoneal, which greatly complicates the diagnosis of acute appendicitis;
- Anterior (ventral) (8-15%) — adjacent to the anterior abdominal wall.
Variants position of the Appendix in relation to cecum
Depending on the placement of the Appendix, the clinical picture of the disease in humans can vary and may mimic diseases of various organs.
For example, the rear location of the Appendix may simulate the symptoms of renal colic with lower back pain, disorders of urination and not severe abdominal pain. Another option, internal placement, when the patient complains of diarrhea, pain around the abdomen, which in turn may push the patient and even the doctor thought about banal intestinal infections.
Inflammation of the vermiform Appendix — acute appendicitis
Inflamed Appendix, the Term “acute appendicitis” implies an acute nonspecific inflammation of the layers of the Appendix. Depending on the distribution of the reaction, it is possible to lose only the mucosa or all layers of the organ, until the occurrence of perforation (a hole) the wall.
Classification of acute appendicitis:
- catarrhal inflammation of the mucous membrane only;
- abscess — the mucosal, submucosal and muscular sheath;
- gangrenous — the defeat of all layers of the body;
- gangrenous-perforated — as the defeat of all layers, but with the presence of pathological hole in the wall of the Appendix (perforation).
Causes of acute appendicitis
To date, no single theory of the development of the disease. However, in the last century, surgeons have attached great importance to some of them, who now have a place to be:
- The vascular theory. It is based on the interruption of the blood supply or blood flow through the blood vessels of the Appendix that can be caused by various diseases such as diabetes, blood disease, atherosclerosis, portal hypertension and others.
- The theory of stagnation. Violation of contractility in the Appendix often leads to a delay of feces in the lumen of the organ. In the presence of stagnation of the contents there is a sharp development of pathogenic bacterial flora, which leads to the penetration of bacteria into the wall of the Appendix, and its inflammation.
- Theory of fecal stones. The Appendix can sometimes formed fecal stone, which can cause bedsores wall of the bone and penetration of bacteria in all layers of the body.
- The theory of worm infestation. The presence in human intestines of different types of parasitic worms, prevents their release into the lumen of the Appendix and the penetration in the wall that is the response of the inflammatory response.
- Infectious theory. This assumption is based on histological analysis of remote inflamed and normal appendices. The study discovered that the cause of inflammation of the wall of the Appendix was the bacterial effect on the mucous membrane. The main microorganism which carries the impact is Enterococcus. This bacterium under normal conditions is in the lumen of the intestine, however, with the weakening of the body or increase the virulence of the microbe, it causes pathological changes in the wall of the Appendix, contributing to inflammation.
- Hematogenous theory. Theory is associated with the feature structure of the wall of the Appendix is the huge amount of lymphoid tissue. As is known, lymphocytes are responsible for the protective reaction of the organism against the pathogen. Here, in the presence of pathogen-associated lymphoid tissue of the Appendix first, from the abdominal cavity, reacts to the threat. Thus, an inflammatory reaction starts in the Appendix, and with the correct diagnosis and performing timely surgery, doesn’t spread to other abdominal organs.
Experience shows that the timely removal of the inflamed Appendix, pauses and even stops the development of the inflammatory process in the abdominal cavity.
The first symptoms of appendicitis
You must remember a few simple symptoms that will help you to determine appendicitis at home:
- pain in the abdomen;
- muscle tension of the abdominal wall;
- nausea, sometimes vomiting;
- General weakness, malaise.
So, let us dwell on each of them.
Migration of pain is the main symptom of appendicitis is abdominal Pain. This is perhaps the most important sign of presence of pathology in the abdominal cavity. You need to remember the main symptom of acute appendicitis – symptom Volkovich-Kocher. It is characterized by migration of pain from the upper abdomen (sometimes patients say “my stomach hurts”) or whole abdomen in the right iliac region for 3-8 hours.
I emphasize this symptom is fundamental in the diagnosis of acute appendicitis. Although in rare cases this symptom may not occur, e.g., when the patient slept through the night, or didn’t pay attention to him, as it periodically has problems with the gastrointestinal tract. Further, pains are exhausting character and are localized mainly in the right iliac region.
Muscle tension of the abdominal wall. This important symptom is also found in the majority of patients with acute appendicitis. It occurs when the patient wants to cough or perform any physical activity, this raises the pain and tension of muscles of abdominal wall in right iliac region. If the patient should try to touch this area, he can feel how tense his muscles.
This symptom of appendicitis is more informative for the physician who examines a patient, but if a sick person will discover this sign, then it must refer to a specialist.
Nausea and sometimes vomiting. There are a variety of dyspeptic symptoms in the presence of inflammation in the digestive tract, but these two in the complex create a picture of disease, in which necessarily need to contact the doctor. Vomiting and nausea are not specific symptoms of acute appendicitis, however, often accompany the disease. Nausea may be constant, and vomiting is to have a single character.
General weakness, malaise, fever. Fever, General weakness appear when you influence on an organism of toxic substances that enter the blood in the presence of inflammatory focus, which may be an inflamed Appendix.
The symptoms of appendicitis in adults women and men
In adults, the symptoms of appendicitis are virtually indistinguishable, however, differential diagnosis may be some difficulties for the doctor. Will present a list of diseases which may have a similar clinical presentation with acute appendicitis and occur equally in men and women: inflammation of the diverticulum of Mekele, Crohn’s disease, enterocolitis, renal colic, colon cancer, etc.
In women, the symptoms of appendicitis are similar to the signs of the following diseases: inflammation of the uterine appendages (adnexitis, salpingitis, tubo-ovarian abscess), disturbed ectopic pregnancy, ruptured ovarian cyst, ovarian syndrome, ovarian apoplexy. The main point that you need to grasp all — all these diseases need of qualified treatment in a clinic, or at least the advice of a doctor.
The symptoms of appendicitis during pregnancy
In pregnant women observed erased picture of the disease, which may mislead the initial evaluation of women. You need to pay attention to pregnancy, because late-term fetus is increased, thereby expanding the cavity of the uterus, which displaces the Appendix upward. In this case, the pain can be located in the right hypochondrium, to be intense and grow when pregnant turn to the right side, due to the pressure of the uterus on the inflamed Appendix. Otherwise, similar symptoms can be vomiting, nausea, fever, weakness.
The safest and most reliable method of diagnosing appendicitis during pregnancy is abdominal ultrasound. Upon confirmation of the diagnosis of acute appendicitis is an urgent need to perform surgery to remove the inflamed Appendix.
Signs of appendicitis in children
In children there is some feature of the structure of the Appendix and abdominal cavity:
- wide and short Appendix at the age of 3-4 years, with no accumulation or stagnation of the contents in the lumen of the Appendix;
- the relatively large area of the peritoneum that may contribute to the rapid absorption of toxic substances, and the development of fatal complications of acute appendicitis is sepsis;
- a short greater omentum (the body consists mainly of fat tissue and must cover all the abdominal organs, but in children it is not able to do that can lead to generalization of purulent inflammation in the abdominal cavity).
Acute appendicitis generally develops in children older than 5 years, but this fact does not prevent the presence of appendicitis in infants or younger than 5 years. Acute appendicitis occurs very rapidly and with severe General symptoms. Have younger children the symptoms of appendicitis may include: fever, temperature up to 39 C, vomiting, sometimes diarrhea, weakness, drowsiness, lack of physical activity.
When examining a child marked pain and muscle tension in the right iliac region, positive symptoms of peritoneal irritation. Signs of appendicitis in older children, as well as the course of the disease is identical to adult.
Signs of appendicitis in the elderly
The elderly appendicitis can start with pain “in the stomach”, which gradually shifts to the right iliac region. However, the problem of diagnosis of appendicitis in this population is often late presentation of the patient to the doctor, uncertainty, abdominal pain, sclerotic changes in the nervous system (thus the patient may not remember when the pain started, how much it hurts, can not show the exact location of the pain). In the first place stands General weakness, increased body temperature to 38 C, bloating, constipation.
You need to remember that any pain that lasted more than a day, should cause suspicion. In the diagnosis of acute appendicitis helps ultrasound, and abdominal CT. Treatment of appendicitis in the elderly is identical with all categories of the population – the surgical removal of the inflamed Appendix.
First aid for suspected acute appendicitis
In the first place when there is a suspicion on the acute appendicitis you can’t take painkillers, as they can erase the clinical picture of the disease. When you recognize the symptoms of appendicitis, you need to consult a doctor immediately. Before the arrival of the doctor can afford to take a pill of Drotaverine (no-Spa) or make intramuscular injection antispasmodics (drotaverine or papaverine).
Diagnosis of acute appendicitis
To confirm the diagnosis of acute appendicitis in a medical facility use the following diagnostic methods:
- General analysis of blood (there is leukocytosis with a shift formula to the left);
- urinalysis (often without pathological changes);
- biochemical analysis of blood (the first stage of the inflammatory response in acute appendicitis levels of bilirubin, urea, creatinine, total protein are within normal limits, but with the development of complications these indicators are rising);
- Ultrasound (in our time, has a very high percentage of accurate diagnosis, the physician-diagnostician may indicate the size of the Appendix, its location, the presence or absence of free fluid in the abdominal cavity);
- computed tomography of the abdominal cavity (is the gold standard in the diagnosis of acute appendicitis).
Treatment of appendicitis without surgery, a surgical intervention is impossible, so all patients with suspected acute appendicitis go straight into surgery. The surgeon has at his disposal only 2 hours to determine the diagnosis. The delay in this case is impossible.
For 2 hours you can spend conservative therapy (antispasmodics, antibiotics, infusion therapy) and dynamic observation. If in conjunction with the clinical picture and the deterioration of the results of additional methods of examination, the surgeon established the diagnosis of acute appendicitis, the patient required emergency surgery.
Surgical access in the early stages of the disease is in the right iliac region, in an oblique direction of the long 7-10 see If there are signs of peritonitis, perform a median laparotomy, that is an incision from navel to pubis. This access allows cleaning of the abdominal cavity, to get rid of accumulated fluid and to cure the patient.
The types of incisions, depending on the method of removing the inflamed Appendix
Medicine does not stand still, so produce appendectomy laparoscopically can, only three small incisions on the abdominal wall, which further significantly reduces the duration of postoperative recovery.
The postoperative period
The duration of the operation can vary from 40 minutes to several hours, depending on the duration of disease, presence of complications and the location of the inflamed Appendix in the abdomen.
In the postoperative period the patient receives appropriate drug therapy:
- antibiotics for 5-7 days;
- infusion therapy (method of treatment based on the introduction into the circulation of the various solutions of definite volume and concentration, with the purpose of correction of the pathological loss of the body or prevent them.);
On the first day after surgery is prohibited food and drink, as everything the patient receives, together with the infusion, but, in the absence of complications, it is already possible to move independently. On the second day after surgery you can drink mineral water, compote from dried fruits, eat a light soup, baked apples. Since this will start the peristalsis of the intestine, it is possible to expand the diet.
The patient performed daily dressings of the wound to ensure healing of the tissue and lack of wound complications.
Period of stay at the hospital after surgical treatment of acute appendicitis depends on the timing of the operation and its fashion. In a typical access and the lack of complications, 6-8 and by laparoscopy 3-4 days only.
After surgery to remove the Appendix contraindicated exercise for at least for 2 months.
Complications in surgery were and will be, however, depends on the patient, which must not self-medicate, and at the first suspicious symptoms, immediately consult a doctor.
Here are examples of some of the complications of acute appendicitis.
Occurs in the case of late presentation of patient to the hospital for acute appendicitis and is 4% of cases. Usually at home people with abdominal pain take pain relievers, antibiotics without prescription, which leads to the development of the infiltration.
This complication is ogranichivaya the inflamed Appendix from the abdominal cavity using a subject to him of organs such as small intestine, greater omentum, cecum, abdominal wall. These bodies create a barrier against the spread of purulent inflammation from the Appendix into the abdominal cavity.
Treatment infiltration only conservative, in any case not operational. Apply a broad-spectrum antibiotics, detoxification and anti-inflammatory therapy for 8-10 days, until disappearance of signs of infiltration.
This complication is the next stage of infiltration, when not made the appropriate treatment. Develops purulent fusion of the Appendix with the formation in its place of a purulent focus, which bordered the nearby organs.
The main complaints are: abdominal pain, fever with temperatures up to 40 C, weakness, malaise, and sometimes vomiting.
Treatment only operative, and to reveal the abscess is not transabdominal, so as not to infect the abdominal cavity.
Peritonitis is an inflammation of the peritoneum, which covers all abdominal organs. Threatening complication, which indicates poor case of acute appendicitis is characterized by pain around the abdomen, fever, intoxication, low blood pressure.
When a patient with this diagnosis need to first perform preoperative preparation in the form of infusion therapy, and then perform a laparotomy, cleaning the abdominal cavity and remove the inflamed Appendix.
The postoperative period in this case is greatly prolonged, is not excluded irreparable consequences. Therefore, you should always consult a qualified doctor who in time will suspect the diagnosis of acute appendicitis that may help to prevent severe complications.
A life-threatening complication that is characterized by thrombosis of the portal vein, which leads to liver failure. Condition manifested by fever, loss of consciousness, jaundice and acute hepatic-renal insufficiency.
This is a very rare complication, it is almost impossible to predict, but can be prevented in time going to the doctor.
In conclusion we can say that timely access to a surgeon and the rejection of self-medication, to avoid complications of acute appendicitis!