appendicitis
TRANSCRIPT
Acute Appendicitis
The most common acute surgical condition of the abdomen
Anatomy, Pathophysiology, Clinical Diagnosis and Principles of Treatments
Anatomy
Vermiform
Right lower quadrant
Rises from cecum
6 to 10 cmMesoappendix
Appendicular A. & V.
Many lymph follicles
Anatomy (various position)
Pelvic
Retrocecal
Retroileal
Left lower quadrant
Right lower quadrant
Etiology and Pathogenesis
Obstruction of the lumen
Hypertrophy of lymphoid follicles
Fecaliths
Foreign bodies
Inflammatory strictions
OthersFever, tachycardia, and leukocytosis
Vein
Continuing secretion &Bacteria multiplication
Intraluminal pressure increases
Impairment of blood supply & endotoxins
PainDistention
Artery
Engorgement
Mucosa damaging
Bacterial invasion
Serosa involved
Ellipsoidal infarcts
Characteristic shift in pain to RLQ
Perforation Abscess
Generalized peritonitis
Nausea & vomiting
• History• Physical findings• Laboratory examinations
Clinical Diagnosis
Symptoms
•Abdominal pain
Typical shifting abdominal pain•Anorexia
•VomitingGeneralized
Clinical Diagnosis
Lower epigastrium
Umbilical area
Right lower quadrant
very constant
after the onset of painThe sequence of symptoms
Abdominal pain→Anorexia & Vomiting (if happens)
•Obstipation, Diarrhea
VariationsLeft lower quadrant Long appendix
Flank or back pain Retrocecal appendix
Suprapubic pain Pelvic appendix
Testicular pain Retroileal appendix
Malrotation puzzling pain patterns
Clinical Diagnosis
Signs
• Vital signs T, P normal or slightly elevated
• Somatic Position lie supine, thighs drawn up
• Classic RLQ signs–Tenderness at or around McBurney’s point
–Rovsing’s sign–Psoas sign–Obturator sign–Rectal examination
–Rebound tenderness –Cutaneous hyperesthesia–Muscular resistance
• Variations
Clinical Diagnosis
• Laboratory Findings
– Leukocytosis– Urinalysis– Radiographic studies
• Plain films of the abdomen
• Ultrasonography
• CT
– Laparoscopy
Essentials of Diagnosis
• Shifting abdominal pain
• Gastrointestinal symptoms
• Localized abdominal tenderness
• Leukocytosis
• Systemic symptoms
Differential Diagnosis
• Adult– Acute gastroenteritis– Cholecystitis– Pyelitis– Salpingitis– Tubo-ovarian abscess– Ruptured ovarian cyst
• Young children– Mesenteric adenitis– Intussusception
Principles of Treatments
• Appendectomy
• Antibiotics
• Laparoscopic Appendectomy
• Nonoperative therapy
Acute Appendicitis
• Anatomy
• Pathophysiology
• Clinical Diagnosis
• Principles of Treatments
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