A boy 8 years old, became ill badly. 4 hours ago there was epigastric pain, nausea. You - the family doctor, on examination of the child revealed pallor.

A boy 8 years old, became ill badly. 4 hours ago there was epigastric pain, nausea. You - the family doctor, on examination of the child revealed pallor of coatings, dry tongue. The temperature of 37.6 C, pulse 110 beats per minute, at the time of examination the child complains of pain in right hypochondrium region.

Your preliminary diagnosis?:Acute cholecystitis?Acute appendicitis?Food Poisoning?Acute pancreatitis?

Embryogenesis of rotation of the intestine

A theme of the lecture :"Purulent inflammatory diseases of the abdominal cavity in children"

Specific objectives:

- Master the basic list of surgical diseases that are associated with inflammation of the abdominal cavity in children.- Recognize the major clinical manifestations and the local symptoms of inflammation of the abdominal cavity.- Differentiate the symptoms of inflammatory diseases of the abdominal cavity, requiring surgery.

Features of the central nervous system, abdomen,1. The overall processes dominate on the local.2. Short omentum, which contains no fat (prevalence of inflammation).Low plastic abilities of the peritoneum (the lack of restriction of the inflammatory process).3. Well developed vascular "grid" in the peritoneum (the predominance of exudative processes).4. Children under 3 years old - little lymphoid tissue (not often appendicitis).5. High dome location cecum (incomplete rotation of the intestine).6. High resorption of peritoneum (fast development of the intoxication syndrome).

Features of the clinic, diagnosis and treatment of acute appendicitis in children.1. Features associated with age:A second signal system is not formed.The overall processes dominate on the local.2. Changing behavior: anxiety of the child;after 3 years of age, a child lies on his back or on his side.3. Reflex vomiting until 3 years - many times;after 3 years - nausea, one or two time vomiting.4. Temperature: until 3 years-38 C or higher;after 3 years - up to 38 C.5. Feces: until 3 years - frequent, liquid;after 3 years - constipation.6. Many somatic and infectious diseases in young children have the same abdominal syndrome with abdominal pain:pneumonia; hemorrhagic vasculitis, viral infections.

What should to inspect (to examine) in a child with suspectedacute appendicitis?:

1. Stomach?2. Chest?3. Larynx ?4. Skin?5. All of the above?

Features of the inspection of the child- A warm room;- Warm hands;- Must not only examine the abdomen and only child (stomach look in the least!) - Predominates in children abdominal breathing.- Pectoral type of breath - a disaster in the abdomen!- During abdominal palpation should talk with the patient.- You should never ask, "Does it hurt? Does it not hurt? ".- Follow for the child's face Noone of the young children are unable to hide a grimace of pain on their face.- Manual examination should begin of percussion. It is better not to do on your own fingers, but on the child fingers of his hands and legs. Do not talk to the child during the percussion!- If there is an inflammatory process - the child will reject your hand from his abdomen.

Features of the inspection (examination) of the child

Palpation of the abdomen should be very superficial .Ask your child to cough (cough shock symptom).Turn the child on the left side (Rovzing`s symptom).Check Shchetkin-Bljumberg`s symptom in position on the left side.The symptom of "Repulsion hands."The symptom of "pull-up of leg."Voskresensky` symptom ("symptom shirt").Rectal examination. It should warn the child about the study.

1. Exclude the diagnosis of acute appendicitis without rectal examinationabsolutely impossibly!2. Examination of the child during medical sleeping (sodium hydroxybutyrate)!3. For adequately assess of the information obtained in the survey- Sit down and write down everything in a patient`s disease history!

What changes are in the clinical picture of acute appendicitis during destruction of appendix?

1. deterioration of general state2. The appearance of vomiting?3. Increased pain in abdomen?4. There comes a "lucid interval" ?5. There are frequent liquid bowel movements

(liquid faeces)?

Features of the clinical picture of acute appendicitis, are associated with pathologic changes in the appendix.All the doctors should remember About a "light interval" in the clinical course of acute appendicitis:- Ananmnesis of the disease,- Tachycardia,- Dynamic observation

Features of the clinical picture of acute appendicitis in patients with atypical position of the appendix.

Low position:common symptoms;frequent liquid stools with mucus and tenesmus;frequent painful urination (pee);rectal examination.Position:common symptoms;pain and muscle tension in the right hypochondrium.;laparoscopy.Apendix`s behind caecum position:common symptoms;pain in the lumbar region;vomiting, and leukocytosis;muscle tension.Left-sided position:common symptoms;are the same like in the right-sided position of appendix.

Schematic representation of the variants of atypical localization of the appendix.

The differential diagnosis

Abdominal syndrome in severe pneumonia (severe lesion with the pleura):tachypnea;examination during a dream.

Hemorrhagic vasculitis:common symptoms of appendicitis;examination of the child (bleeding in the joints, etc.);observation for 12 hours in the hormone therapy.

Lymphadenitis of mesentery (mezadenitis):painful palpation of mesentery;signs of viral infection;laparoscopy.

Gynecologic pathology in girls:common symptoms of appendicitis;menstrual pain;apoplexy ovary;adnexitises and pelvioperitonity;laparoscopy.Intestinal colic (coprostasia, helminth infestation):cramping pain (significant);no leucocytosis;the abdomen is soft;enema.

The differential diagnosis

Treatment.Surgery for 3 hours after diagnosis.

primary peritonitis • Primary peritonitis

•1. A simple form

•Start subacute.

•Complaints of abdominal permanent spilled pain .

•t body of 37,5 - 38,5 º C + vomiting

•Palpation of the abdomen in all parts is painfulness, but more in the right iliac region + muscle tension anterior abdominal wall.

•Per rectum - without pathology.

•Leukocytosis is 15 - 20 × 10 g / liter.

• II. The toxic form.

•The beginning is with lightning speed.

•Complaints of sudden severe pain throughout the abdomen.

•t of the body 39 - 40 º C + + repeated vomiting frequent liquid bowel movements.

•Anterior abdominal wall is not involved in the act of breathing, abdominal wall tension + the positive symptoms of irritation of peritoneum.

•Per rectum - painfulness of anterior wall of the rectum.

•Leukocytosis of 45 × 10 g / liter.

Peritonitis in newborns