ACUTE APPENDICITIS

Presented by :Sara Shokri Moghaddam

Anatomy & Function of appendix

The three taeniae coli converge at the junction of the cecum with the appendix.

The tip of appendix can be found in a retrocecal,pelvic,subcecal,preileal or right pericolic position.

Anatomy & Function of appendix

Appendix is an immunologic organ that participate in the secretion of IGs., specially IgA.

Incidence

≈ 7 % of all people andergoes appendectomy during their life

More frequently in 2nd through 4th decades of life

M > FThe percentage of misdiagnosed cases of

appendicitis is higher among women.

Etiology and Pathogenesis

Obstruction of the lumen is the dominant etiologic factor of appendicitis.

The most common cause of obstruction is fecaliths.

Other causes:hypertrophy of limphoid tissue,inspissated barium,tumor,vegetable and fruit seeds and intestinal parasites.

Etiology and Pathogenesis

A sequence of events lead to appendicitis: Proximal obstruction and normal secretion of

mucosa Distention of appendix Stimulation of

visceral afferent nerves a vague diffused pain in the midabdominal or lower epigastrium

Distention of appendix N/V occlusion of capillaries

vascular congestion involvement of the

serosa involvement of parietal

peritoneum SHIFT in the PAIN to RLQ

Bacteriology

The bacterial population of a normal appendix is similar to that of normal colon

The principal organisms seen in the normal appendix,in acute appendicitis, and in perforated appendicitis are Escherichia coli & Bactroid fragilis.

AB prophylaxis

Effective in prevention of wound infection and abcesses.

24-48h in non perforated appendicitis.7-10D in perforated appendicitis.

Clinical manifestations

SYMPTOMS:• Abdominal pain• Shifting of pain to the RLQ• Anorexia• N/V• Sequence of symptoms: anorexia pain N/V(if accours)

Clinical manifestations

SIGNS:Tendernes around Mcburney pointRebound tendernessRovsing signGuardingObturator signPsoas sign

Laboratory findings

Mild leukocytosis (10000 to 18000)Several RBC or WBC can be present from

ureteral or bladder irritation

Imaging studies

Plain films of the abdomenBarium enema examination and radioactively

labeled leukocyte scansCompression sonographyHigh resolution helical CT

Differential Diagnosis

Acute mesenteric adenitisPIDRuptured graffian follicleTwisted ovarian cystRuptured EPAcute gastroentritisMeckle’s diverticulitisCrohn’s entritisColonic lesions Other diseas

Treatment

Open appendectomyLaparoscopic appendectomyNatural orifice transluminatiom endoscopic

surgeryAntibioticsInterval appendectomy

Incidental appendectomy

Childrens about to undergo chemotherapyDisabled patientPatients with crohn’s diseaseThe indivisual who are about to travel to

remote places