Appendix pain

introduction

The leading cause of pain in the appendix is one caused by bacteria Inflammation of its appendix, popularly known under Appendicitis. Of the appendix („caecum") is a Part of the colon and is located in right lower abdomen.

The term “appendix” comes from the fact that the small and large intestines do not simply merge into one another, but rather the small intestine flows into the appendix via a valve, which opens “blindly” downwards and merges upwards into the ascending part of the large intestine (ascending colon) . At the blind end of the appendix hangs the so-called appendix (Latin "appendix"). This is the part that is inflamed when they talk about appendicitis. The appendix itself is usually not affected by the inflammation.

This painful inflammation affects about 100 out of 100,000 people in the year. Children, adolescents and young adults are most frequently affected, although appendicitis is rather rare in children under two years of age.

Causes of appendix pain

The most common cause for pain in the appendix is the colloquial as Appendicitis designated Inflammation of the appendix. This can have various causes:

Since the diameter of the appendix is ​​only about 1 cm, it can be relatively easy to a closure come. This can be done, for example Feces, Kink or scar arise. Rarely can too Foreign bodies close the opening of the appendix, for example a swallowed cherry stone. Occlusion of the process can result in a voiding disorder, which can lead to inflammation.

Another cause one Appendicitis is related to the function of the appendix. For a long time it was assumed that the appendix was a functionless remnant of evolution. Meanwhile it becomes a meaning in the Immune regulation awarded. It is assumed that the lymphatic tissue of the appendix on the Defense against infections and the Processing of immunologically relevant information is involved. If it comes to one inflammation in the body (for example a flu or Tonsillitis) the pathogens can reach the appendix via the blood. Due to its role in immune regulation, this can lead to a violent reaction and one excessive swelling of the appendix to lead.

Another cause for pain in the appendix can Inflammation in other parts of the intestine be. These can spread to the appendix and cause pain. Most often this occurs under the two inflammatory bowel disease Ulcerative colitis and Crohn's disease on.

A so-called appendix can also cause pain in the appendix torsion to lead. This becomes a Twisting of the bowel around its vessel suspensions. The digestive movements of the intestines can cause this to happen Obstruction of the bowel and its blood supply.

Also a so-called Intussusception can cause pain in the appendix area. Intestinal sections turn inside one another, so that it also becomes one Constriction of the intestines and the blood supply comes.

At Intussusception and torsion mostly lie cramping pain in front. In patients with a poor immune system, such as AIDS-Patients or Cancer patients after a chemotherapy, the bacteria that live in the gut and are usually harmless can cause a Inflammation of the appendix cause. In this case there is usually a Combination of fever and tenderness in the right lower abdomen in front.

At a Pseudoappendicitis there is also pain in the appendix area. It comes to Swelling of lymph nodes in the area of ​​the right lower abdomen. On the one hand, this can be directly caused by infection with the Yersinia pseudotuberculosis bacterium be caused. On the other hand, you can with children Infections in the area of respiratory tract cause the lymph nodes to swell, creating the appearance of appendicitis.

There are numerous other clinical pictures that can also manifest themselves with pain in the appendix area and must be considered as a differential diagnosis. This can for example Abscesses or Tumors be. A Inguinal hernia or Diseases such as stones of the ureter and a Twisting of the testicle around the supplying vascular pedicle can express itself with pain in the area of ​​the appendix. Also gynecological diseases, how Ovarian cysts, one Inflammation of the fallopian tubes and Ovary or a pregnancy nested outside the uterine cavity (Ectopic pregnancy) can be accompanied by pain in the right lower abdomen.

Symptoms

Usually one goes Appendicitis With severe pain hand in hand. Typically, this pain occurs very suddenly on.

At the beginning the pain is usually in the middle upper abdomen or around the belly button around. Often he is called dull described, an exact point can usually not be defined more precisely.

Have the bacteria passes through the intestinal wall, so it happens after about 8 to 12 hours permanent pain, the position of which can be precisely described. This change in the localization of the pain, the migration from the upper or middle abdomen to the right lower abdomen, is not always present, but it is characteristic of the pain in the context of a Appendicitis. Since the Appendix is very mobile due to its shape, it can move from the appendix starting in different directions hang. Therefore, the location of the pain depends on the location of the appendix. Almost two thirds of people have that Appendix behind the appendix (retrocecal). This position can lead to the absence of pain in the abdomen. An inflammation of the appendix can instead be caused by pain in the area right flank express. The Raise the straight right leg leads to the position of the appendix behind the appendix that the appendix on the Iliopsoas muscle lays. This can be used in making a diagnosis of appendicitis by testing whether lifting the straight right leg causes or can make pain worse (Psoas sign). A positive psoas sign indicates that the appendix lies behind the appendix and is inflamed. Almost a third of humans the appendix hangs down.In this case, the pain is often through Pressure on the Lanzpunkt (right third of an imaginary line between the two front upper ones Iliac spines) or McBurney point (Middle of an imaginary line between the navel and anterior upper iliac spine) to cause or strengthen.

Plus there is still rare position variations of the appendix. For example, does this hang in the pool Inside, the pelvic organs can become irritated, causing the appendicitis with Urination and stool goes hand in hand. In this case, the pain is mainly in the context of rectal or vaginal exam. In general, the pain often increases with appendicitis to cough, Sneeze and Go. That too Hop on the right leg is often no longer possible due to severe pain.

In addition to pain, appendicitis often goes along with it nausea, Vomit and fever hand in hand. Often lies Loss of appetite in front. The symptoms of appendicitis are often not very typical in young children, old people and pregnant women. Old people and especially diabetics with an existing Polyneuropathy often have little pain and hardly any increase in temperature.

In pregnant women, the appendix moves up through the uterus, which means that the pain is more likely to occur in the middle and right upper abdomen. In some people affected, the pain does not start suddenly, but increases slowly. This variability can make the diagnosis of appendicitis much more difficult.

What does pain feel like with appendicitis?

Usually, pain in the appendix does not begin directly in the right lower abdomen, where the appendix actually lies. Initially there is usually a rather difficult to localize abdominal pain, sometimes in the region around the navel. As the pain progresses, it shifts to the appendix region in the right lower abdomen. If appendicitis ruptures the appendix, the pain will suddenly decrease and the peritoneum will first relax. The secretion that has leaked into the abdominal cavity then leads to increased diffuse abdominal pain.

Pain from irritation of the appendix

When the appendix is ​​irritated, the appendix is ​​usually the first to be affected. Kinking or narrowing this part of the intestine can cause stool to build up inside and bacteria to multiply. Inflammatory reactions are set in motion, which causes the mucous membrane to swell. The appendix is ​​covered by peritoneum which contains many nerve endings. Pressure on them causes pain. At the beginning of an appendix irritation, the pain begins in the middle upper structure or around the navel. As the pain progresses, depending on the position of the appendix, it moves to the right lower abdomen. Pressure on the region can make the pain worse. If the inflammation recedes and the mucous membrane swells, the pain also disappears. However, if the irritation persists, the inflammation will spread and the pain will increase. By pressing and suddenly letting go of the opposite side, the peritoneum is set in motion, which also causes pain in the appendix area (contralateral pain in letting go). Likewise, lifting the right leg against resistance provokes pain (Psoas pain).

Read more on the topic: Appendix irritation

Appendicitis signs

The physical exam by the doctor includes examining what are known as signs of appendicitis. This means pain in parts of the body that is caused or intensified by certain movements or pressing certain points.

It is important that the signs of appendicitis can only serve as clues and must be viewed in conjunction with other findings. None of the signs of appendicitis proves the presence of appendicitis, and the presence of none of the signs cannot rule out appendicitis. If pain medication has already been taken, this must be reported to the doctor in any case, as this can unmask the pain.

The signs of appendicitis include, for example, a painful tenderness on the McBurney point. This is located in the middle of an imaginary line between the navel and the anterior upper iliac spine. The Lanz point is located in the right third of an imaginary line between the two anterior upper iliac spines. Pressure pain at this point can also indicate the presence of appendicitis. When examining the Blumberg sign or letting go pain, in the area of ​​the left lower abdomen ("contralateral“) The lower abdomen pressed in and quickly released. If there is (increased) pain in the area of ​​the right lower abdomen, it is called a positive Blumberg sign.

A positive Rovsing sign refers to pain that can be triggered by stroking the colon in the direction of the appendix with the appendix.

If pain can be triggered by bending the right leg in the hip joint against resistance, then there is a positive psoas sign.

If the right leg is raised in a straight position and then dropping it causes pain, the Baldwin sign is positive.

The Cope stretch sign occurs when, in the left lateral position, overstretching the right leg leads to pain.

Sitkowski's sign is pain in the area of ​​the right lower abdomen that occurs when the abdominal muscles are stretched and relieved when lying on the left side.

The obturator sign is positive if an internal rotation of the right leg causes or intensifies pain in the right lower abdomen.

A positive Chapman sign is when straightening the upper body creates or increases pain.

If the digital rectal examination, the palpation of the anus with the doctor's fingers, leads to increased pain, then there is Douglas pain.

In men, the ten-horn sign is a pain in the right lower abdomen, which is triggered by pulling on the spermatic cord.

Read more on the topic: Ultrasound of the abdomen

Further examinations for pain presumably caused by the appendix

A doctor suspects that a patient's pain is due to a Inflammation of the appendix indicate, then he will carry out further examinations in addition to the clinical examinations already carried out. In many cases, the diagnosis of appendicitis cannot be clearly established. For example, this can provide clues Presence of increased inflammatory parameters in the blood. A temperature difference between the temperature measured in the armpit and the temperature measured in the rectum of more than 1 ° C can also indicate appendicitis. This is also very useful in the diagnosis of appendicitis Ultrasound examination. Different characters like one thickened wall or a enlarged diameter can provide clues as to whether appendicitis is present.

Pain in the appendix in various situations

Pain in the appendix during pregnancy

The position of the appendix can be changed during pregnancy. Depending on how big the uterus becomes, the appendix is ​​pushed further upwards. Thus, irritation of the appendix during pregnancy can also lead to pain in the right upper abdomen. Since during pregnancy, especially towards the end of the pregnancy, there is often pain (Exercise contractions), appendix irritation is often not recognized directly.

You might also be interested in this topic: Appendicitis in Pregnancy

Pain in the appendix when urinating

Pain when urinating is not a typical symptom of appendix irritation. In the course of appendicitis, the inflammation can spread and affect the urinary tract. Pain when urinating is usually found with a urinary tract infection. In addition, there is an increased need to urinate even though the bladder is not filled.

Further information on this topic can be found at: Painful urination

Pain in the appendix when coughing

The abdominal muscles become tense when you cough. This shock brings the peritoneum (peritoneum) to swing. This "wave" spreads to the appendix and leads to pain at the point where the irritated appendix is ​​or in the entire abdomen. Likewise, if you inhale deeply, pain can occur before a cough. However, pain when coughing or breathing is usually only found when the irritation or inflammation has progressed further.

Complications

One complication is that Rupture of the appendix. This initially causes a sudden decrease in painbecause the pent-up pus in the Abdominal cavity can drain. After a while, the pain gets worse again and is usually worse than before. Of the Leakage of stool and bacteria from the intestines to the abdominal cavity leads to a Inflammation of the peritoneum (Peritonitis). One is characteristic as hard as a board, increasing indifference and fever.

Where is the appendix located?

The appendix lies in the right lower abdomen. It is part of the large intestine, more precisely the initial part of the large intestine. As the name suggests, it ends blindly at one end, the other part merges into the ascending colon. The appendix ends at the blind end (appendix). There are different positions here - ascending behind or descending in front of the appendix (Caecum). There are two pressure points that can be used to determine the location of appendicitis. The Lanz point lies on an imaginary line between the two front pelvic bones in the right third (descending position). The McBurney point halfway between the right anterior pelvic bone and the navel (ascending position).