When is the Kocher-Wolkovich symptom observed?

Causes of appendicitis

There are several causes of appendicitis:

Blockage of the entrance to the vermiform end of the rectum is the most common. This can happen due to the ingress of foreign bodies or feces. Blockage can also occur from compression of the upper part of the appendix by the formation of adhesive processes during enteritis and cholecystitis.
Stagnation of the contents of the appendage. This leads to a weakening of its protective functions, which is why pathogenic bacteria - staphylococci, E. coli, streptococci - begin to actively multiply in the appendix. They cause inflammation.
Spasm of the vessels that supply blood to the appendix.
Trauma to the peritoneum, which may result in displacement or damage to the appendix.
Pregnancy. The process may become displaced due to the growth of the uterus.
Tendency to constipation.
Poor intestinal motility.
Binge eating.
Lack of plant fibers, microelements, vitamins in the diet.
Gastrointestinal diseases.
Hereditary factors.
Infectious diseases.
Presence of parasites.
Bad habits.
Stress.

About diagnosing appendicitis in Russia

Appendicitis is inflammation of the appendix of the rectum. For its initial diagnosis, confirmation or refutation of the diagnosis, doctors in Russia use certain symptoms of peritoneal irritation that have been proven over the years. There are few of them, but they are the reliable “old-timers” in clinical practice. Named after the surname of their author:

Sitkovsky's symptom.
Kocher's sign.
Voskresensky's symptom.
Obraztsov's symptom.
Rovsing's sign.
Shchetkin-Blumberg symptom.

The manifestation of each of them depends on a number of factors: the location of the appendix, the cause of inflammation, the advanced stage of the disease, etc. Let's analyze Sitkovsky's symptom and others in more detail.

Symptoms of appendicitis in children

Children and adolescents have bodies that are not as strong as adults. Children are a particular risk area: fragile health and the inability to speak complicate the disease. But in infants under 1 year of age, inflammation of appendicitis is rare.

Inflammation develops faster in children than in adults

Most often, appendicitis becomes inflamed in children and adolescents aged 10 to 18 years.

What causes appendicitis in children:

hypothermia.
helminthic infestation.
poor nutrition.

Kocher's sign

The surest sign by which acute appendicitis can be identified is Kocher syndrome. There is even an expression among doctors: “Kocher doesn’t lie.” Half of the patients suffering from appendicitis have this particular symptom.

It manifests itself as follows: pain from the epigastric region gradually migrates to the right iliac region. It is determined by collecting an anamnesis, interviewing the patient - clarifying the location of the pain syndrome and its nature.

Sitkovsky's symptom

In case of appendicitis, doctors still overwhelmingly give preference to this symptom. The main reason for this is that it can be quickly and easily verified.

The manipulations are as follows: the patient is asked to lie on his left side and describe his sensations. With this movement, the intestinal loops shift, dragging the inflamed appendage with them. Therefore, a patient with appendicitis will inevitably complain of increased pain.

Characteristic signs of appendicitis

In the initial stages, not everyone is able to suspect the inflammation of the appendix.
Problems often begin with a feeling of discomfort in the gastrointestinal tract. Pain appears in the epigastric region, sometimes localized in the navel area. This is Kocher's sign for appendicitis. Many people report feelings of colic, bloating and a feeling of fullness. The condition may improve briefly after passing gas or bowel movements. But the pain intensifies after 1-3 hours. Paroxysmal sensations are replaced by constant ones. The pain is bursting and pressing in nature. Discomfort moves down the abdomen. Moreover, any movement and load only worsens the situation. The pain worsens with deep breaths, coughing, walking, and driving (when shaking). This is observed equally in adults and children.

Voskresensky's symptom

Another name is “shirt symptom.” The sign helps to diagnose not only appendicitis, but also other inflammatory processes of the abdominal cavity. Therefore, in clinical practice it is no less popular than the Sitkovsky symptom.

It is checked as follows: on a slightly stretched shirt, which is put on the patient, quickly run the edge of the palm over several areas in the abdomen. If during these actions the patient feels pain in the right iliac region, then appendicitis can be diagnosed.

Voskresensky

The most common technique for checking for peritoneal irritation is the Voskresensky symptom (otherwise known as the “shirt sign”). It is characteristic not only of appendicitis, but also of all other inflammatory diseases of the abdominal organs. The symptom is checked by quickly running the edge of the palm along a slightly stretched shirt along the abdomen in several places. With appendicitis, this manipulation will produce pain in the right iliac region - a positive Voskresensky sign.

Symptoms of chronic appendicitis in women

Shchetkin-Blumberg symptom

Another sign of peritoneal irritation, not inferior in popularity to Sitkovsky’s symptom. It is considered a reliable test for peritonitis, which is why it is used for all complaints of abdominal pain.

The following actions must be performed: the doctor slowly places his palm on the patient’s anterior abdominal wall and gently, without force, presses. Then he abruptly removes his hand. If the patient felt a sharp pain, then the Shchetkin-Blumberg symptom was confirmed. In the acute form of appendicitis, the patient will feel pain during this in the right iliac region.

Diagnostics

However, to determine the disease, it is not enough to know the signs of Kocher’s symptom in appendicitis. There are others, according to which an accurate diagnosis can be made. For example, the patient is unable to sit up independently from a lying position. This sign is called Bailey's sign.

The pain may worsen if the patient leans to the left. This sign is also characteristic of inflammation of appendicitis and is called Volkovich's symptom. The patient's condition will worsen if one tries to bring the right leg to the stomach.

Mendelian signs may also occur. It is as follows: the pain is aggravated in the iliac abdomen if you tap your fingers on its front part. This symptom is positive in most cases, up to 80%.

In order to determine the onset of peritonitis, a slightly different diagnosis should be performed. Kocher's sign is observed in the early stages of inflammation. If it develops, the symptom disappears. The patient's pain will intensify if you press on the iliac region on the right side and then sharply remove your hand. A similar symptom is called the Shchetkin-Blumberg symptom. It is observed in 98% of cases of onset peritonitis.

We looked at how the Kocher-Volkovich symptom manifests itself in appendicitis.

Rovsing's symptom

It is quite rarely used in practice, which does not negate its validity, which is why the symptoms of Rovsing and Sitkovsky are constantly mentioned in the literature. It is determined when pain occurs due to the accumulation of gases in the rectum.

The doctor performs the following manipulations: with the patient lying down, it is necessary to squeeze the colon descending colon in the left iliac part of the peritoneum with your hand. Use your right hand to apply push-like pressure slightly higher. If, with such a change in pressure in the intestinal tract, the patient feels pain in the right iliac region, then he is diagnosed with appendicitis.

Treatment of appendicitis

If “acute appendicitis” is suspected, the patient is hospitalized and sent for tests to exclude other abdominal diseases.

To establish the position of the appendix in the peritoneum, an ultrasound of the abdominal cavity is performed. According to it, experts judge:

Availability of the appendage for removal.
Anatomical features of the adhesion of the appendage to other organs.
Possible anatomical abnormalities in development.

The accuracy of ultrasound is not inferior to that of CT, but it is faster and more accessible than tomography.

There are cases where the patient's appendix was located on the left side. In this case, the wandering pains shifted to the left iliac region. The left-sided position of the appendix is typical for people with mirror image of organs, which is rarely diagnosed.

If a patient in the hospital experiences a decrease in pain, then this is a sign of a breakthrough in the walls of the appendix. An emergency appendectomy is performed.

Traditional resection of the appendix is not popular due to large incisions and long wound healing times. Laparoscopy is preferable, but costs more. Using a flexible tube (laparoscope), the operation is performed through three miniature punctures in the abdomen.

The postoperative period includes adherence to a gentle regimen:

In nutrition (treatment table No. 5 is prescribed).
Sports activities (physical therapy and gymnastics).
Lifting weights (first month up to 3 kg).
Giving up bad habits.
Sexual abstinence.

What is possible and what is not allowed after appendicitis is determined by the attending physician.

Obraztsov's symptom

After we have talked about the symptoms of Rovzing, Sitkovsky, Voskresensky, it would not be amiss to talk about Obraztsov’s sign, which helps to identify the retrocecal location of the appendix.

The patient is asked to lie on his back and raise his right leg straight at the knee. At this time, the muscles of the anterior abdominal cavity and lower back tense and begin to affect the receptors of the appendix. If the latter is inflamed, the patient will complain of pain in the right iliac region.

Other symptoms

We examined a number of appendicular symptoms, Sitkovsky's symptom. Let's get acquainted with less common, but existing in medical practice, methods for diagnosing acute inflammation of the appendix:

Barthomier-Michelson's sign. The patient lies on his left side, and the doctor, palpating the right side of the peritoneum, finds a painful spot.
Varlamov's symptom. When tapping in the area of the right XII rib, pain occurs in the characteristic right part of the peritoneum.
Ben-Asher's sign. The doctor presses with the tips of two fingers into the patient’s left hypochondrium. The patient is asked to breathe deeply or cough. If during this manipulation pain occurs in the right iliac region, appendicitis is suspected.
Asaturyan's symptom. The doctor presses the fist of his right hand on the patient’s left iliac region. On the bulging right area, with his free hand, the specialist palpates the cecum to localize the pain.
Bassler's sign. Soreness is determined by pressing between the superior anterior iliac spine and the navel towards the spine of this bone.
Iliescu's sign. Pain in a characteristic area occurs when pressure is applied to the cervical point of the right phrenic nerve.
Brando's sign. Used in diagnosing appendicitis in pregnant women. When pressing on the left rib of the uterus, pain occurs in the right region of the peritoneum.
Zatler's syndrome. The patient in a sitting position is asked to straighten his right leg. If the appendix is inflamed, the patient will feel pain in the right iliac region with this movement.
Cope's sign. When rotating the right hip, the pain in the right iliac zone increases.

• Appendiceal symptoms

Appendiceal symptoms

Shchetkin-Blumberg symptom

The examiner's left palm is placed on the right iliac region and applies pressure to it, then the hand is quickly removed. The symptom is positive if, at the moment of removing the hand from the abdominal wall, severe pain appears in the area being examined. The symptom is positive in other inflammatory diseases of the abdominal cavity. Pain occurs above the site of inflammation.

"Fading soreness" symptom

A diagnostic symptom that allows you to differentiate chronic appendicitis from gastritis. With chronic appendicitis, patients can feel pain only in the epigastric region for a long time and even treat gastritis.

The symptom is as follows: if in chronic appendicitis and (even acute) there is pain on palpation in both the epigastric and right iliac region, or only in the epigastric region, then with one hand press on the painful area in the right iliac region and, at the same time, with the other hand palpate the epigastric region.

In the presence of appendicitis, pain in the epigastric region disappears. As soon as the pressure on the appendicular region is stopped, the pain in the epigastrium is restored.

Sitkovsky's symptom

If a patient with acute appendicitis, lying on his back or on his right side, is turned onto his left side, then the pain in the right iliac region intensifies or, if it was not there, appears. Pain occurs due to displacement of the cecum and inflamed appendix.

Rovzinga symptom

Pressure of the descending segment of the large intestine in the left iliac region causes pain in the right iliac region. Gases, moving through the large intestine, stretch the cecum and thereby, in acute appendicitis, increase pain.

Obraztsov's symptom

Pain during palpation of the right iliac region in acute appendicitis increases if the patient is forced to raise his right leg straightened at the knee joint.

Kocher's symptom

Pain in the navel and epigastric region is an early sign of the onset of acute appendicitis.

Voskresensky symptom

The patient's shirt is pulled on with his left hand, and at the moment of exhalation, the fingertips of the right hand slide along the shirt from the epigastric region to the right iliac region. The hand stops without leaving the abdominal wall. In the presence of acute appendicitis, at the moment the slide ends, the patient notes increased pain in the right iliac region.

Symptom of cough shock

Increased pain when coughing when the right iliac region is pressed with fingers.

Barthomier-Michelson's sign

Pain upon palpation of the cecum intensifies when the patient is positioned on the left side.

Zatler's symptom

In patients in a sitting position, when raising the straightened right leg, pain occurs in the right iliac region.

Liver diseases

Ortner's symptom

Tapping on the right costal arch for diseases of the gallbladder causes sharp pain in the liver area.

Murphy's symptom

When the fingers are deeply pressed into the right hypochondrium during cholecystitis, the patient cannot take a deep breath.

Obraztsov's symptom

Sharp pain when inserting the hand into the area of the right hypochondrium when the patient inhales. The symptom is characteristic of liver and gallbladder disease.

Pancreatic diseases

Mayo-Robson symptom

Pain in the left costovertebral angle when palpating the posterior abdominal wall as a sign of acute pancreatitis. If the lesion is only in the area of the head of the gland, this symptom is negative.

Shchetkin-Blumberg symptom

The abdomen is divided into three floors by two horizontal lines: epigastrium, mesogastrium and

hypogastrium , which, in turn, are divided into 9 regions by two vertical lines (along the outer edges of the external abdominal muscles).

Epigastrium: the epigastrium itself, the right and left subcostal regions.

Mesogastrium: periumbilical, right and left lateral areas.

Hypogastrium: suprapubic, right and left iliac regions.

Source: //emhelp.jimdofree.com/%D1%88%D0%BF%D0%B0%D1%80%D0%B3%D0%B0%D0%BB%D0%BA%D0%B8-03/% D1%85%D0%B8%D1%80%D1%83%D1%80%D0%B3%D0%B8%D1%8F/%D0%B0%D0%BF%D0%BF%D0%B5%D0 %BD%D0%B4%D0%B8%D0%BA%D1%83%D0%BB%D1%8F%D1%80%D0%BD%D1%8B%D0%B5-%D1%81%D0% B8%D0%BC%D0%BF%D1%82%D0%BE%D0%BC%D1%8B/

Consequences of acute appendicitis

Complications of appendicitis are divided into two groups:

Preoperative. Their reasons: The patient delayed seeking medical help.
The attending physician made the wrong diagnosis.
The operation was carried out with errors.
Inflammation gave rise to new diseases or the development of chronic ones.

Postoperative. Their reasons:

Failure to follow doctor's recommendations after surgery.

Inflammation of the surgical wound.

Inflammation of nearby organs, peritoneum.

Thus, appendicitis is not the most dangerous inflammatory process that can be easily eliminated surgically. The following complications are scary:

Perforation is an early type of complication that develops in conjunction with peritonitis. It is characterized as purulent melting of the walls of the appendix and the outpouring of pus into the abdominal cavity.
Appendiceal infiltrate - develops in patients who seek help late. This is the spread of inflammation from the appendage to neighboring organs.
Appendiceal abscess is a rare form of complication. This is a purulent inflammation in the right iliac region, between the intestinal loops, under the diaphragm, in the retroperitoneal space.
Pylephlebitis is a severe purulent-septic inflammation of the portal vein of the liver, in which many abscesses form. Dangerous and fatal.
Peritonitis is inflammation of the peritoneum.
Intestinal fistulas are a consequence of errors during surgery. This is an accidental lesion of the intestinal loops during removal of the appendix.

We looked at what disease the symptom of Sitkovsky, Obraztsov, Voskresensky, etc. is observed. As you have seen, with the help of these diagnostics you can easily and quickly determine appendicitis in a patient.

Acute appendicitis: description and causes

There are many factors that cause inflammation of the appendix

Everyone has heard about acute appendicitis. Everyone is afraid of him, especially mothers of babies, who often have stomach pains. The disease itself can be treated surgically and rarely has serious complications if treated promptly, but if left untreated it can lead to death. There are a number of symptoms to diagnose appendicitis, for example, the Kocher-Wolkovich symptom. It is very difficult to determine this disease without medical help.

Appendicitis is an inflammatory process that occurs in the appendix of the cecum. The acute form of this disease is more common. Chronic appendicitis is rare. It is accompanied by a series of remissions and relapses and requires surgical intervention. The causes of this disease are still not reliably known.

There are several theories regarding the causes of acute appendicitis:

Infection. When the appendix is removed, strains of various coccal bacteria are found in it. They are the ones who cause suppuration and inflammation of the appendix. If left untreated, the appendix ruptures and pus enters the abdominal cavity, causing peritonitis. This is the most dangerous complication of appendicitis, in some cases leading to death.
Congenital anomaly. Abnormalities in the structure of the cecum may increase the risk of appendicitis. The process may become bent, causing it to become inflamed.
Blockage of the lumen. Blockage of the lumen of the appendix can occur for various reasons: due to the entry of a foreign body, kinking of the intestine, etc.

Appendicitis has practically no age restrictions. It can occur in both a small child and an elderly person.

It is believed that people with chronic constipation, intestinal infections, heart and vascular diseases are at risk.

In adults, inflammation of the appendix is often caused by fecal stones that block the intestinal lumen.

Kocher-Volkovich symptoms

The Kocher-Wolkovich symptom allows you to quickly determine inflammation of the appendix.

Symptoms of appendicitis can be confused with food poisoning or an intestinal disorder. The danger of this disease is that acute appendicitis can burst within 24 hours and cause peritonitis.

Diagnosing appendicitis without medical help is very difficult, since the concept of “acute abdomen” includes a huge number of different manifestations. They can mean either appendicitis or an intestinal infection. This includes severe pain in the abdomen, nausea, vomiting, abnormal bowel movements, and a slight increase in temperature. There are a number of specific symptoms due to which the doctor determines that a patient has appendicitis.

Kocher-Volkovich symptom in acute appendicitis, perhaps, this symptom can be called the most popular among specific signs.

Everyone knows about it, but they cannot always interpret it correctly. The Kocher-Volkovich symptom consists of a gradual shift of pain to the right iliac region or, roughly speaking, to the right side. Many people expect the pain to initially appear on the right side, but it may initially occur in the navel area and only move to the right after a few hours. This symptom helps to identify appendicitis with more than 90% confidence. However, it cannot be called absolutely accurate, since the appendix can move in the abdominal cavity.