Definition and pathological types
Acute Appendicitis is a condition characterized by inflammation of surgical ileo – cecal appendix . She is one of the most common causes of abdominal pain and may have evolved acute or chronic , acute form resulting large number of emergency surgery .
Acute appendicitis is called the youth due to the frequency with which the disease occurs in this period of life (10-20 years) , corresponding to maximum development of the lymphatic system.
Anatomically , the appendix may present different positions to check the most common being the right iliac fossa . It can be localized subhepatic sub- mesenteric , pelvic , in the left iliac fossa etc . In these positions , in some patients , it is difficult to diagnose .
Appendix pathologically through several phases :
– Appendicitis failure, inflammatory process appears ;
– Phlegmonous appendicitis , the inflammatory process continues with microabscesses in appendicular wall . The first two stages are reversible ;
– Suppurative appendicitis when microabcesele grow in size and confluiază ;
– Gangrenous appendicitis when the foci of necrosis penetrate causing gangrene anaerobes . In that place cecal perforation occurs followed by localized or generalized peritonitis .
Local and general signs of acute appendicitis
Acute appendicitis is manifested clinically by cecal crisis , which brings together two types of symptoms: local and general.
Dieulafoi up local triad of symptoms and consist of :
– Pain in the right iliac fossa . There are points that should be sought painful and most characteristic is the mid spinoombilicale straight line ;
– Defense muscle located in the iliac fossa ;
– cutaneous hyperaesthesia , or excessive skin sensitivity iliac fossa
General symptoms of poisoning are caused left the appendix:
– Nausea and vomiting ;
– Constipation or diarrhea. Diarrhea signifying the existence of complications ;
– Not too high fever (up to 390c ) and may even miss the old ;
– Pulse faster ;
– Leukocytosis is almost always present ;
– erythrocyte sedimentation rate (ESR ) is increased .
Evolution and complications
Evolution of acute appendicitis is unpredictable . Sometimes resting , fluid regime , ice bag can cause regression phenomena . However it must Surveillance for careful and must intervene immediately to any change in the picture . Undiagnosed at the time, or delayed surgery leads to complications.
Acute appendicitis may be complicated by :
• localized cecal peritonitis , which is the appendicular inset in whose development is divided into three phases: infiltrative , the abcedere and fistulization . Progressive alteration occurring general condition, type curve suppurative fever , leukocytosis upward evolution ;
• generalized peritonitis may occur : primary or secondary infection by promoting the drilling Appendix ;
• regional or distant abscesses ;
• portal vein thrombophlebitis ;
• pleuropulmonary infectious complications .
Treatment of acute appendicitis
Treatment of acute appendicitis is surgical and emergency only , without special training digestiv.În tube septicemic form , antibiotic therapy should be started preoperatively and continued postoperatively with antibiotics specified by antibiotic . Parallel will perform fluid resuscitation and fluid .
Appendectomy is the surgical time: anesthesia (local, spinal, epidural or general), incision, exploration and sampling FID, ligation and transection meso appendix ligation with catgut and cutting the base in exchange cecal appendix stump clogging, skin suture. Regarding drainage should be considered an elective position in apendicitele drilled drainage is useless.
Postoperative fever is good when reduced in the early days, and then normalize, transit intestunal resumes, leukocytosis, and overall decreases improves.