Appendicitis is a very common disease, affecting approximately 7% of the population, making it a major medical emergencies worldwide. Appendicitis usually occurs between 10 and 30 years, but can occur at any age, although it is rare in children under 2 years.
The appendix is an organ with size and location variables, and their proximity to other organs of the pelvis and abdomen can cause the symptoms of appendicitis are similar to those of other diseases. Abdominal pain appendix usually do differential diagnosis with several other of the abdomen or pelvis problems, including diverticulitis, ovarian torsion, ectopic pregnancy and even kidney stones.
In this article we will deal exclusively with the possible symptoms of appendicitis in adults and children.
Leukocytosis (increased number of leukocytes in the blood count).
Not all signs and symptoms listed above are necessarily present in patients with acute appendicitis. In fact, some of them, such as diarrhea, constipation or bloating occur in fewer than half the cases.
Next, we'll talk in more detail about each of these 10 symptoms, demonstrating their importance for the diagnosis of appendicitis. Let us first describe the clinical features of appendicitis in adults and then in babies, children and adolescents.
The most typical symptom present and in virtually 100% of cases of appendicitis is abdominal pain. Such as abdominal pain can be caused by dozens of different problems, know the typical features of appendicitis pain is important for diagnosis.
a) Typical appendicitis pain
Appendix itself is a poorly innervated organ, so at the start of an appendicitis frame, when the inflammation is confined to the appendix, the brain has some difficulty in recognizing the exact location of the intestinal tract that is suffering. Despite the appendix be located in the lower right quadrant of the abdomen, the pain of appendicitis board in their first 6 to 8 hours usually be located around the navel. The patient can not determine exactly the spot that hurts. When questioned, he makes a circular motion with your index finger around the navel.
Over the first 24 hours, as inflammation worsens and begins to reach not only the appendix, but also the intestinal loops around and the peritoneum (the membrane surrounding the gastrointestinal tract), the brain begins to get more precise messages affected area, making it clear to the patient that there is a problem in the lower right part of the abdomen.
This pattern of poorly localized pain around the navel, that within hours migrates to the right lower quadrant of the abdomen, becoming restricted to a very particular point, is the most typical symptom of appendicitis, occurring in over 60% of cases. Every time a doctor sees a patient with this type of abdominal pain, the possibility of appendicitis should be prioritized.
When the peritoneum is affected, the pain of appendicitis intensifies, and palpation of the abdomen becomes very painful. The pain also tends to worsen when the patient coughs, tries to walk or make any sudden movements with the trunk.
On physical examination, there is a typical sign of acute appendicitis pain called decompression or Blumberg sign. This signal is investigated as follows: pressed by hand the lower right part of the abdomen and asked the patient if he feels pain. In general the answer is yes. Then, abruptly withdrew from the hand pressing the belly and observe the patient's behavior. When there is appendicitis, with irritation of the peritoneum, this rapid hand removal causes an intense pain at the site, much stronger than the pain caused by compression of the abdomen.
Although physical examination, another common finding is a tightening of the abdominal muscles. When the patient has an intra-abdominal inflammatory process, the trend is that there is an involuntary contraction of the muscles in that region, one sign that we call "abdominal defense." When palpating the abdomen of a patient with appendicitis, it is noted that the abdominal wall to the right is hard and very painful.
b) Other appendicitis pain patterns
In fact, when the patient presents to the emergency department with the typical pain of appendicitis, there are few doctors who have difficulty in establishing the diagnosis. The problem occurs when the patient has an atypical headache pain, or when it can not describe their symptoms appropriately, as in the case of very young children or elderly people with dementia. Immunocompromised patients who do not develop exuberant inflammatory processes, may also have atypical presentations of appendicitis.
In about 15% of people appendix is located posteriorly, causing the location of appendicitis pain is different. Instead of the typical pain in the right lower quadrant, the patient may complain of back pain right, right upper quadrant pain or pain around the right flank.
There are also those patients with lower appendages, whose tip extends to the pelvic region. In these cases, pain may be right groin, anus or pubic region. Evacuate or urinate can cause pain exacerbations.
c) Appendicitis with pain in the left side of the abdomen
As you may have noticed, even in atypical cases, the pain of appendicitis usually be restricted to the right side of the abdomen. Although rare, it is not impossible that the patient has appendicitis pain on the left side of the abdomen, where the appendix is longer than usual and extend up to the left side of the abdominal cavity. However, appendicitis should not be the first diagnosis in patients with abdominal pain on the left, except in rare cases of situs inversus (a rare condition in which patients have organs of the chest and abdomen in opposite direction to that expected).
Nausea, vomiting and loss of appetite are three symptoms that usually come together soon after the onset of abdominal pain. This malaise occurs in up to 90% of cases of appendicitis.
As everyone knows, nausea with or without vomiting, and loss of appetite are very nonspecific symptoms, which may arise in a multitude of different medical problems. However, when associated with a pattern of periumbilical abdominal pain that worsens and migrates to the lower right quadrant within 24 hours, they make the diagnosis of appendicitis extremely likely.
The classic triad of symptoms of appendicitis is abdominal pain, vomiting and loss of appetite.
Fever is not usually present in the first hours of evolution, especially in children and the elderly. Some people, however, may have mild fever, with temperatures around 37.5°C and 38°C.
High fever usually does not occur in cases of appendicitis, except in the most serious situations, when there appendix perforation and leakage of fecal material from the intestines into the abdominal cavity, which creates an intense inflammatory reaction and severe infection.
Significant diarrhea is an unusual sign in appendicitis. When present, the physician should consider other diagnoses priority, although it should not completely rule out the possibility of appendicitis.
Patients who have an appendix in a more pelvic location may have diarrhea if inflammation of appendicitis also primarily affects the rectum. In general, however, what the patient has is not exactly diarrhea, but an increased frequency of bowel movements, without necessarily having large losses of watery stools.
As well as in diarrhea, constipation is not a typical symptom of appendicitis. Most patients do not have it, but that does not mean it can not be part of the clinical picture of appendicitis.
Leukocytosis
The leukocytosis is a laboratory sign means an increase in the number of leukocytes in the blood. Leukocytes are one of the most important defense cells in our immune system. When there is an infection or extensive inflammatory process in progress, one of the first social securities that our immune system takes is to increase production of white blood cells.
Over 80% of patients with acute appendicitis have leukocytosis in examining blood count. The more intense the leukocytosis, in general, the more extensive the inflammatory process.
Signs and symptoms of appendicitis in infants, children and adolescents
The clinical picture of appendicitis in adolescents is basically the same as adults. Already in children under 12 years, symptoms may be somewhat different.
a) Symptoms of appendicitis in children between 5 and 12 years
As in adults, abdominal pain and vomiting are the most common symptoms in school-age children, although the characteristic migration of pain periumbilical region to the lower right quadrant may not occur.
The frequency of signs and symptoms of appendicitis in this age group is as follows:
Pain in the lower right quadrant of the abdomen - 82%
Nausea - 79%
Loss of appetite - 75%
Vomiting - 66%
Fever - 47%
Diarreia - 16%
b) Symptoms of appendicitis in children between 1 and 5 years
Appendicitis is uncommon in children under five years. Fever, vomiting, diffuse abdominal pain and abdominal rigidity are the predominant symptoms, although irritability, wheezing, difficulty walking and complaints of pain in the right hip region can also be present.
The typical migration of pain to the right lower quadrant of the abdomen occurs in less than 50% of cases. Diarrhea and fever, however, are far more common than in adults. Young children often have low-grade fever (around 37.8°C) and blushing cheeks.
The frequency of signs and symptoms of appendicitis in this age group is as follows:
Abdominal pain - 94%
Fever - 90%
Vomiting - 83%
Pain decompression - 81%
Loss of appetite - 74%
Abdominal Stiffness - 72%
Diarreia- 46%
The abdominal distension - 35%
c) Symptoms of appendicitis in children under 1 year
If appendicitis in children under 5 years is unusual, appendicitis in newborns and in the first year of life is even rarer. The low frequency of appendicitis in this age group is probably due to the tapered shape and less prone to obstruction of the appendix, as opposed to the tubular organ in adults and older children.
Although rare, unfortunately, the neonatal mortality appendicitis is almost 30% since early diagnosis is very difficult, since the clinical picture is often very atypical. Abdominal distension is more common than the very abdominal pain, fact caused probably because babies can not communicate properly.
The frequency of signs and symptoms of appendicitis in this age group is as follows:
