acute appendisitis

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DIAGNOSIS APENDISITIS Dr Donald Aronggear SpB SMF Bedah RSUD Jayapura Papua 2007

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  • DIAGNOSIS APENDISITISDr Donald Aronggear SpBSMF Bedah RSUD Jayapura Papua2007

  • Epidemiologi7% penduduk US1,1 per 1000 penduduk per tahunLaki-laki : perempuan = 1,4 : 1Mortality rate 0,2-0,8%Mortality rate pada usia > 70 th = 20%Perforasi paling tinggi umur < 18 th dan >50 thUSA 250.000 apendektomi/tahun

  • Anatomi

  • ACUTE APPENDICSITISPredisposing factor: - low fibers dietCausative factor: - obstruction - infectionObstructive agents: - in the lumen of the appendix:- fecalith- corpus aleinum- parasiteInfective agents: - intra lumenar origin - haematogenous origin

  • PathologyObstruction of the lumenMucous retentionDistension (increase intraluminar pressure)Lymph and venous occlusionMucosal and sub mucosal oedemaBacterial translokationInflammation / suppurationPus enter the lumenOver distensionArteriak occlusionPressure necrosis / gangrene

    perforation

  • Progression of disease

    - Gangrenous- Perforation : - general peritonitis - peri appendicular mass: - phlegmoon / infiltrate - absces - sepsis

  • Symtoms- abdominal pain: - visceral - somatic- anorectia, nausea, vomiting- obstipation- Others: - dysuria - leucorrhoea

  • - Tenderness on the rigth iliac fossa (specifically on Mc Bourney point) - Rebound tenderness- Muscular guarding (locally)- Rectal examination : pain in the right- sometimes : - right rectal rigidity - hypersensitive on the sherens triangleSigns

  • Rovsings signPsoass signObsturators signTern Horn sign

    Signs

  • Psoas sign

  • Obturator sign

  • TANDA & GEJALA

  • TANDA & GEJALA

  • Laboratory finding Leucocytosis (more than 10. 000/cm2 - Diff. Tell : shift to the left (neutrofilia) Urinalisa PP Test CRP

  • Differential Diagnosis1. G.I Tract.- mesenteric lymphadenitis- peptic ulcer perforation- acute cholecystitis- diverticulitis : - jejunal - ileal (Meckel) - colonic- ileitis terminalis - tumor of the cecum

  • 2. Urinary tract.- rigth ureteric colic- urinary tract infection3. Gynaecologic disease.- ruptured ectopic pregnancy - twisted / torsion ovarian cyste- ruptured ovarian cyste- adnexitis4. Non specific abdominal pain

  • TreatmentAcute appendicsitis: appendectomyNegative pathology: 15 20 %perappendicular mass: - conservative treatment : - bed rest (fowler position) - liquid diet - antibioticif resolution: appendectomy a froidif deteriorate: laparatomy & appendectomyRadical treatment: laparatomy & appendectomyGeneral peritonitis: laparatomy & appendectomy

  • Antibiotic : for gram positive , gram negative and anaerobe microganismeRegimen : - ampicilin, gentamycin and metronidazol - seftriaxon and metronidazol

  • Chronic abdominal pain in the rigth iliac fossa, but not severe - Continue or intermittent- sometimes gastritis like symptoms- The lumen of the appendix not totally obstructed- Appendicogram : - non filling - partial filling - filling defectCHRONIC APPENDICITIS

  • Ultrasonogram showing longitudinal section (arrows) of inflamed appendix.

  • laparoskopi