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| Presentation on the topic of appendicitis. Presentation on the subject of appendicitis viconav student group f. Lyvostoronniy gostry appendicitis |
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slide 1 gostry appendicitis Department of surgery No. 2 KhNMU
slide 2 Value and width Gostry appendicitis is an incineration of the worm-like outgrowth of the mucous intestine, one of the most common surgical ailments. Occupation with appendicitis in the warehouse is 4-5 per 1000 population. Most often, the appendicitis occurs in children from 20 to 40 years, women are sick 2 times more often, below the number of people. The lethality becomes 0.1-0.3%, while the operative acceleration is 5-9%.
slide 3 In 1886, Reginald Fitz first described and gave the name OA yak "fired wormlike sprout"
slide 4 anatomy The worm-like outgrowth is a bezposredny extension of the mucous intestine. Win roztashovuutsya in the middle of the evil three late lines (teny). Dovzhina yogo kolivat in the arch of wide gaps. In the middle of the year, become 7-10 cm, a little more from 0.5 to 30 cm or more. In the majority of the appendix vipads, there is a brizhechki duplication of the queue. Perivascularly along the artery of the worm-like outgrowth, nerves penetrate into the new one - old upper mesenteric gossip.
slide 5 physiology There is a large number of pre-adolescents in the presence of a large amygdala of the intestinal tract, and there is a large number of lymphoid tissues in the mucous membrane. The lymphoid fabric is most popular in a child's life, especially in 12-16 years. After 30 years of repair, the number of follicles will change significantly, and up to 60 years of stench will increase.
slide 6 options roztashuvannya Most often the worm-like sprout of straightening is in the middle of the queue and the top of the straightening is down. However, there are growing variations in the growth of the intestine, as well as the growth of the intestine itself.
slide 7 Varianti of appendix roztashuvannya * Rose (according to Allen): in the right club yamts medial retrocecal
slide 8 Rose (according to Allen): from the thermal end of the club gut lateral
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slide 10 Ethiology and pathogenesis * I will not be able to bring up the reasons for the grave appendicitis until the present hour. For an explanation of the mechanisms of development, the development of a worm-like growth is projected without the theory. Basic theories: Infectious diseases; neurosudinne; Take the factor: Obturation (stone, worms, etc.)
slide 11 Ethiology and pathogenesis
slide 12 Neurodynamic theory: The adherents of the neurovascular theory take into account, as a result of reflexive impairment of the regional blood flow into the adduct (spasm of sudin, ischemia), Deyakі slіdniki nadayut the important meaning of an allergic official. On the cinnamon of the central theory, the number of slime and crystals of Charcot-Leiden in the enlightenment of a worm-like outgrowth is significant.
slide 13 Current detection: The process of repairing from functional dislocations from the side of the ileocecal cut (bauginospasm), the intestine and the wormlike appendage. Until the emergence of spastic manifestations lead to destructive etching (strengthening of rotten processes in the intestine, atony and in.), As a result of which the intestine and worm-like growth are badly emptied. Provokuvati spasm can be found in the growth of foreign body, feces, stones, worms. Spasm of smooth muscles of the spasm can also lead to regional convulsive spasm and local damage to the trophism of the mucous membrane (Aschoff's primary affect).
slide 14 Occasional detection: Disruption of evacuation, congestion of the intestinal instead of taking into account the disturbance of the intestinal microflora, the yak, with the presence of the primary problem, easily penetrates into the wall of the adduct and the typical process of failure. A collection of leukocyte infusion of only the mucous membrane and the mucus ball, and then of all the vermopoid outgrowth. Inflammation of the supernatant is also used for the overdose of lymphoid tissue (hyperplasia). Determination of the zones of ischemia and necrosis of the disease, the establishment of pathological enzymes (cytokinase, calcareous and in.)
slide 15 Classification (V. I. Kolesov, 1972) * Vid_lyayut onset of the form of a gastric appendicitis: 1) weak bends (appendicular ring); 2) simple (superficial); 3) destructive: a) phlegmonous, b) gangrenous, c) perforated; 4) acceleration: a) appendicular infiltration (good interruptions, progressive), b) appendicular abscess, c) ginny peritonitis, d) accelerated appendicitis (sepsis, pylephlebitis, etc.)
slide 16 pathology Gostriy prosty appendicitis Gostriy phlegmonous Gostriy gangrenous Perforated
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slide 21 Gostriy appendicitis is characterized by a singular symptom complex, which can be found for a number of reasons: an hour, at the time of illness, localization of the adolescent, the nature of pathomorphological changes in the very adolescent, such as in the midwife
slide 22 KLINIKA * Zagvoryuvannya to obey rapt, average prosperity, without prodromal period. The most persistent symptom is a beating in the stomach, yak, which, as a rule, is of a persistent nature. Localization of pain on the cob is not pernicious. Most often, you will find yourself immediately in the right club area, or more often in the epigastria (Kocher symptom), or in the umbilical region (Kummel symptom), and only after a few years moved to the right club area. In some cases, the clinical picture of a gosty appendicitis develops even more burstingly, but it does not localize at all, but it spreads all over the stomach.
slide 23 The most important symptom is bloating. Vona is susceptible to approximately 40% of ailments and to have a reflex character in the cob stages of ailment. Bloating is often single. Nudota, as a rule, is due to pain and to be of a sickly nature. In some cases, there is a risk of catching style, a decrease in appetite, or perhaps a one-time carry, which is part of the case with a retrocecal abnormally pelvic growth of a burnt outgrowth and can serve as a pathognomonic symptom of atypical forms of seizure. The destruction of the sechovialization is spared rarely and can be tied with an unprecedented localization of the sprout (prilyaga to nirtsi, sechovodu, chaff). Temperature reaction to lie down as a form of seizure and early manifestation (as subfebrile, febrile, rare - hectic)
slide 24 The main symptoms: Rozdolsky's symptom - with superficial palpation, a zone of hyperesthesia appears in the right club area; do not see the left hands, right viroblyaє short shipment to the front end of the wall for the viscera of the small intestine. With a positive symptom of ailments, there is a problem in the right club area.
slide 25 The main symptoms: The symptom of Voskresensky is a drug, the right-handed person grows out of the sick person, pulls his shirt with his left hand, and his right hand pulls his fingers through the fingers to the right-hand side of the club right up to the right. In the case of ailments, there is a sharp bile (the symptom is positive). Sitkovsky's symptom - Ailing is laid on liviy bik. Potential for any pain in the right club area is typical for a patient with appendicitis.
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slide 27 The main symptoms: Dumbadze's symptom is a sore throat with a pre-slung throat with a fingertip through the navel. The symptom of Yaure-Rozanov is stagnant for the diagnosis of appendicitis with retrocecal growth of the adrenal mass: when a finger is pressed in the area of the transverse tricuspid, there is ailment.
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slide 31 The main symptoms: More important in the development of a gastric appendicitis may be rectal (in cholovikiv) or vaginal (in females) for a long time. Smells of guilt are carried out by all ailments and may be due to the sensitivity of the pelvic neck (cry of "Douglas") and the size of the pelvic organs, especially in women. Symptom Schotkіna - Blumberg wicked to the onslaught of the fingers on the black wall and to the quick smoothening of the hand. At the moment of waking up the hand, the gostra appears to be localized bіl vnaslіdok teased fired up queue.
slide 32 Features key breakdown *
slide 33 Peculiarities of overcoming auspicious appendicitis in children * Gostriy appendicitis in children grows up in any occasion, and in its particularity, it is overwhelmed by the decrease in the stiffness of the queue to infection, the small sizes of the omentum, and also by the organisms of reactive At the connection with the cymbal appendicitis in children it is important, the ailment develops more quickly, lower in older adults, with great destructive and perforated forms.
slide 34 brown ear of sickness; temporal temperature 38-40 ° С; a lot of pain in the abdomen; bagatorazova blues, carry; the heart rate is not very sensitive to temperature; shvidka development of destructive changes in worm-like growth; symptoms of intoxication; often the development of spilled peritonitis.
slide 35 Peculiarities of a perennial appendicitis in the case of a kidnapped and an old man * erasure of being ill because of the organisms' reactivity and other illnesses; the temperature is often normal, the temperature is often up to 38 ° C and the food is more susceptible to a small number of ailments in the abdomen; zhisne the tension of the m'yaz_v throughout the day is or is twisted weakly; high development of destructive, changes in the worm-like growth (in the case of sclerosis of the sclerosis), a slight increase in the number of leukocytes in the blood, the reduction of the leukocyte formula in the form of destructive
slide 36 Peculiarities of overcoming auspicious appendicitis in women * In the first half of the vaginosity, a severe appendicitis does not occur from the most common manifestations
slide 37 In the other half of the vaginosity, there is a change in the localization of pain and ailment (reduction of the intestinal tract and worm-like growth by an enlarged uterus). Zakvoryuvannya often repaired raptus for the appearance of a severe pain in the abdomen, scho have a persistent character, boring blues. At the connection with the change of localization of the appendix, pain in the abdomen may not only start in the right club area, but in the right side of the abdominal flanks, the right ridge and go to the epigastric area. M'yazovu vaprugu vyavity viyaviti not expect, especially in the rest of the third of vaginosti, through the swiveling over-stretching of the anterior cervical wall. In most cases, the most diagnostic value is the symptoms of Shotkin-Blumberg, Voskresensky, Rozdolsky. Leukocytosis in case of gastric appendicitis in women with large vipadillosis 810912109 / l, often with malignancies.
slide 38 DIAGNOSTICS * Retalny zbіr, details of the scarg of the sick and the anamnesis of the sickness. Evidence of symptoms characteristic of a gastric appendicitis (palpation, abdominal percussion). Rectal and vaginal dosage. Laboratory Doslidzhennya. Vinyatok zhvoryuvan, simulate pathology gostru in black empty
slide 39 Laboratory dosage * Up to the minimum laboratory diagnostics, allowing to establish a diagnosis of gastric appendicitis, be aware of: zagalny analysis of blood, sachet, test of neutrophil-leukocyte count (n / l), leukocytic hypersensitivity
slide 40 Laboratory dosage Leukocytosis is characteristic for all forms of acute appendicitis and is not of pathognomonic significance; Look at and interpret the next step only at once with the typical manifestations of the ailment. Greater diagnostic value for the assessment of leukocyte formulas (the presence of neutrophilic suvu - the appearance of young forms, an increase in the efficiency of n / l more than 4 indicates the destructive process). With the development of a destructive process, a decrease in the number of leukocytes can be promoted (even more significantly) in the number of leukocytes in the normal range when the fireball neutrophils are overgrown and in young forms, and this can lead to the development of blood-borne systems. The Danish phenomenon is called "leukocytosis of survival".
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slide 42 instrumental doslіjennya X-ray of the OChP ultrasound CT Laparoscopy Tsi methods for detecting in total vapors, including for differential diagnostics and for the inclusion of other ailments, which simulate hospitality appendicitis
slide 43 instrumental diagnostics Radiography of the OChP gives the possibility in some cases of diagnostics of the OA and the diagnosis of the state of health of the patient.
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slide 46 Differential diagnosis Gostriy appendicitis is necessary to differentiate with hospitable organs of the black empty space and the space beyond the urethra. There is a significant variability in the growth of a worm-like outgrowth in the empty queue, which is not very common in the typical clinical picture of the disease.
slide 47 Differential diagnosis * Gostriy pancreatitis Gostriy cholecystitis Perforated bend of the slunk about the 12th intestinal tract Right-sided nirkova kolka Kharchova toxicoinfection
slide 48 Hirurgichesky lіkuvannya All ailments with the establishment of a diagnosis of a grievous appendicitis right away every hour, before the ear is overwhelmed, for a surgical treatment. The principle of early operation is guilty of being unbreakable. It is important to allow for the operation, to find a problem with a relatively easy interruption, and to avoid important and fatal expeditions.
slide 49 Operatively treatment is not shown in two categories of ailments: for good reason, formed by the appendicular infiltration, as there is no tendency to abscess formation; zi weakly circulating with appendicitis, called "appendicular coli". In such a condition, with the presence of normal temperature, normal in the place of leukocytes in the blood, caution is shown for the ailment for 4-6 years with the necessary methods of advancement (laboratory, X-ray, instrumental, etc.).
slide 50 Access: Oblique winter growth in the right club area (according to Mac-burhlivo, according to Volkovich-Dyakonov) Paramedianna according to Lennander Laparoscopic Mid-middle laparotomy perebuvati over the specified line and 2/3 - below it (Fig. 5.1).
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slide 61 NOTES - Natural Orifice Translumenal Endoscopic Surgery Endoscopic transluminal surgery through natural openings Transgastric Transvaginal TRANSRECTAL EXTREMELY COMBINATIONS
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slide 63 Accommodation of the guest appendix Appendicular infiltration: with involution infiltration in 4-6 months. і from abscesses Extensions of gnarial peritonitis Internal abdominal abscesses (pelvic, midget, subphrenic)
slide 64 appendicular infiltration The appendicular infiltration will take up to 3-5 days from the ear of the disease. It is a conglomerate, which is stored from the ignition-changing loops of the intestines, the omentum, which is interconnected from the dead worm-like spindle and is bought around a new exudate. The most important sign of infiltration is that it can be detected during palpation of a sore fiery swelling in the right club area. The sick man’s camp is getting worse up to the hour, the temperature drops, and the pain changes. Ailment is uniquely dull in the right club area, so you can feel it when you walk. Signs of the teasing of the queue of the day. Appendicular infiltration can be reduced or abscessed.
slide 65 At the first drop, the temperature will normalize, there will be a change in inflammation in infiltration, ailment in the right club area, blood counts are normalized for conservative therapy, including the post-therapy regimen. We all have a problem, in some conservative therapy appeared to be effective, it is recommended to apendectomy in 1.5-2 ms. sending the whiskey to the stationary.
slide 66 Abscessive appendicular infiltration With other options, there is an abscess of the appendicular infiltration. The appendicular abscess is opened under endotracheal anesthesia due to the loss of muscle relaxants through the extra-abdominal growth of Volkovich-Dyakonov, or by extra-abdominal access closer to the ridge of the clubhouse populations When I see pus, I can protect the revision of the leocecal area and when a gangrenous outgrowth appears, I can see it. Empty gn_ynik is drained. In such a rank, with an abscess appendicular infiltrate, rostin abscess is shown, with a formed fatty infiltration of all manipulations, crimson tamponade, contraindications.
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slide 68 Enlargement of ginny peritonitis When the rosette of the black emptying occurs, a poured peritonitis appears, the operation through the local access in the right club area is pinched and the middle laparotomy is shown. The tactics of surgical involvement should not be based on the principles of advanced peritonitis.
slide 69 for operational acceleration Folding from the side of the operative wound (infiltration, suppuration, ligature fistula). Folding from the side of the organs in the black empty: gn_septic (enlargement of peritonitis, internal abscesses), as well as bleeding in the black empty, intestinal laxity, intestinal fistula. Folding from the side of the other organs and systems.
slide 70 Folding from the side of the organs of the black empty Up to the whole group it will be delayed to bring the peritoneal peritonitis, education of pericult infections, abscesses (interloop, pelvic and subaphrenic gnosis), bleeding in the intestinal tract.
slide 71 Pislyoperative peritonitis is carried out on an occasional basis, but rather on a slower pace. The reason for the peritonitis is the inability of the seams of the kuksi, as well as the perforation of the necrotizing dysplasia, or the suppuration of hematomas. Likuvannya - relaparotomy and treatment of peritonitis in accordance with the rules of the whole acceleration.
slide 72 Infiltrates and abscesses of empty emptying. You can be tied with permissive pardons in the event of an operative engagement, with severe punctures of the mucous membrane when a purse-string suture is applied. Infiltration in the right club area may be due to some reasons, often not to be found in a surgeon, but due to all the peculiarities of pathology stone and іn.) So we are averse to carrying out relaparotomy and rosin abscess and drainage.
slide 73 Bleeding from a worm-like adolescent worm-like adolescent ligation during an unclean ligation of a worm-like ligature for an hour of operation. Gostra kishkova poor performance of the operation with the drive of a severe appendicitis is developing rather quickly. The reason for the gastrointestinal failure, how to develop during the operation, is the spike process or the establishment of the ignition infiltrate.
slide 74 Intestinal fistulas occur during the operation from the drive of the gastrointestinal appendicitis, most often in cases of inflammation of the lumps and small intestines, which develops during the transition of the destructive process from the worm-like appendage to the abscess to the abscess to the abscess. Intestinal fistulas develop frequently on the basis of events, but not so often as they develop. The role and technical errors in the apendectomy are allowed when a purse-string suture is applied.
slide 75 Folding from the side of the other organs and systems Tse persh for all cases of operative pneumonia and thrombosis in case of which it is shown to be more conservatively treatment. Folding from the side of the heart-vascular system and can be diagnosed in patients of a kidnapped and old person if they have other illnesses
The first period - from the old hours to 80 years of the XIX century, since the understanding about OA has not yet disappeared, and the abscesses of the right club hole were called "psoitami", "narivami", Dupuytren's abscesses Another period - from the 80 years of the XIX century. Hirurgic tactics were conservative. The third period is the first quarter of the XX century. There is a need for a termine apendectomy, if only in the first year from the ear of the ear.
Being a rudiment of the intestinal mucosa, the appendix still has a number of functions: secretory - the mucus membrane of the viroblyaus, which reveals mucus, followed by the enzymes in amylase, lipase; swiftly - the peristalsis is poorly rotated without spitting; hematopoietic - lymphopoietic, immune, purchase of lymphoid tissue.
Infectious theory is the most early and until the present hour is the most recent. One of them caused a diagnosis of appendicitis due to an infectious organism (influenza, typhoid fever, gnarial processes with Pim and in.). The Іnsha theory caused the development of appendicitis with the enterogenic penetration of infection into the worm-like growth. The third version of the infectious theory of intercourse with the names of the native nymetsky pathologist Aschoff, which, in the case of hospitality, appendicitis is a microinfectious process, which will summarize the changes in virulence
Obstruction of the education of the worm-like outgrowth, so that the worm-like outgrowth is in place, or the illumination of the closed empty space. Tsi stays can be equipped with coprolites, lymphoid hypertrophy, foreign bodies, Helminths, mucous plugs, deformations of the spine. Sudin damage, which can lead to the development of the convulsive stasis, thrombosis of the sudin, appear segmental necrosis. Neurogenic deterioration, which is superfluous to peristalsis strength, overstretching of the outgrowth, mucus alleviation, microcirculation deterioration.
Cortico-vіstseralnі, vіstsero-vіstseralnі, autovіstseralnie (very vіdrostka) neuro- regulyatornі torn down Sudinnі i m'yazovі spasm, thrombosis, embolіya gіlok appendicular arterії GOSTR apenditsit Aktivіzatsіya nespetsifіchnoї іnfektsії (kishkova palichka, enterokok) torn down zagalnoї i mіstsevoї reaktivnostі Іshemіya i trofіchnі the destruction of zones or the growth itself
І. Gostrium appendicitis appendicular colka Gostrium prostate (superficial) appendicitis Gostriy destructive appendicitis a) phlegmonous b) gangrenous c) perforative d) pace of the worm-like appendix 4 , sepsis and іnshі) P. chronic appendicitis primary - chronic appendicitis residual chronic apendicitis recurrent chronic appendicitis
Symptoms in the back 1. Bile in the abdomen 2. Dyspeptic syndrome 3. foreign signs ailments In 20-40% of vipadkіv bіl winyk a few in the epigastral dіlyantsі, instead of moving to the right of the club region (with - m Volkovich - Kocher), or even the ear itself is localized in the right club region
Zagalny 1. Interfacing the sleeves in the right tazostehnovoy slope when walking, walking right hand club area, in the lid it is important to lie on the right botsi from the bottom of the right tazostegny slope lower end: 2. Mova is often dry and plating 3. The temperature of the body is adjusted (up to 38 ° C), post-war; rectal temperature - increased lower by one degree from the temperature (Lenander's symptom); 4. Pulse - adequate to the adjusted temperature of tila - tachycardia.
Trida D'elofua (classic Tridada OA): o spontaneous beat at the right club yamtsi; o sprain of mucus in the right club area with palpation of the abdomen; o hyperesthesia of the school of the right club area. Symptoms: Rovzing, Sitkovsky, Bartomier - Mikhelson, Voskresensky, Yaure - Rozanova, Cope, Ivanova, Obraztsova
To verify the diagnosis of "gostry appendicitis" most often in the clinical practice of viciousness; - zagalny analiz sich - normal for simple and nonspecific signs of intoxication with destructive gostromy appendicitis. Krym, for the verification of a gastric appendicitis in the vicinity of the disease, you can vikoristovuvuvuyu oglyadovuvuyu oglyadovuvayut organs of the black empty, to determine the contact temperature of the child or the thermogram of the anterior cranial wall, ultrasound dosage organs of worms, laparocentesis, laparoscopy.
Differential diagnosis of right-sided basal pleuropneumonia; Infarction of myocardium; hospri zhvoryuvannya internal organs of females (apoplexy of the ovary, damaged post-malignancy, twisting of the ovary's bones, adnexitis, endometritis, pelvic peritonitis)
Lecture plan 1. Visnachennya of the understanding of the gostry appendicitis. 2. Anatomical and physiological features. 3. Classification of appendicitis. 4. Clinical symptoms of appendicitis. 5. Atypovі form of gosstry appendicitis. 6. Differential diagnosis... 6.Likuvalnoy tactics and vibration method of treatment. 7. Management of the state of the art for appendicitis, clinical diagnosis, diagnosis, treatment. 8. Chronic appendicitis, clinical diagnosis, diagnosis, treatment. 9. Videophilm. GOSTR appendicitis - nespetsifіchny (often flegmonozno- gnіyny) Ignition Process chervopodіbnogo vіdrostka, yaky vinikaє in rezultatі dії (perevazhno sukupnostі) number faktorіv: pervinnoї nespetsifіchnoї іnfektsії, Change log zagalnoї that mіstsevoї reaktivnostі, torn down krovopostachannya, obumovlenogo disfunktsієyu neurohumoral aparata mіstsevogo chi zagalnogo pohodzhennya. The term of the proponation of R. Fitz in 1886 r Gostry appendicitis is one of the most common hospitality surgical organs of the empty waste. The prevalence of sickness is prevalent among women, it is more important to lay it down and become (V.G. Zaitsev, 1989): for children under 1 rock - 3.48 vipadkiv per 10 yew. Population, for children from 1 to 14 years - 11.4, from 15 to 59 years - 114.9, from 60 to 69 years - 29.7, 70 years and more - 15.8. In such a rank, as mentally the average triviality of life becomes 60 years, then the skin of a person until the end of life will be seen as a worm-like growth.
Throughout the last 10 years of operation, lethality in Ukraine with a state of appendicitis rises in the range of 0.16-0.24%. Especially vrazhayut absolute figures: 0.2% of 220 yew. There are 440 operative warehouses!, So there are more than three, less students in one course of the Ternopil Medical University. Mortality in case of state appendicitis in 10 regions of Ukraine in 2005 was caused by the following officials: - severe illness 19.7% - failure of hospitalization 46.1% - technical pardons for an hour of operation 5.2% - tactful pardons 6.8% 7.7% - with congenial disabilities 9.3% - deceased operations 5.2%
Cortico-vіstseralnі, vіstsero-vіstseralnі, auto vіstseralnі (very vіdrostka) neuro- regulyatornі torn down Sudinnі i m'yazovі spasm, thrombosis, embolіya gіlok appendicular arterії GOSTR apenditsit Aktivіzatsіya nespetsifіchnoї іnfektsії (kishkova palichka, enterokok) torn down zagalnoї i mіstsevoї reaktivnostі Іshemіya i trophic damage to the zones or the growth itself Pathogenesis of gross appendicitis
Klinichna Classification (V. Kolesov, 1959). І. Hostria prostate (superficial) appendicitis: a) without zagalno key signsі with bends, swiftly knowing, muscular manifestations; b) with insignificant zagalnoklinic signs and twists and turns, muscular manifestations of an affliction. II. Destructive appendicitis (phlegmonous, gangrenous, perforated): a) with a clichéd picture of mediocre severity and signs of muscular peritonitis; b) with an important clinical picture and signs of muscular peritonitis. ІІІ. Folding appendicitis: a) with appendicular infiltration; b) s appendicular abscess; c) with diffused peritonitis; d) with іnshim accelerated (pilephlebitis, sepsis).
І. Gostry simple appendicitis. II. Gostria destructive appendicitis: 1. With muscular non-transient peritonitis. 2. Folding: a) appendicular infiltration of the growth localization; b) appendicular abscess of small localization; c) we will pour out peritonitis; d) pilephlebitis; e) liver abscesses; f) sepsis. CLINIC CLASSIFICATION
Patanatomical classification of the state of the art of appendicitis (A.I. Abrikosov, 1957). І. Catarrhal (superficial) appendicitis, primary affection. II. Phlegmonous appendicitis: 1. Simple phlegmonous appendicitis. 2. Phlegmonous-virazkovy appendicitis. 3. Apostematous appendicitis: a) without perforation; b) s perforation. ІІІ. Gangrenous appendicitis (primary, secondary): a) without perforation; b) s perforation.
Zagalny 1. Interchange of sleeves in the right tazostegon loam when walking, while walking around the right hand of the club area, it is important to lie on the right side of the loop, which is often folded in the tazostegon loam of the right lower juvenile: 2. 38 ° C), post_yna; rectal temperature - increased lower by one degree from the temperature (Lenander's symptom); 4. Pulse - adequate to the adjusted temperature of tila - tachycardia. ob'ktivnі signs
Mistsev - 1. Intercourse of the anterior abdominal wall in the right club area and the right half of the abdomen s sensitiveі in terms of soreness 4. Local beats are swollen with palpation in the right club area, sometimes with irradiation in the paraumbilical and epigastric area 5. Weakened peristaltic noise in case of auscultation
Appendicular infiltration Sub'active signs 1.transferring an attack of a grievous appendicitis, since the days that have been given to those who have been up to 38.0 -38.5 0 C) is adequate to the temperature of the tachycardia in the right club area (for in the last one, the location of the worm-like outgrowth in a particular patient on the background in the ignition sign subdividing the urinary tract by palpation visually start the puffy-like appearance of the wrong form with more clear contours, not a smooth surface, cracked, little or no nerves, ailing, with a size of 3-4 to cm; It is also possible to see pukhlinopodibneosvita in case of vaginal and rectal diminished leukocytosis with an insignificant loss of leukocyte formula in addition to an increase in SHOE.
Appendicular abscess Signs of 1 improvement and enlargement of muscle pain (supportive and active) 2 reduction of the back pain (increased temperature of cold, lack of breath, anti-toxicity) 3 hectic temperature of the same Infiltration 5 moss the symptom of fluctuations in palpation, infiltration through the anterior cranial wall, or in the case of recurrent (rectal) pre-existing 6 rotations of growth of leukocytosis and of a leukocyte formulation in case of ultrasound, 7 signs of abscess
Pilephlebite Signs 1 zagalny camp is important, revealing the blood, soup or eating sclera, small zagalny weakness 2 post-mortem bile but importantly in the right half of the abdomen, on the right side of the belly 3 the temperature is 39-40 ° C, while the temperature is 39-40 ° C. pulse is partial, weak 5 alive with swelling, mild, slightly painful, symptoms of a mockery of a negative 6 symptoms, pain with palpation of the liver, a positive Ortner symptom, in some cases of high leukocytosis 9 , with progressing anemia, hypertension 8 in the right pleural emptying, reactive exudate does not appear frequently, but it is verified by radiological or ultrasound; the presence of signs of liver abscess with ultrasound
Laboratory and instrumental methods of diagnostics. To verify the diagnosis "gostry appendicitis" most often in the clinical practice of viciousness; - zagalny analysis of the sech - normal for simple and nonspecific signs of intoxication with destructive gostromy appendicitis. Krym, for verifying the patient's appendicitis in the vicinity of the disease, it is possible to perform an oglyad radiogram of the organs of a black empty, to determine the contact temperature of the child, and the thermogram of the anterior cranial scintillation, ultrasound examination of the
Diferentsіalny dіagnoz RIGHT basal plevropnevmonіya Іnfarkt mіokarda Mіzhreberna nevralgіya GOSTR gastritis Phlegmon shlunka Zagostrennya virazkovoї hvorobi GOSTR cholecystitis GOSTR pancreatitis GOSTR kishkova neprohіdnіst GOSTR mezenterіalny thrombosis GOSTR divertikulіt (Meckel) Gostrі zahvoryuvannya zhіnochih vnutrіshnіh statevih organіv (apopleksіya yaєchnika, Porush pozamatkova vagіtnіst, perekruchuvannya kіsti yaєchnika, GOSTR adnexitis, endometritis, pelvic peritonitis)
Licuval tactics and vibration method of treatment Conservative treatment is indicated for deprivation in case of appendicular infiltration, diagnosed before any hour of the operation, including: obmezheniya rukovy mode; povnotsіnnu viskokalorіynu dіetu z viklyuchennyam z ratsіonu products, abundant on klіtkovina; cold on the right ileal area with obvious local signs of mocking the queue (0.5-1.5 dobi), with liquidation of the remains - warm (grilka, UHF); complex, based on principles of antibacterial therapy (more beautifully parenteral), direct to the colonic flora; paranephral novocaine blockade with antibiotics every other day (3-5 per course); disintoxication infusion therapy (osmotherapy, stimulation of duresis in the first few days); stimulation of zhisnih forces to organism. With a positive result of such a treatment, the appendicular infiltration gradually grows out (in the middle after 1-2 months), after a period of time, the conservative treatment is adequately changed. The letter of the clinics is a sign of a sick person to be sent to the hospital with a recommendation in 2-4 months, it is obligatory to visit the appendectomy in a planned manner.
Chronic appendicitis Classification 1. Pervinniy - pathological changes in the outgrowth develop in deeds without a sign of a hostile attack. 2. Secondary: 1). residual (surplus) - pathological changes are caused by an attack of a gastric appendicitis, appendicular infiltration, appendicular abscess; 2). recurrent - when a new attack occurs again. Clinical symptomatology Sub'єktivnі signs: - transfers to the last gostry appendicitis (NOT operations), appendicular infiltration (abscess); - bіl in the right club area is of a versatile character on the cob, tied to the implantation of a person, the physical activity of a sick person, of a similar intensity; - unstable, pomirnі (chi insignificant) signs of damage to the intestinal passage, intestinal motility; - visibility is a sign of the ignition process. Ob'ktivnі signs: - bіl with glibokіy palpation in the right club area (in the zone of worm-like growth); - visibility mіstsevyh signs the ignition process і is a sign of teasing the queue; - may (not pathognomonic) positive appendicular symptoms
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APENDICITIS - inflamed wormlike appendix (appendix) of the slit intestine, most likely to become ill in the middle of the organs of worms emptying. On a new fit up to 70% of the tumors of the gross abdomen. In the middle of the skin, 250 people are sick with appendicitis. The mortality rate from the hospitalized appendicitis becomes 0, 1% with non-perforated growth and up to 3% with the first perforation, moreover, the mortality rate in the middle of hospitalized patients in the 1st add is 5-10 times lower, below the middle of the patients who were admitted to the hospital. Bring numbers to talk about the need 
Cause of the development of appendicitis Vvazhayut, how the appendicitis is repaired, if the openings between the wormlike appendage and the intestine are clogged. The blockage can appear through the thick mucus nasal in the middle of the appendix, or through the feces, which are consumed into the worm-like adrost from the slough intestine. The mucus will harden, become solid, like a stone, and clog the openings. Such stones are called coprolites. In some drops of lymphoid tissue in the worm-like growth, the worm-like growth can swell and clog. Organism reacts to the same vprovazhennya zapalennyam. The Іnsha theory of the causes of appendicitis is the coarse opening of the worm-like outgrowth with the onset of enlargement of the bacteria behind the worm-like outgrowth. The reason for this appearance is unclear, but it may be tied to the worms, which appear in the lymphoid tissue, which whistles the wall of the wormlike appendage.
It also expands in the range of worm-like growth, which can grow in size. The development of infection can be widened along the black empty; protest, start the process of intermingling with a small space, so I drain the worm-like outgrowth (forming the so-called "periapendicular abscess").
There is a clear picture of the appendicitis. Bil has a rosy character, but in the first year of illness, it is especially often localized in the epigastric period (the so-called epigastric phase). At the beginning of the year of self-reliant pains, they fix the localization in the right club area (symptom of Kocher-Volkovich pain change). The stench should be of a persistent nature, as a rule, it will turn around. In case of appendicitis, it can be more strong, sometimes weak, I call some sickly ailments insignificant, or even do not lean on sickness.
Rapid and rapid pain relief, as a rule, superficially alarmingly familiar and indicative of perforation of the worm-like outgrowth. Risky pains, which are supervised by the sick, develop in the form of ailing appendicitis, which are characterized by assertions in a wormlike appendage of a closed nasty emptying (the so-called rate of the sprout). Characterized by the loss of appetite, approximately in half of the vomiting of the buoy the tediousness and the disposable bloat in the first year of illness. Repeated vomiting with shlunkovym vmіstom, or zhovchu with gross appendicitis, indicate the progress of peritonitis. It is not unreasonable to read the style. Constipation is an inherited paresis of the intestine, characteristic of any peritonitis.
When the belly is prolonged, a picture of muscular peritonitis appears in the right club area. You have to build up on the resistance of the mucous and local ailments during palpation in the right club area (the symptoms of the daytime only when the appendix is rostered behind the intestine or in the empty pelvis). Swelling and symptoms of the muscular quill (Shhotkin-Blumberg symptom and percussion ailment of the anterior abdominal wall in the club area on the right). When postukuvanny, navit to the guardian, ailments mean more in the right club area as a result of a stricken quail (Rozdolsky's symptom).
Additional signs of appendicitis, a symptom of Rovzing - ailment in the right club area with jerky finger pressure in the left club area (for a change of gas in the area); Sitkovsky's symptom - pain relief in the position on the left bowel (for the reduction of the intestine and the appendix and the tension of the burned neck); Obraztsov's symptom - amelioration of the ailment when the right leg is stretched out when lying on the back
Behind the blame, there is a rare occurrence of the even rapidly progressing so-called hypertoxic forms of gross appendicitis, 
Tazovi and retrocecal appendicitis appear to be the most important interruption, gangrenous and perforated forms are more often promoted, the stench is characterized by a significantly greater lethality. It’s not the case that the abnormal growth of the worm-like outgrowth can lead to a more important interruption 
The development of retrocecal appendicitis is even more difficult, with any irregular occurrence prevailing in the backward order (fever, headache, blues), and the symptoms of maceration are insignificant. In cich patients, soreness is often referred to as significantly lateral to the right of the club area and appears with a bimanual (two-handed) transverse eczema in the position of a sick person on the other side.
Laboratory and instrumental diagnostics. The price is more typical for children. Laparoscopy is a surgical procedure, when a thin fiber-optic tube with a camera is inserted into the empty space through a small opening in the abdomen. Laparoscopy allows the formation of a worm-like growth and an organ of a worm-like waste and a pelvis. When appendicitis occurs, it is possible to immediately see a wormlike outgrowth.
Uskladnennya apenditsita Mezenterіolіt (broken-winded brizhі chervopodіbnogo vіdrostka) іnfіltrat (Mauger rozvinutisya 3 4th Dobou zahvoryuvannya at vіdmezhuvannі ignition Process), abscess (proyavlyaєtsya zbіlshennyam іnfіltratu in rozmіrah i appears hectic lihomanki) peritonіt (rozvivaєtsya vіdrazu w pіslya bolovogo will attack abo on 3rd - 4th add in cases of gangrene (chi perforation), sepsis
Treatment of appendicitis As soon as the diagnosis of "appendicitis" is established, it is most often to carry out visualization of the worm-like outgrowth (apendectomy). Antibiotics can be repaired before surgical intervention, as soon as diagnostics are delivered. Lіkuvannya of all forms of state of the art appendicitis is only prompt. Ailments with a diagnosis of a severe appendicitis (or, if you are susceptible to a disease), require a secure hospitalization in a surgical procedure, with maximum peace of mind when transporting in a lying bed. It is categorically contraindicated for the type and penetration of peristalsis. 
In the present hour, two methods are used to see the worm-like outgrowth: the traditional operation, which can be seen through the rose, and the endoscopic operation, how to be afraid through the punctures under the control of the TV set. In the case of an appendage, the growth of the worm-like growth through the growth, through the worm-like growth of the belly over the area of the growth of the worm-like outgrowth, to control the growth of the worm-like growth of 8 -10 cm. When I look around the area near the worm-like outgrowth, the worm-like outgrowth is visible at all times. A breech of a worm-like outgrowth and the outgrowth itself overwhelm, and in such a rank they sound the ligament with the intestine; Sew up the openings in the intestines. It’s an abscess, there can be drainage behind additional drainage (humic tubes), as it goes through the abscess through a drain called. Then we sew up the roses.
A new way of seeing the worm-like outgrowth includes a laparoscopic test. Laparoscope - tse thin 
Prevention of appendicitis Significantly trim the systematicity of the style, to prevent the formation of constipation. Be-like a manifestation of stagnation in the intestines of the Veda until the establishment of suppuration. Also, it is not unimportant for the nobility, well 
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