Acute appendicitis — acute inflammatory and necrotic disease of the vermiform Appendix of the cecum, usually caused by obstruction of the lumen of the Appendix, and proceeding with the participation of microflora that live in the lumen of the Appendix (facultative and obligate anaerobes).
Appendicitis may occur a slight increase in temperature for 24 hours, followed by a greater increase in temperature may indicate a ruptured Appendix.
• Lack of appetite (anorexia)
• Nausea, vomiting 1-2 multiple and is reflex in nature. The appearance of nausea and vomiting prior to the onset of pain is not typical for acute appendicitis.
• The rise of the temperature up to 37-38 °C (low-grade fever) (Murphy Triad — anorexia, vomiting, temperature)
• Possible loose stools, frequent urination, increased heart rate and blood pressure (very rarely).
• There are "atypical" manifestations of appendicitis with atypical location, and the children, the elderly and during pregnancy.
• Clinical manifestations depend on the location of the Appendix. If the Appendix retrocecal (located behind the cecum), the pain is mitigated. If the Appendix is in the pelvis manifested atypical pain.
• Surgical removal of the Appendix;
• Intravenous fluids and antibiotics;
Treatment of acute appendicitis involves open or laparoscopic appendectomy; because procrastination increases the frequency of the lethal outcomes, acceptable is 15% frequency is unjustified appendectomy. As a rule, it is possible to remove even a perforated Appendix. In some cases the location of the Appendix is difficult to ascertain: in such situations, it is usually localized behind the cecum or the ileum and the mesentery of the right colon.
Contraindication to appendectomy is an inflammatory disease with lesions of the cecum. However, if you have terminal ileitis and the absence of changes in the cecum, the Appendix should be removed.
Appendectomy should be preceded by intravenous antibiotics. Preferably, the assignment of cephalosporins of the 3rd generation. In appendicitis without perforation, further administration of antibiotics is not indicated. If perforation of the Appendix and antibiotics continued until the normalization of the body temperature of the patient and of the content of leukocytes, or is the course duration according to the preference of the surgeon. In case of impossibility of surgical intervention, administration of antibiotics significantly improves survival, although it cannot achieve the cure.
If you define a large inflammatory infiltrate with involvement of the Appendix, terminal ileum and cecum, preferably resection of all tumor with the imposition of an ileostomy. In advanced cases, when the formation of periodicheskogo abscess, it is drainage through a catheter for percutaneous access under ultrasound control or by open method (with subsequent delayed implementation of appendectomy).
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