Appendicitis - an inflammation of the appendix, or cecum (the appendix of the large intestine).Most often appendage located at the junction of the small intestine in thick.However, the appendix may be located in subhepatic space, and in the pelvis, and the ascending portion of the colon.Moreover, the process is not always located in the lower abdomen - and he may be on the left.It is believed that this disease is more common in adults, but in this article we consider the symptoms, causes and treatment of appendicitis in children. Content
Since not fully understood the function of the appendix, and the reasons for its allegedly inflammatory few.It is believed that inflammation of the appendix due to blockage of the lumen of the
Close the clearance process and its connection to the intestine may overgrowth of lymphoid follicles that form it.It may make a difference and congenital anomalies (bends) process.In the lumen of the appendix remains with the bacteria from the gut.
can be brought back to germs as blood or lymph, because appendicitis often develops after suffering tonsillitis, otitis media, acute respiratory viral infection, acute respiratory infections and other diseases.Some infections (yersiniosis, tuberculosis, typhoid fever, and others.) Are the cause of the inflammation process.
bacteria in the lumen of the appendix multiply and cause inflammation;enhanced mucus secretion, edema and venous stasis in the intestinal wall.Further it may lead to the development of necrosis (necrosis) process, rupture of its wall and the entry of intestinal contents (feces and pus) into the peritoneal cavity - peritonitis develops.
predisposing factor for the development of appendicitis in children can be constipation, worm infestation, overeating, excessive sweets, goiter, insufficient intake of dietary fiber.
Up to 2 years of age a child appendicitis is rare (although it may also appear in the newborn).This is due to the nature of child nutrition and insufficient development of lymphoid follicles in the process.The appendix of this underdevelopment due to reported bowel wide hole, which is difficult to block.And to 6 years of lymphoid tissue matures and increases the frequency of appendicitis.
are acute and chronic appendicitis.
Varieties of acute appendicitis:
manifestations of appendicitis in children are very diverse and depend on the age, location of the process and its stages of inflammation.
Small child becomes sluggish, is not interested in toys, refuses meal.The first sign of appendicitis - a pain.Kid trying to protect a painful place: often falls on the left side, draws in the legs, feet Sucitu crying when he takes on his hands, resists examination of the abdomen (pushes his hand).
The child has a fever to 38˚S, and sometimes higher.The child, pale, palpitations learning appears vomiting and diarrhea.The younger the child, the more often vomiting;can quickly develop dehydration small child, manifested severe thirst.
greatest difficulties in the recognition of appendicitis in children 3-4 years old: it occurs suddenly, symptoms are not always typical, and can be for lightning.Children can not always clearly show the place exactly where they localized abdominal pain.Most often, they point pen on the navel, or show the entire stomach.
Children do not necessarily exhibit all the symptoms listed above.The process of inflammation process may be exacerbated by rapidly, and within a few hours may develop peritonitis.The pain spreads to the entire stomach, pale child, the temperature rose to 40 ° C, belly swollen, there may be a delay chair.
danger in the fact that many parents believe that at this age there is no appendicitis, and these manifestations blamed on eating, poisoning and other causes.And some are even starting to self-treat the baby.Without a surgical treatment process may burst (this occurs in 25-50% of children), it leads to complications, prolonged treatment in a hospital.
From 6-7 years child is able to specify the location of abdominal pain.In the classical version of the pain at the beginning of the process it is localized in the epigastric or umbilical region, and then (2-3 h.) Descends to the right iliac fossa (the projection arrangement process).When subhepatic location shifted his pain in the right upper quadrant, at the location of the cecum - worried about back pain in pelvic location - marked pain in the suprapubic region.
nature of the pain of appendicitis is constant, without labor, pain, mild expressed.Constant pain leads to sleep disorders.The pain does not make the child toss.The child refuses to eat.Very often a single or double and vomiting.Possible delay chair.
temperature increased within 37.5 C;sometimes rises to high numbers, but may remain normal.For the older age group of children is characterized by a mismatch pulse and temperature.Typically, the temperature rises by 1 degree pulse rate of 10 beats.A pulse of appendicitis is much higher than the temperature rise.
in pelvic location of appendix observed frequent urination.At catarrhal appendicitis tongue moist, coated with white bloom at the root;when phlegmonous - he too wet, but completely coated;when gangrenous - dry tongue and all coated.
By the age at high risk for the development of inflammatory process is the age from 9 to 12 years - the most common group of children suffering from appendicitis.Despite the frequent development process on the classic version, the diagnosis is more difficult to put children than adults.At this age a child can continue to attend school, even if the stomach aches.But the process continues to evolve, and the child's condition can rapidly deteriorate at the time of complicated appendicitis.
chronic appendicitis in children is less common than in adults.It is characterized by the appearance of recurrent attacks of pain in the projection of the location process, with fever and nausea.
avoid complications should be timely to conduct surgery.If this is not done, it may be a number of complications:
To diagnose appendicitis are different methods:
When inspection and palpation (palpation) of the abdomen the doctor identifies local or diffuse pain, the backlog of the abdomen during breathing, the tension of the abdominal muscles,as well as special peritoneal irritation symptoms (symptom Shchetkina-Blumberg, a symptom of the Resurrection, a symptom Rovsinga and others).
parents should not be engaged in the diagnosis of appendicitis or excluding yourself: to evaluate the symptoms mentioned, you need to have the experience of their determination and comparison.In young patients sometimes have to check the symptoms during sleep.Rectal digital examination reveals tenderness doctor and the overhang of the front wall of the rectum and exclude other diseases.
blood test reveals the increase in the number of leukocytes appendicitis, increase in the number of neutrophils.In the analysis of urine can be marked red blood cells, white blood cells, protein as reactive, secondary reactions.
Young children sometimes used electromyography to detect muscle tension anterior abdominal wall.A more accurate method for diagnosing appendicitis (95%) - US: method allows not only to diagnose acute appendicitis, but also to identify the presence of fluid in the abdominal cavity, infiltrates and abscesses.
sometimes required to diagnose the dynamic observation of the child surgeon for 6-12 hours in the hospital.
Basic rules for parents:
With timely treatment and diagnosis of appendicitis surgery carried the child.And acute and chronic appendicitis - absolute indications for surgical intervention.The operation may be conducted open to traditional and laparoscopic method.Both the operational process is carried out under general anesthesia.
operation lasts 30-60 minutes.The prognosis for timely operations is favorable.After surgery, the child can not drink the liquid, and can only moisten his lips.Allows meal and determines the nature of the food only surgeon.In uncomplicated cases, the child is usually prescribed for 5-8 hours.
preferable method of laparoscopic surgery is less traumatic: the surgeon makes a small incision (or several) and with the help of special tools and a telescopic camera removes the inflamed appendix.The child will be restored after such an operation.But in the case of complicated appendicitis surgery is performed open way.
in destructive forms of appendicitis before surgery are trained for 2-4 hours: appointed infusion therapy (intravenous fluids for the removal of intoxication), and antibiotics are administered.Technically, this operation is somewhat more complicated, and postoperative hospital stay longer.After discharge, the child should be observed that in the case of fever or other symptoms seek medical advice immediately.
have 15-20% of children operated for perforated appendicitis, develop complications in the postoperative period (abdominal abscess is formed).Treatment of this complication is individually (removal of pus from the abdomen, antibiotic therapy, detoxification therapy).After the destructive appendicitis may also develop adhesive disease.
Mortality (death) for appendicitis in children is 0.1-0.3%.
matters proper balanced diet of the child, respect for the food.Parents should monitor the regularity of bowel movements.Equally important is the timely, high-quality treatment of any chronic and acute disease in children.
On how closely the parents are to the health of your child, how fast they seek medical care for any abdominal pain depends on the timeliness and volume of surgical treatment of appendicitis, as well as the outcome of the operation and the development or absence of complications.