Symptoms in children and infants
Recognizing the symptoms in children or infants can be very demanding for the treating doctor. Young people behave differently than adults during an illness and the effect on their body varies considerably. The immune system is not yet as developed as that of adults.
As a result, it is not possible to react quickly when infested with pathogens. The infection may become established earlier and progress in the further course. This is why rapid progression of the disease is typical in children with appendicitis.
The symptoms are more severe than in adult patients. The characteristic pain, which in many cases occurs in adults, is usually of no use in children. Infants and children usually lack the ability to qualitatively assess pain or to indicate an exact localisation.
The general condition may deteriorate when pain is experienced or abdominal pain may be perceived as nausea. When dealing with young patients, care must be taken to spread as little excitement as possible and to try to evaluate the child’s statements from the outside. In addition to the pain, symptoms such as vomiting and fever are more common.
In addition, the white blood cells also increase in children in the classic way (leukocytosis), which is due to the immune system‘s attempt to get the infection under control. Due to the rapid progression of the inflammation, intestinal perforation (intestinal rupture) occurs more frequently in children because the bacteria have infiltrated and destroyed the intestinal wall. As a result, peritonitis, an inflammation of the peritoneum, develops.
Here too, the course of the disease is more severe than in older people. The stage of development of the omentum majus plays a major role here. The omentum majus is the so-called abdominal net.
It consists mainly of fat deposits that form a barrier between the abdominal organs and the peritoneum. It also contains many defence cells. In children, the omentum majus is not yet too large and does not have enough fat to effectively seal off infections.
As a result, peritonitis is more frequent and spreads rapidly. As the diagnosis of appendicitis can be extremely complicated, the examining doctor should always weigh up other possibilities and exclude them by diagnostic means. Other inflammations of the gastrointestinal tract can cause similar symptoms. Pneumonia (inflammation of the lungs) or meningitis (inflammation of the meninges) can also be responsible for various symptoms, which also occur in appendicitis.
Symptoms in men and women
There are no fundamental differences between the symptoms of appendicitis in men and women. However, appendicitis occurs more frequently in men. In both sexes, the course of acute appendicitis begins with unlimited, not precisely localised abdominal pain, which is usually described in the area around the navel.
After some time, usually a few hours later, the pain moves slowly to the right lower abdomen. There it can be localized well and remains constant for the time being. If the pain is aggravated by walking or violent body movements such as coughing, this can be a further indication of appendicitis.
The symptoms are accompanied by other signs such as nausea and vomiting, but also by diarrhoea or constipation. Usually a slight fever also occurs. If a perforation occurs – the inflammation breaks through the intestinal wall – it is not uncommon for the pain to diminish.
A sudden reduction in pain is usually not a good sign, because after a short period of improvement, stronger pain often follows, signalling inflammation of the peritoneum. Now the pain is no longer necessarily limited to the right lower abdomen, but can occur overall with a deterioration in the general condition. If in this acute emergency situation the patient does not act immediately and the appendix is removed, blood poisoning with a state of shock (septic-toxic shock) may occur.
Not all people, whether male or female, have such clear symptoms as those just described. Almost half of all cases of acute appendicitis occur with less severe initial symptoms and are therefore only detected at a late stage. Atypical or weaker symptoms affect especially children and elderly people, in whom such infections can cause more than in healthy adults with an intact immune system.
Certain gender-specific diseases can cause similar pain and symptoms. Various diseases of the female internal sex organs, as well as the male testicles, can cause pain in the lower abdomen. Nevertheless, the mortality rate (lethality) in appendicitis is extremely low as long as no perforation has occurred. The mortality rate increases to 1% in the case of a perforation. This topic may also be of interest to you: Duration of appendicitis
