Appendizitis

under a Appendizitis becomes an inflammation of the Wurmfortsatzes of the blind intestine understood. In the German linguistic area this disease picture is linguistically not called correctly appendicitis. Actually if the blind intestine (the Coecum ) is ignited, in the technical language of a Typhlitis one speaks.

The process of the illness can of an easy provoking, across which up to the wall break-through (perforation into the free abdominal cavity) and thus to a Peritonitis lead heavy inflammation.

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anatomy, causes,Frequency

the blind intestine is the blind initial part of the large intestine ascending in the hypogastric region (Colon ascendens). At the blind intestine is an appendage, the Wurmfortsatz in such a way specified (appendix vermiformis). The Wurmfortsatz contains many Lymphfollikel and can by infection with pathogens or however (more frequently)by transfer for example with excrement stones or foreign bodies (Kirschkerne, more rarely: Cores of Weintrauben or melons) ignite. A worm infestation (Askariden or Oxyuren) of the intestine is sometimes associated with it.

The Appendizitis is the most frequent cause for the acute abdomen and steps with a frequency ofabout 100 cases per 100.000 inhabitant per year up. The risk in the course of the life at a Appendizitis to get sick (run time risk) is with approximately 7 8%.

complaints

usually are pain in the area of the belly navel as well as in the gastric region noticeably,however they shift within fewer hours in right hypogastric region.

The moreover one the patients under loss of appetite , nausea , vomiting also often suffer and from blockage. The Körpertemperatur can rise on up to 39 °C (fever) with according to accelerated pulse (Tachycardia).

By a misalignment of the Wurmfortsatzes it can come with pregnant women to pain into the right upper or Mittelbauch. With older patients the complaints are not so clearly pronounced, the symptoms can be not so easily assigned.

diagnostics

the diagnosis of appendicitisin the context of the medical examination one places. There is no proof for the fact that a Appendizitis is present. However the diagnosis is meanwhile safe with typical findings in the ultrasonic, since the dissolution of ultrasonic improved in the last years strongly. The exclusion of a Appendizitis with überblähtemIntestine is however often difficult.

The diagnosis worm extension inflammation confirms itself by clinical findings:

akute Blinddarmentzündung im CT
acute appendicitis in the CT
  • the Palpation of the hypogastric region McBurney point, Lanz point, retrogerades intestine deleting toward appendix
  • retort-lateral releasing pain (Bluem mountain character): Here a manual pressure becomes up on the body opposite side (against-laterally, thus left)the hypogastric region exercised and suddenly again released. In the positive case places itself thereupon on the right of a pain in.
  • Psoas Dehnungsschmerz (the leg in the thigh bent against a resistance, if with it pain in the hypogastric region arises, is positive the test)
  • Temperaturdifferenzmessung Achselhöhle-Mastdarm (> 1°C) in approximately 50% of the cases
  • laboratory testthe urine and the blood (leukocyte eye, increase of the CRP and. A.)
  • ultrasonic investigation of the abdominal cavity (Kokardenformation, tubuläre structure, abscess, exclusion of other illnesses)
  • computer tomography (CT)
  • possibly. Roentgen, possibly. gynäkologisches Konsil

thereby the laboratory tests (leukocytes, CRP) are most important, the ultrasonic and with investigation-technical difficultiesthus the CT.

  • With the anamnesis the misalignment of the pain of the centric Oberbauch is important in to right hypogastric region and stopping or the epigastrischen pain periumbilikalen at first.
  • The sudden occurrence of a pain-free interval with following substantial pain generally speaking abdominal cavity speaks for a break-through(a perforation) the Appendizitis.

Also with a clinically typical Appendizitis is today before the operation an ultrasonic investigation to be always aimed at, in order to exclude other illnesses with same symptomatology as for example the disease Crohn.

treatment

exists the suspicion on appendicitis, is the Appendektomie as operational measure indicated. Should be operated as early as possible (within approximately 48 hours).

Being waiting with conservative treatment (bed peace, Antibiose, Nahrungskarenz and constant medical control) is possible in principle, but should be considered it only, if an immediate operation is not possible.

The prognosis of the illness is good. The lethality of the interference is with not-perforated Appendizitis under 0,001% - with break-through (perforation, 10% of the cases) however with 1%.

see also

conglomerate tumor, perityphlitischer abscess

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