Symptom of Kocher. Characteristic signs of appendicitis.
It is difficult to overestimate the importance of timelydiagnosis of acute appendicitis. After all, ignoring the characteristic signs can cause peritonitis and lead to death. One of them is a symptom of Kocher. But it, unfortunately, is not observed in all patients.
Description of the symptom
There are many signs that ythe patient began to have an inflammation of the appendix. But one of the first signs is the following symptom. First, pain occurs in the epigastric region. Also it is called epigastric. It is located immediately below the xiphoid process - the shortest part of the sternum, to which the ribs meet in front.
The symptom of Kocher-Volkovich is thatAfter 1-3 hours after the onset of pain, a person notes that they are moving to the ileum. As a rule, they are localized below, on the right side of the abdominal wall.
To ease the condition, patients often take this position: they lie down on the right side, legs bend at the knees and pull up to the stomach.
Characteristic signs of appendicitis
At the initial stages not everyone is able to suspectthe arisen inflammation of the appendix. Often problems begin with a feeling of discomfort in the gastrointestinal tract. There are pains in the epigastric region, sometimes they are localized around the navel. This is a symptom of Kocher with appendicitis. Many note the sensations of colic, bloating and a feeling of raspiraniya. After the release of gases or defecation, the condition may improve for a short time.
But the pain intensifies after 1-3 hours. Paroxysmal sensations are replaced by permanent ones. The pains are bursting and pressing. Discomfort moves down the abdomen. At the same time, any movement and load only worsen the situation. Pain aggravated with deep breaths, coughing, walking, riding on transport (during shaking). This is observed in an equal measure in both adults and children.
Localization of the inflamed process
Knowing that the symptom of Kocher is observed in acuteappendicitis, you can diagnose the onset of this disease. Also, to localize pain, you can understand exactly where this organ is located. With the standard classical version of the arrangement, it will be on the right side. But if the pain is localized elsewhere, it is possible that it is placed differently. This must be remembered when conducting the diagnosis.
So, if the pains are concentrated in the region of the womb andthe lower right side of the abdomen, then the pelvic position of the inflamed organ can be observed. With its location in the area of the medial (middle) body line, unpleasant sensations will be localized in the navel area.
Sometimes pain concentrates in the lower back,groin and genitals. This may indicate that the appendix is behind the cecum. However, in this case it is important to conduct differential diagnosis and exclude kidney pathologies or lesions of the ureter.
It is rare to see pain in the left lower abdomen. This means that the appendix is located outside the box. He, along with the cecum, is on the left.
In order to determine appendicitis, little to knowonly a symptom of Kocher. There are a number of other signs that can be used to make an accurate diagnosis. So, the patient can not sit down from a recumbent position without outside help. This is called Bailey's symptom.
The pain intensifies when the patient is tilted to the left. This is also a characteristic sign, called the symptom of Volkovitch. The condition worsens also in the event that you try to bring your right foot to your stomach.
Mendel's symptom is that when the fingers are slapped on the front of the abdomen, the pain is aggravated in his ileal right side. It turns out to be positive in 80% of cases.
To determine the onset of peritonitissomewhat different diagnosis. The symptom of Kocher is determined only at the initial stages of the disease. With the development of inflammation, it is no longer observed. If the patient is pressed on the right iliac region and abruptly takes his hand away, then the pain intensifies. This symptom is called the symptom of Shchetkin-Blumberg. It is observed in 98% of patients with the onset of peritonitis.
Trace in medicine
The Swiss surgeon Kocher was the first to determine thatinflammation of appendicitis begins with pain in the epigastric region under the xiphoid process. He lived in the XIX-early XX century. It was in his honor that this sign of the onset of inflammation of the appendix of the cecum was called.
The symptom of Kocher is observed during exacerbationappendicitis. Therefore, timely diagnosis is so important. The movement of pain from the epigastric to the right iliac region is called the Koher-Volkovich symptom.
But in honor of this surgeon was named not onlyspecified characteristic. Also known among endocrinologists is the symptom of Kocher. It consists in that, when looking up, the movement of the eyeball lags behind the speed of movement of the upper eyelid. At the same time, a sclera is visible between the edge of the iris and the upper skin fold. This is a sign of toxic diffuse goiter.
Also Koher is known as the inventor of a numberspecial surgical instruments. So, for example, clamps for blood vessels, stomach, probes through which operations on the digestive organs are performed, drainage tubes made of glass are also used by modern doctors.