How inflammation develops
The vermiform appendix extends from the cecum and has a narrow lumen. If it is blocked by a fecal stone, overgrown lymphoid tissue after an infection, or, less commonly, by a foreign body and tumor, the outflow of contents is impaired. The pressure inside increases, the wall of the appendix swells, the blood supply deteriorates, and bacteria actively multiply. Further, the inflammation goes through stages from catarrhal to phlegmonous and gangrenous, and then perforation can occur - a breakthrough of the wall. From the first symptoms to this moment it usually takes from one to several days, but in children and the elderly everything develops faster.
- Blockage of the lumen of the appendix
- Swelling of the wall and proliferation of bacteria
- Phlegmonous and gangrenous stages
- Perforation and release of contents into the abdominal cavity
- Local or diffuse peritonitis
- Appendicular infiltrate and abscess
Symptoms
The typical onset is a dull pain in the upper abdomen or around the belly button that moves to the right and downward over several hours and becomes constant. Appetite almost always disappears, vomiting often occurs once, and the temperature rises moderately. The pain intensifies when coughing, walking, trying to jump, or driving on uneven roads. A person usually lies on his right side with his legs drawn up. The classic picture occurs in approximately half of the patients: with an unusual location of the process, pain can radiate to the lower back, right hypochondrium or pelvis.
- Pain moving from the navel to the right and down
- Loss of appetite
- Nausea, sometimes single vomiting
- Temperature 37–38 °C
- Increased pain when coughing and moving
- Abdominal muscle tension in the lower right
Special groups: children, pregnant women, elderly
In young children, appendicitis is more difficult to recognize: the child cannot pinpoint the location of the pain, refuses to eat, becomes lethargic or, conversely, restless, and experiences vomiting and loose stools. The course is faster, and complications develop earlier, so an examination by a pediatrician and surgeon is needed without delay. In pregnant women, an enlarged uterus displaces the appendix upward, and pain may be felt in the right hypochondrium. In older people, the symptoms are erased: the temperature and pain are mild, but the inflammation progresses. In all these groups, the threshold for seeing a doctor should be as low as possible.
- In children - lethargy, refusal to eat, vomiting, rapid progression
- In pregnant women, pain shifts higher, closer to the hypochondrium
- In the elderly - a blurred picture with severe inflammation
- In all cases, an urgent examination by a surgeon is required.
- You can't rely only on temperature
Diagnostics
The basis is an examination by a surgeon: he evaluates the localization of pain, muscle tension and special symptoms characteristic of peritoneal irritation. A general blood test usually shows an increase in white blood cells with a shift in the formula, and C-reactive protein shows inflammatory activity. Ultrasound of the abdominal cavity allows you to see a thickened appendix and free fluid, as well as exclude gynecological and renal pathology. When the picture is unclear, a computed tomography scan is prescribed. For women, a gynecological examination and pregnancy test are required, because ectopic pregnancy and cyst torsion can look similar.
- Examination by a surgeon with palpation of the abdomen
- Complete blood count and C-reactive protein
- General urine test to exclude renal colic
- Ultrasound of the abdomen and pelvis
- Computed tomography with an unclear picture
- Pregnancy test and gynecological examination for women
- Observation in hospital for several hours if in doubt
Treatment and recovery
The standard treatment for acute appendicitis is surgery to remove the appendix. More often it is performed laparoscopically, through several small punctures: it is less painful, leaves small scars and allows you to quickly return to normal life. Perforation and peritonitis may require open surgery and longer treatment with antibiotics. When an appendiceal infiltrate has formed, sometimes conservative treatment is first performed, and surgery is performed later. After an uncomplicated operation, you are usually discharged home after one to three days, and physical activity is limited for several weeks. Before being examined by a doctor, you should not take painkillers, apply a heating pad, or give an enema.
- Laparoscopic appendectomy is the main method
- Open surgery for complications
- Antibiotics for perforation and peritonitis
- Discharge usually 1–3 days after uncomplicated surgery
- Limiting physical activity for several weeks
- Before being examined by a doctor, do not warm your stomach, do not numb the pain, do not eat or drink.
