The appendix, the protagonist of this disease, is located at the beginning of the large intestine in the lower right abdomen. Worm-shaped, pink (when not inflamed) and in its interior there are several lymphoid follicles immune system. No known function in humans, and is believed to be a vestige of evolution.
Appendicitis is defined as inflammation of the appendix, affecting mucosal lymphoid tissue and muscle layer. It does not always have clear symptoms, so sometimes confused with other conditions, delaying diagnosis. While it may appear at any age, there is a peak incidence between 10 and 30 years without known reason.
Several studies showed that there are two different conditions: one without complications, which may result from seasonal variations, and could be treated with antibiotics, and other way with complications requiring surgery. However medicine must advance, mainly in the field of imaging technique to pinpoint the diagnosis of this disease without complications, so accurate.
The problem of appendicitis is inflammation of the appendix itself, but if the picture evolves, this organ can become necrotic and literally rot inside the abdomen. This would cause an emergency, known as peritonitis, at great risk to the patient’s life.
Therefore it is essential to make a diagnosis and early treatment to prevent the progression of appendicitis. The only effective treatment is surgical removal, making appendicitis the most common cause of abdominal surgery.
Appendicitis usually occurs as a result of the obstruction of light, ie the inner conduit of the appendix. This obstruction occurs for several reasons:
Hyperplasia of lymphoid follicles: is the most common cause. Lymphoid follicles appendicular work just like the pharyngeal tonsils, so that if they are infected by a microbe swell, grow obstruct the light.
Appendicolith or fecalito: It is the second most common cause; through the large intestine flows stool to the anus. Sometimes a small stool can occlude the appendiceal lumen.
Foreign bodies: just as a fecalito, a foreign body ingested could clog the appendiceal lumen.
Microorganisms and parasites: either because they directly obstruct light or because inflamed lymphoid follicles. The organism that most related to appendicitis is the Yersinia.
Regarding demonstrations, these may vary and the picture is very difficult to diagnose in the case of young children, the elderly and women of childbearing age.
The first symptom is usually abdominal pain; It can be initially mild, but then become more severe acute. It may be accompanied by loss of appetite, nausea, vomiting, dizziness and low fever.
The pain tends to shift to the right lower abdomen and focuses on a point directly above the appendix (called McBurney’s point). This occurs most often 12 to 14 hours after onset of illness.
If the appendix opens (breaks), it is likely to experience less pain for a short time and a slight improvement; However, after increases when walking, coughing or make sudden movements. Also, other symptoms include chills and shivering, hard stools, diarrhea, fever, nausea and vomiting.
Importantly, certain gynecological disorders such as ectopic pregnancy, torsion of an ovarian cyst and ovulation process the unique cycle can cause pain without fever and confused with appendicitis. In pregnancy, this picture is difficult to diagnose because the appendix is shifted to the right upper quadrant of the abdomen.
Based on various histological findings and the macroscopic appearance, it can differentiate four stages of appendicitis:
1. inflammation microscopically Appendicitis:
When light is obstructed appendix, which secretes mucus can not flow freely and begins to accumulate therein, and thus forming bacteria of the intestinal flora and overgrow the inflammatory process begins. At this stage the appendix has a normal appearance and can only be identified appendicitis:
2. fibrinous Appendicitis: Appendix slowly distends by increasing its internal pressure; when the pressure is so great that the blood can not properly irrigate the appendix. Body appearance is inflammatory.
3. gangrenous Appendicitis: Appendix walls are weakened, either by lack of blood supply, such as increased internal pressure. There are parts that start to become necrotic and black, and can secrete pus.
4. Perforated Appendicitis: Finally, walls are broken and pus and feces is released into the abdominal cavity leading to peritonitis.
All these steps occur within 24-36 hours from the start of the process in adults. In young children the progression of the disease is usually mind so fast that the first of three pathological stages usually occurs before medical consultation occurs.
In this sense, a picture of appendicitis can cause the following complications:
Pylephlebitis: The most severe and rare, when septic emboli going to the liver and can form abscesses are formed.
It should be noted that it is now rare to occur, except in the case of people who have weakened defenses the (elderly) or that the very advanced appendicitis by a late diagnosis.
To arrive at a diagnosis of appendicitis need to be made:
The patient’s general condition is usually good, although in advanced stages of appendicitis usually deteriorate. The temperature ranges between 37.5 and 38 ° C.
There are signs that can help such as:
Pain McBurney point: mark a line from the navel to the tip of the right pelvic bone. The point is the union of two thirds closer to the navel with the outer third.
Blumberg sign: By pressing a remote area of the abdomen appendix pain occurs reflexively. It indicates peritoneal irritation and occurs in other diseases.
Abdominal pain by extending the thigh: this maneuver is only useful when the appendix is placed behind the colon and, therefore, palpation of the abdomen is not as effective.
Lab tests on blood, appendicitis usually associated with an increased white blood cell count with increased neutrophils, although only been observed in advanced stages. A complementary analysis leukocyte count is the analysis of blood markers of acute inflammation (C-reactive protein).
Diagnostic Imaging: basically chest radiography is required (to rule out other conditions, such as cardiopulmonary diseases), ultrasound (very useful for the diagnosis and rule out other diseases), computed tomography (CT very reliable method) or laparoscopy (used in cases of difficult diagnosis, especially in the case of women of childbearing age, obese patients or elderly).