Chronic appendicitis. Symptoms in women in the elderly, in pregnancy. Diagnosis, treatment

The symptoms of chronic appendicitis in women are recurring attacks of pain in the lower abdomen on the right. According to medical statistics, it is the female half of the population is most affected by this inflammatory disease. On average, 1000 women accounted for 2 clinical cases of chronic appendicitis.

What is chronic appendicitis

Chronic appendicitis in women - this disease is an inflammatory etiology that is characterized by lesions of the tissues and the mucosa of the appendix of the colon. Appendicitis distinguishing feature of this form is that an inflammatory process inside the abdominal cavity is sluggish.

Pathology worried woman periodically in the form of recurrent attacks. It often occurs in patients who have previously suffered an acute peritonitis. Women suffer chronic appendicitis is almost 2 times more often than men.

Types of chronic appendicitis

The symptoms of chronic appendicitis in women have expressed a clinic, or else appear slight malaise. This depends on the type of the disease. The table below shows the variety of chronic appendicitis that are classified by the frequency of occurring seizures, and saturation of the inflammatory process.

Type of chronic appendicitis in women	pathology Description
The residue (residual)	It occurs in patients who have previously suffered an acute inflammation of the appendix, colon cancer, but did not seek help from a doctor-surgeon. This is possible if the disease outbreak was suppressed by its own immune system cells, or else not fully cured antibacterial agents. After that, the inflammation does not disappear, but remained concerned about the woman.
palindromic	Appears periodically after a physical activity, heavy lifting, overeating, use large amounts of fried fatty, protein. It characterized by severe pain in the lower abdomen to the right, fever, general malaise. Attack of acute phase lasts 1-2 days, or else just a few hours. Once again this disease becomes chronic to the next exacerbation.
Flaccid (primary chronic)	This type of asymptomatic chronic appendicitis in women. It is considered the most dangerous pathology, as the symptoms of the disease manifest themselves practically. Pain inside the abdomen absent. Flaccid inflammation can be detected only by palpation and diagnostic ultrasound when the surgeon scrutinizes the surface of the abdomen, located just above the right hip joint from the groin area.

Chronic appendicitis (symptoms in women occur on a daily basis or only during the exacerbation of the disease) - a disease whose clinical picture depends on the species. Type of disease is determined by a surgeon during a patient examination, as well as on the results of a more detailed examination.

Stage and grade of chronic appendicitis

Development of chronic appendicitis in women is divided into 4 main stages. All of them are characterized by sluggish inflammatory process, which gradually progresses, destroying tissue and the mucosa of the appendix of the colon.

Allocate the following stages of chronic appendicitis:

• Stage 1 (Bluetongue) - the patient is observed leukocyte swelling exclusively intestinal mucosa;
• Stage 2 (surface) - formed primary affect with progressive inflammation, appendiceal mucosa saturated leukocytes, and capillary hemorrhage are within its lumen;
• Stage 3 (abscess) - leukocyte infiltration extends over the entire surface of the mucous membrane, affects colon tissue and fibrin appears in the serosa, which indicates the growing inflammation;
  
• 4, step (phlegmonous-ulcer) - all the layers of the appendix infiltrated with copious amounts of white blood cells in the mucosa of ulcerative shaped formation and capillary blood is present in its lumen.

After all of the above stages in the development of chronic appendicitis are completed, the disease becomes acute form of flow. Also, there are clinical cases, when the defeat of the appendix tissue continued without significant aggravation, making it difficult to diagnose the disease.

The symptoms of chronic appendicitis

Chronic appendicitis (symptoms in women occur with the growth of the inflammatory process) - a disease that can not disturb the patient over an extended period of time.

In general, the pathology is expressed by the following features:

• aching pain in the lower abdomen on the right side, which increases during sudden movements, lifting, exercising;
• complete loss of appetite, nausea, which in most cases has a reflex response, manifested in the form of short spasm and then stops;
• Body temperature rises to 37 degrees centigrade, there are signs of low grade fever, sore batters, there sweating, fever;
• there is disorder of the intestine, resulting loose stools (this symptom does not occur often);
• due to the presence of inflamed appendix shell occurs irritation of the bladder wall, which are disposed in close proximity to the appendix (because of this woman starts to feel false urge to urinate, as well as the frequency increases allocating urine);
• anorexia, which develops against the background of a prolonged lack of appetite;
• there is irritable bowel syndrome, which disrupts the entire digestive system, woman feel symptoms such as rumbling in the stomach, bloating, feeling of fullness, increased flatulence;
• during palpation portion right iliac region detected abdominal muscle hypertonicity fibers (thus arranged near fabric are soft to the touch).

Unlike the acute form of the disease chronic appendicitis may be concerned about the woman for several months. It is important that the disease was detected as early as possible, as delays in starting treatment can lead to complications.

Causes of chronic appendicitis

Chronic appendicitis (symptoms in women are largely dependent on the stage of the disease) is a rare disease, the nature of the origin of which still remains controversial.

The following development of the theory of sluggish bowel inflammation wormlike:

• periodically relapse of acute forms of appendicitis, which a woman suffered before, but she did not It underwent surgical removal of the colon, and a conservative therapy with antibiotics;
• presence of foreign objects into the cavity of the appendix, which were ingested during the meal (fish bones, sunflower seed husks, and other litter);
• penetration into the colon process of parasitic forms of life (often within the appendix find ascarids, and until the 20th century it was believed that it was the parasites become a cause of the development of this disease);
• tumors of the appendix and benign tumors developing in its cavity (polyps, nodules);
• scar adhesions appendix that developed due to the presence of other inflammatory processes within the abdominal (their presence leads to a kink appendix, lymph fluid outflow disturbance and venous blood);
• prolonged constipation and fecal stones formation in the large intestine (the most common cause of chronic appendicitis in women);
• inflammatory diseases of appendages and internal genitalia;
• infectious contamination of the appendix, which occurs by hematogenous fabric having a center of chronic infection;
• presence of concomitant diseases such as chronic cholecystitis, perityphlitis, colitis, enteritis, adhesive disease abdominal cavity, adnexitis;
  
• complication previously undergone surgical intervention is performed on the pelvic organs or within the abdominal cavity.

Chronic inflammation of the small vessels of the capillaries, which is present in the tissue of the appendix can also cause the development of this form of appendicitis. Therefore, women with comorbid diagnoses - vasculitis, are particularly at risk.

Until now doctors have debated the nature of the origin of chronic appendicitis in women, as well as the factors that provoke it. That the above causes of the disease are more common in medical practice.

Diagnosis of chronic appendicitis

Chronic appendicitis (symptoms in women hard to detect without laboratory research methods) is the latent disease, the diagnosis of which is engaged in a surgeon.

The primary stage is the survey external examination patient history based on the formation of current symptoms and palpation of the lower abdomen on the right side, the study of umbilical rings. After that, the doctor assigns the following diagnostic methods.

Ultrasonography

This first instrumental examination method, which is shown women with obvious signs of chronic appendicitis. In the presence of inflammation ultrasound diagnostic displays that inside the appendix is ​​extraneous liquid, the lumen is increased by more than 6 mm in diameter.

In this case, the peristalsis of intestine will be completely absent. Prolonged forms of chronic appendicitis may provoke accumulation of fluid in the cavity peritsekalnoy the right iliac fossa. This phenomenon is also fixed by means of diagnostic ultrasound.

Ultrasound examination is the most efficient and accurate method of diagnosis, but his conduct can be complicated the presence of intestinal gases, obesity, increased abdominal muscle tone which, under the influence of a protective response reduced.

If the results of diagnostic ultrasound detected normal appendix tissue with no signs of inflammation, the suspected appendicism refuted.

radiography

This diagnostic method makes it possible to detect chronic appendicitis, which is in the early stages of development. On the X-ray image can be clearly seen, that the appendix has a tubular shape. An effect of "sentinel loop" that is expressed in the bend of the inflamed appendix.

This can also be seen on the X-ray image. This method of diagnosis used in health care, where there is no ultrasound machine, or else in order to obtain more information about developing pathology.

irrigoscopy

The principle of this diagnostic method lies in the fact that the patient drinks contrast agent, and then passes X-ray procedure. In the presence of chronic appendicitis mucosa of the appendix is ​​so swollen that the contrast agent does not penetrate the intestinal cavity.

Interpretation of the results irrigoskopii performs surgeon. In this case, the doctor using palpation method checks whether the process of displacement has occurred.

Laparoscopic study

It is shown in chronic appendicitis in women, when all the previous research methods do not allow a single affirmative answer to the presence or absence of the pathological process. Laparoscopic diagnosis provides for micro-operations, so you need a written consent of the patient.

The principle of this survey is that the body of the patient perform a small incision in the iliac cavity.

After that, the doctor enters the abdominal cavity device with a video camera that transmits a digital image on a computer monitor. This method enables the surgeon to see for the state of the mucosa of the appendix, as well as the degree of leukocyte infiltration of its tissue. Diagnosis is carried out in a sterile environment of the operating room.

CT scan

CT provides comprehensive information on the health status of the appendix in the event that used spiral tomography. On examination revealed the patient bowel obstruction, there are signs of expansion of the walls of its lumen, as well as their thickening occurs (average of 1 mm).

Inside the appendix is ​​fibrous effusion. Prolonged chronic inflammation of the appendix possible accumulation of fluid within the abdominal cavity. All these pathological signs of computed tomography displays.

When to see a doctor

Access to a doctor, the surgeon should be immediate. After the appearance of aching pain in the lower abdomen on the right side, a woman should visit a specialist profile and get tested. The Community Health Center medical consultation and diagnosis of the abdomen is immaterial.

In a private clinic for the above methods of inspection have to pay from 2000 to 3000 rubles. Timely diagnosis allows enough time to eliminate the hotbed of the inflammatory process, or else conduct the removal of the appendix.

Prevention of chronic appendicitis

Chronic appendicitis is a disease that is always original cause of its development.

Prevent the occurrence of the disease is possible, but you need to remember on a daily basis and perform the following preventive measures:

• promptly eliminate chronic infection foci, which are localized in the tissues of the abdominal cavity (to avoid infiltration of hematogenous bacterial appendiceal wall);
• monitor the quality of the food, to saturate the diet of biologically useful products in the form of chicken, rabbit, turkey, veal, wheat, barley, corn, oat, buckwheat grains, fresh vegetables, herbs, fruits;
• avoid overeating, eating excessive amounts of fatty, fried, smoked foods;
• not lift objects whose weight is greater than 3 kg;
• lead an active lifestyle, exercise, but do not overwork;
  
• if surgery on the abdominal organs was moved, it is absolutely necessary to take the entire course rehabilitation, follow the instructions of your doctor, so as not developed adhesive disease, which can affect all layers appendix.

In the event of an acute form of the disease, it is necessary to consult a doctor-surgeon and go through the whole course of medical or surgical treatment. This is necessary to prevent a recurrence of the inflammatory process in the future, as well as to prevent its transition to the chronic form of the flow.

Methods of treating chronic appendicitis

Upon detection of a woman's symptoms of chronic appendicitis, doctors recommend not to waste time at the reception drugs, and hold a surgical operation to remove the inflamed appendix process.

This is due to the fact that over time, the pathology will still go into an acute form, which will require surgery, but then there may be complications such as peritonitis or peritoneal abscess cavity.

Medications

In case of failure of women from the surgery, your doctor following drugs antibacterial spectrum can be used.

Scroll:

• ciprofloxacin;
• Zanotsin;
• levofloxacin;
• Elefloks;
• macrofoams;
• Ofloksin;
• Avelox.

Dosage selection, determining the length of a course of antibiotic therapy is carried out individual surgeon on the basis of current symptoms and the severity of the inflammatory process.

There is no single medical treatment protocol for chronic appendicitis with antibiotics as always shows the removal of the appendix having signs of inflammation (both acute and sluggish).

Traditional methods

For the treatment of chronic appendicitis in women recipes of traditional medicine are not used, as this illness requires intensive antibiotic therapy, or the surgical removal. The use decoctions, ointments and tinctures of medicinal herbs of healing properties will not have the desired therapeutic effect, and will lead to deterioration of health of the patient.

Other methods

Performing surgery is the primary and most effective method of treatment chronic appendicitis in women, which at any moment can turn into severe or complicated current form.

Surgery performed in several stages, namely:

1. The patient is transported in a sterile operating conditions.
2. The anesthesiologist was intravenously administered to the patient an analgesic.
3. Once the patient goes into a sleep medication, a surgeon starts operation.
4. Performed the incision of the skin surface of the right iliac region with penetration into the abdominal cavity.
   
5. After detecting the appendix carried by its cutting off the main part of the colon.
6. With clamp surgeon fixes the bleeding vessels.
7. In damaged tissue and wound suture superimposed portions.
8. Performed suturing plow surface epithelium.

The operation lasts an average of 40-60 minutes. After completion of the surgical procedures the patient is transferred to the surgical department of a hospital, where over the next 5-7 days. When the positive dynamics to the healing of postoperative joint and tissue repair, the patient can be discharged before the deadline.

possible complications

In the absence of timely treatment, or the use of malformed course of therapy may develop complications.

They are as follows:

• the transition of the disease in the acute form of the current, which requires the provision of a woman medical emergency;
• retroperitoneal abscess;
• gap inflamed colon tissue with fibrous outflow fluid inside the abdominal cavity;
• contagious infection of the appendix;
• emergency surgery to remove the inflamed appendix;
• spread of inflammation to adjacent tissues and organs located within the abdominal cavity;
• the incidence of thrombophlebitis of the veins of small pelvis;
  
• sepsis portal vein.

The symptoms of chronic appendicitis diagnosed in women, should be a signal for the early commencement of conservative or surgical treatment. In this case, a favorable prognosis for recovery, and minimal risk of complications. Chronic appendicitis - is a disease that is very rare.

Its appearance is almost always associated with the acute form of this disease, which has not been properly treated before. Chronic appendicitis is a disease that requires constant monitoring in the doctor-surgeon and the control of the patient.

Registration of the article: Lozinski Oleg

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