Appendicitis in women: causes, symptoms, diagnosis

Appendicitis is inflammation of the appendix (appendix). This pathology is one of the most common among diseases of the gastrointestinal tract. According to statistics, appendicitis develops in 5-10% of all inhabitants of the planet. Doctors cannot predict the likelihood of its occurrence in a particular patient, so there is little point in preventive diagnostic studies. This pathology can suddenly develop in a person of any age and gender (with the exception of children who are under one year old - they do not have appendicitis), although in women it occurs a little more often. The most “vulnerable” age category of patients is from 5 to 40 years. Before 5 and after 40 years, the disease develops much less frequently. Before the age of 20, pathology occurs more often in men, and after 20 - in women.

Appendicitis is dangerous because it develops rapidly and can cause serious complications (in some cases life-threatening). Therefore, if you suspect this disease, you should immediately consult a doctor.

The vermiform appendix is an appendage of the cecum, hollow inside and without a through passage. On average, its length reaches 5-15 cm, and its diameter usually does not exceed a centimeter. But there are also shorter (up to 3 cm) and longer (over 20 cm) appendixes. The vermiform appendix arises from the posterolateral wall of the cecum. However, its localization relative to other organs may be different. The following location options are available:

Standard. The vermiform appendix is located in the right iliac region (in the anterior part of the lateral region, between the lower ribs and pelvic bones). This is the most “successful” location from a diagnostic point of view: in this case, appendicitis is detected quickly and without any particular difficulties. Standard localization of the appendix is observed in 70-80% of cases.
Pelvic (descending). This location of the appendix is more common in women than in men. The vermiform appendix is located in the pelvic cavity.
Subhepatic (ascending). The apex of the appendix “looks” at the subhepatic recess.
Lateral. The appendix is located in the right lateral paracolic canal.
Medial. The vermiform appendix is adjacent to the small intestine.
Front. The appendix is located on the anterior surface of the cecum.
Left-handed. It is observed with a mirror arrangement of internal organs (that is, all organs that should normally be on the right side are on the left, and vice versa) or strong mobility of the colon.
Retrocecal. The vermiform appendix is located behind the cecum.

Appendicitis that develops with a standard location of the appendix is called classic (traditional). If the appendix has a special localization, we are talking about atypical appendicitis.

Role of the appendix

Some patients wonder: if appendicitis is a fairly dangerous disease that can occur in any person, then perhaps it would be advisable to remove the appendix for preventive purposes in order to avoid the development of pathology?

Previously it was believed that the vermiform appendix is a rudiment. That is, once the appendix had a slightly different appearance and was a full-fledged organ: people who lived in ancient times ate completely differently, and the vermiform appendix participated in the digestive processes. Due to evolution, the human digestive system has changed. The appendix began to be passed on to descendants in its infancy and ceased to perform any useful functions. At the beginning of the 20th century, vermiform appendices were even removed from infants to prevent appendicitis. Then it turned out that the importance of the appendix is greatly underestimated. Patients who had their appendix cut out in childhood had significantly reduced immunity and were much more likely than others to suffer from various diseases. These people also had problems with digestion. Therefore, over time, doctors abandoned the practice of removing the appendix for preventive purposes.

Modern scientists believe that there are no unnecessary organs in the human body, and if rudiments continue to be passed on from generation to generation, it means they perform some functions (otherwise they would have “died out” long ago). If they do not bother the patient, then there is no need to remove them for preventive purposes. There are several scientific theories regarding the role of the appendix in the modern human body, the most common of which are the following:

The vermiform appendix is part of the immune system . The wall of the appendix contains a large amount of lymphoid tissue that synthesizes lymphocytes. Lymphocytes are blood cells that provide protection to the body from foreign particles and infections.
The appendix helps maintain the balance of beneficial intestinal microflora . The intestines are populated by microorganisms involved in digestive processes. Some of them are unconditionally useful and do not pose a threat to the body under any circumstances. Others are opportunistic, meaning they become dangerous only when a number of conditions are met. In a healthy body, the necessary balance is maintained between all microorganisms. With the development of infectious diseases of the gastrointestinal tract (salmonellosis, giardiasis, dysentery, rotavirus infection, etc.), this balance is disrupted, causing digestion processes to suffer. Some scientists believe that beneficial bacteria also live in the appendix, where they are protected from infection. Due to diseases, important microorganisms die in the intestines, but not in the appendix. This allows the intestinal microflora to recover fairly quickly. Beneficial bacteria that multiply in the appendix “exit” into the intestines and normalize the balance. Scientists came to this conclusion when they noticed that patients who underwent surgery to remove the appendix often have problems with the microflora of the digestive tract.

Treatment of appendicitis almost always involves removal of the appendix (except in cases where surgery is contraindicated for the patient), since it is not a vital organ. But this does not mean that as a result of surgery a person will necessarily develop health problems. He will just have to pay more attention to his immunity. And modern drugs - probiotics and prebiotics - help to avoid intestinal dysbiosis.

Types of appendicitis

Appendicitis can be classified according to its form and the nature of its course. The form of the disease is:

Spicy . It develops rapidly and manifests itself with pronounced symptoms. In the absence of medical assistance, it continues to progress. In very rare cases, self-healing occurs. However, it is not recommended to rely on this possibility; if left untreated, appendicitis can cause serious complications.
Chronic . Quite a rare form. In most cases, it develops as a result of acute appendicitis in the absence of treatment. It has the same symptoms as acute appendicitis, but the symptoms are more subtle. Like any other chronic disease, it is characterized by periods of exacerbations and remissions.

According to the nature of the course, an acute disease (according to the most common surgical classification) can be uncomplicated or complicated. Types of uncomplicated pathology include:

Catarrhal (simple, superficial) appendicitis. Only the mucous membrane of the appendix becomes inflamed.
Destructive (with tissue destruction) appendicitis. It has two forms - phlegmonous (the deeper layers of appendix tissue are affected) and gangrenous (death of the wall of the appendix occurs).

Complications of acute appendicitis include:

Perforation (rupture) of the wall of the appendix.
Formation of appendiceal infiltrate (inflammatory tumor around the appendix).
Peritonitis (inflammation of the peritoneum).
Development of abscesses (ulcers).
Sepsis (blood poisoning).
Pylephlebitis (a purulent inflammatory process that results in thrombosis of the portal vein, a large vessel that delivers blood from the abdominal organs to the liver for its neutralization).

Chronic appendicitis is divided into:

Residual (residual). It is a consequence of acute appendicitis, which ended in self-healing. It manifests itself as a dull aching pain in the right iliac region. The development of residual appendicitis is often associated with the formation of adhesions.
Recurrent . Occurs against the background of acute appendicitis. It is paroxysmal in nature: exacerbations occur from time to time, followed by remission.
Primary chronic . Develops independently, without preceding acute appendicitis.

What does leukocytosis indicate in acute appendicitis?

The norm of leukocytes in the blood for an adult is 4.0–9.0 × 109 per liter. Leukocytosis, that is, an increase in the number of leukocytes, indicates an inflammatory process in the body. With appendicitis, changes in the blood test will depend on the stage of inflammation at which the examination is carried out:

In the catarrhal form of appendicitis, which can last up to two days, there may be no leukocytosis or it will be completely insignificant. The absence of changes in the tests is usually observed in the first hours of the development of the pathology, so it is important to repeat the tests several times after the patient is admitted to the hospital and if the diagnosis is questionable. Increasing leukocytosis with a shift in the leukocyte formula to the left, together with the characteristic symptoms of inflammation of the appendix, makes it more likely to correctly diagnose.
In destructive forms of inflammation, that is, when pus forms in the appendix and areas of dead tissue appear, leukocytosis can reach 18 or higher. As the number of leukocytes increases, the patient’s pulse also increases; with extensive inflammation, it can reach up to 120 beats per minute. With such indicators and the clinical picture of an acute abdomen, a treatment regimen should be determined as quickly as possible. Usually in such situations, surgery is prescribed, which is carried out against the background of antibiotic therapy.
An increase in the number of leukocytes to 20 or higher may indicate complications of the disease. Perforation of the walls of the appendix leads to the release of purulent contents into the abdominal cavity, where, under the influence of infection, all organs are included in the inflammatory process.

It is necessary to understand that with appendicitis, a large number of leukocytes will not always be observed in blood tests. There may be no leukocytosis in elderly patients or in the first hours of illness. When examining older people with suspected appendicitis, the peculiarities of the course of the disease during this period of life are always taken into account. In old age, in addition to the absence of an increased number of leukocytes in the blood, there may be no characteristic pain in its manifestations.

When examining pregnant women for possible inflammation of the appendix, one must take into account the fact that during this period, expectant mothers are almost always diagnosed with leukocytosis. Normal levels during pregnancy are considered to be 8.0-12.0 x109/l. That is, with appendicitis in pregnant women, it should be said when leukocytes in the blood are detected above 12.

Causes of appendicitis

The exact causes of the development of the disease have not yet been established. There are several hypotheses, the most common of which are:

Infection theory . This hypothesis associates the development of acute appendicitis with an imbalance of microflora inside the appendix, as a result of which bacteria that are safe under normal conditions, for unknown reasons, become virulent (poisonous), invade the mucous membrane of the appendix and cause inflammation. The theory was proposed in 1908 by the German pathologist Aschoff, and some modern scientists adhere to it.
Angioneurotic theory. Its supporters believe that as a result of psychogenic disorders (neuropsychic disorders, for example, neuroses), vascular spasm occurs in the appendix, due to which tissue nutrition is greatly deteriorated. Some areas of tissue die and then become sites of infection. As a result, inflammation develops.
Stagnation theory . Proponents of this hypothesis believe that appendicitis occurs due to stagnation of feces in the intestines, as a result of which fecal stones (hardened feces) fall inside the appendix.

Modern doctors come to the conclusion that there is no single cause of appendicitis that is relevant for all cases of the disease. Each specific situation may have its own reasons. Risk factors include:

Blockage of the lumen of the appendix with a foreign body, helminths, tumors (both benign and malignant).
Infections. The causative agents of typhoid fever, tuberculosis and other diseases can cause inflammation of the appendix.
Abdominal injuries, which can cause the appendix to move or become kinked and cause further blockage.
Systemic vasculitis (inflammation of the walls of blood vessels);
Binge eating;
Frequent constipation;
Lack of plant foods in the diet.

The walls of the appendix become more vulnerable to negative factors when the immune system malfunctions.

Symptoms of appendicitis

Symptoms of acute appendicitis are:

Continuous pain in the abdominal area. It appears suddenly, most often in the morning or at night. At first, the pain is localized in the upper abdomen, near the navel (or “spreads” throughout the entire abdominal area), but after a few hours it moves to the right side - the iliac region (just above the hip). This movement is called the Kocher-Volkovich symptom and is considered the most characteristic sign of appendicitis. At first the pain is dull and aching, then becomes throbbing. The pain is relieved if you lie on your right side or bend your knees towards your stomach. When turning, coughing, laughing and deep breaths become more intense. If you press on the abdomen in the iliac region with the palm of your hand and then quickly release it, the patient will experience a sharp attack of pain. With an atypical location of the appendix, the localization of pain may be different: in the left side of the abdomen, in the lumbar region, pelvis, pubis. The abdominal wall with appendicitis is tense. In some cases, pain may go away on its own, but this does not indicate recovery, but necrosis (death) of the tissues of the appendix. It is imperative to seek medical help, because inaction can cause the development of peritonitis.
Periodic bowel disorders (diarrhea or constipation).
Nausea and vomiting that does not bring relief.
Changes in blood pressure (either increases or decreases).
Increased heart rate.
Increase in body temperature: first to 37-38 degrees, then, as the disease progresses, to 39-40. In the interval between these two stages, the temperature may return to normal.
Dry mouth.

In older people, the symptoms of appendicitis may appear less clearly: minor pain, mild nausea. High temperature and tension of the abdominal wall are not observed in all cases. At the same time, appendicitis in older people is often characterized by a severe course and the development of complications. Therefore, at the slightest suspicion of appendicitis in an elderly patient, you should immediately consult a doctor.

In children under 5 years of age, the symptoms of appendicitis are not as pronounced as in adults. The pain often has no clear localization. Appendicitis in a small child can be recognized by increased body temperature, diarrhea and the presence of plaque on the tongue. Despite the fact that other, much less dangerous diseases may have such symptoms, the young patient must be shown to a doctor.

Appendicitis in women: causes, symptoms, diagnosis

24.09.2019

Appendicitis occurs much more often in women This is due to the structural features of the body. The inflammatory process often begins during menstruation and is manifested by abdominal , nausea and vomiting. Every woman should know the symptoms of inflammation of appendicitis - this will help her avoid complications.

Reasons for appearance

The appendix is a lymphoid organ up to 5 cm long. It provides immune protection to the digestive organs. Most often, appendicitis occurs in women aged 20 to 40 years.

The causes of the disease may be the following:

displacement of the appendix as a result of its compression by the abdominal organs. This situation occurs during pregnancy;
blockage of the organ with small debris (for example, seeds);
clogging of the lumen with feces;
poor nutrition;
transfer of infection from the pelvic organs;
inflammation of the lymphoid tissue in the appendix;
infection through the blood or intestines ;
individual structural features of the appendix.

To avoid the disease, women should:

Healthy food. Foods high in fiber help eliminate the problem of constipation and improve digestion;
support immunity . Taking vitamins, physical activity, hardening - protect the body from inflammatory diseases and prevent infection from getting into the appendix;
fight allergies , which can greatly reduce immunity ;
do not expose the body to emotional tension and stress.

First symptoms

The most common sign of appendicitis abdominal pain . It can intensify during movement, spread throughout the abdomen and radiate to the leg. The pain is pressing and pulling in nature, often moving from the right side to the left, and vice versa.

After some time, the woman begins to feel a low-grade fever. Typically it varies from 37 to 38 degrees. Feeling gradually worsens, nausea and vomiting appear.

Due to the fact that food is no longer digested normally, a person begins to experience diarrhea or constipation . of urination also increases significantly .

The first symptoms of appendicitis most often occur against the background of a normal condition.

Dangerous manifestations of appendicitis

Despite the fact that appendicitis is a common disease, it is not always possible to diagnose it yourself. Sometimes the symptoms of a disease manifest themselves differently and are interpreted incorrectly by a person.

A disease that is accompanied by complications can be recognized by the following signs:

vomiting mixed with bile is a symptom of blockage of the bile ducts;
black feces indicate the presence of blood ;
increased gas formation - signals inflammation of the pancreas ;
prolonged absence of menstruation .

The danger of these symptoms is that they can lead to serious complications and rupture of the appendix.

Diagnostics

As soon as a person has the first symptoms of the disease, you need to call a doctor .

Under no circumstances should you:

drink water;
carry out active movements;
reduce the temperature with antipyretic drugs;
use painkillers.

To make sure that the pain is a consequence of appendicitis , you can diagnose the pathology by palpation.

a flat surface and bend her knees . After this, she should gently press her fingers on the right side of her abdomen . If the pain intensifies during palpation, then the appendage is inflamed.

You can also detect inflammation of the appendix by loud coughing. If during a cough a woman feels pain in the area of the right ilium , this indicates confirmation of the diagnosis.

Appendectomy

It is impossible to cure inflammation of the appendix; the appendix is removed surgically .

There are two types of operations:

emergency - carried out immediately after arrival at the hospital . The surgeon makes an incision on the right side of the peritoneum. After removing the appendage, a small scar remains on the body;
planned - carried out a few hours after admission to the hospital . Elective surgery is performed on patients with any contraindications.

Further stay in the hospital is no more than 7-10 days. Rehabilitation after removal lasts until the doctor removes the stitches.

During this period, it is important to follow some recommendations:

refuse to visit the bathhouse;
do not expose the body to physical stress;
do not lift weights weighing more than 2 kg;
stick to a diet ;
do not drink alcoholic beverages.

It is important for women to normalize their bowel movements, so they should drink as much clean water as possible.

Published in Surgical diseases Premium Clinic

Diagnosis of appendicitis

A surgeon diagnoses appendicitis. First, anamnesis is collected and the patient is interviewed, as well as a visual examination with palpation of the abdomen. The examination reveals clear symptoms indicating the presence of the disease. The following studies are also carried out (not necessarily all from the list - it depends on the specific case):

general blood and urine tests (particular attention is paid to the level of leukocytes in the blood - in case of appendicitis it is elevated);
blood chemistry;
Ultrasound of the abdominal organs;
CT scan;
magnetic resonance examination.

Additional studies may also be prescribed:

stool analysis (for the presence of hidden blood or worm eggs);
coprogram (comprehensive stool analysis);
irrigoscopy (x-ray examination of the intestine);
laparoscopic examination through the abdominal wall.

Treatment of appendicitis

Treatment of acute appendicitis is almost always carried out surgically. Conservative therapy is carried out only if the patient has contraindications to surgery. For chronic appendicitis, drug treatment can be prescribed not only if there are contraindications to surgery, but also if the disease is sluggish, with rare and subtle exacerbations.

An operation (appendectomy) involves removing the inflamed appendix. It can be carried out in two ways:

Traditional (classical). The vermiform appendix is removed through an incision in the anterior abdominal wall. The incision is then sutured.
Laparoscopic. This operation is much less traumatic and has a shorter rehabilitation period. Surgery is performed using a thin laparoscope equipped with a video camera through a small puncture in the anterior abdominal wall.

Before and after surgery, the patient is prescribed antibiotics. The method of surgical intervention is chosen by the doctor depending on the complexity of the case and the presence/absence of complications.

How to treat appendicitis?

The pathology requires immediate treatment, since the appendage may burst and its contents will spill into the abdominal cavity and peritonitis will begin. Therefore, the only solution is to remove the appendix surgically.

Appendectomy is a surgical operation to remove the appendix. It can be carried out in two ways:

classic – abdominal surgery
laparoscopic, when there are no large incisions

Abdominal surgery is performed if the appendix ruptures and if its contents spill into the abdominal cavity, as well as if the rupture causes an abscess.

Laparoscopy is considered the most modern method of removing the appendix for various reasons: less invasiveness, quick recovery, and fewer complications.

The operation is carried out as follows:

the surgeon makes small incisions through which access to the appendix appears
a camera with illumination is introduced
other instruments are used to remove the process
areas are treated to disinfect infectious material
the operated area is examined and sutures are placed