急性闌尾炎英文課件綜述

1、Acute appendicitisWangJunThe second general surgical department Peoples hospital of yuxi cityAcute appendicitisWangJunOutlinesGeneral considerationsHistorical perspectiveAnatomyPathophysiology Clinical findings DiagnosisTreatmentOutlinesGeneral considerationsGeneral considerationsAbout 8% of people

2、in Western countries have appendicitis at some time during their life, with a peak incidence between 10 and 30 years of age.Acute appendicitis is the most common general surgical emergency.(10%)General considerationsAbout 8%General considerationsAcute appendicitis has protean manifestations.It may s

3、imulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions. Progression of symptoms and signs is the rule in contrast to the fluctuating course of some other diseases.General considerationsAcute apHistorical perspective Willard Packard performed the first

4、 surgery in 1867.In 1886,Reginald Fitz described the characteristic,clinical findings and pathology of the disease,identified the appendix as the primary cause of right lower quadrant inflammation. Fitz coined the term appendicitis and recommended early surgical treatmentHistorical perspective Willa

5、rdHistorical perspectiveIn 1889, Chester McBurney described characteristic migratory pain as well as localization of the pain along an oblique line from the anterior superior iliac spine to the umbilicus. In 1894, McBurney described a right lower quadrant muscle-splitting incision for removal of the

6、 appendix.Historical perspectiveIn 1889,Historical perspectiveIn the 1940s,the mortality rate from appendicitis improved with the widespread use of broad-spectrum antibiotics. In 1982, Laparoscopic appendectomy was first reported by the gynecologist Kurt Semm but has only gained widespread acceptanc

7、e in recent years.Historical perspectiveIn the 1急性闌尾炎英文課件綜述Anatomy physiologyThe base of the appendix is located at the convergence of the taeniae(3) of colon. This anatomic relationship facilitates identification and location of the appendix at operation. Anatomy physiologyThe base o急性闌尾炎英文課件綜述急性闌尾

8、炎英文課件綜述Pathophysiology Obstruction of the lumen is believed to be the major cause of acute appendicitis. This may be due to lymphoid hyperplasia, inspissated stool, fecalith, vegetable matter or seeds, parasites, or a neoplasm.Pathophysiology Obstruction ofPathophysiologyObstruction of the appendice

9、al lumen Bacterial overgrowth Continued secretion of mucus Intraluminal distention and increased wall pressure PathophysiologyObstruction of PathophysiologySubsequent impairment of lymphatic and venous drainage mucosal ischemia These findings in combination promote a localized inflammatory process t

10、hat may progress to gangrene and perforation.PathophysiologySubsequent impaPathophysiologyInflammation of the adjacent peritoneum gives rise to localized pain in the right lower quadrant.Perforation typically occurs after at least 48 hours from the onset of symptoms and is accompanied by an abscess

11、cavity walled-off by the small intestine and omentum.PathophysiologyInflammation ofClinical findingsClinical findingsClinical findingsClinical finhistory and symptomAppendicitis needs to be considered in the differential diagnosis of nearly every patient with acute abdominal pain The typical present

12、ation begins with vague peri-umbilical pain followed by anorexia,nausea and vomiting. Then localizes to the right lower quadrant. history and symptomAppendicitihistory and symptomThe classic pattern of migratory pain is the most reliable symptom of acute appendicitis Fever ensues, followed by the de

13、velopment of leukocytosis Occasional patients have urinary symptoms or microscopic hematuriahistory and symptomThe classimigratory painmigratory painPhysical ExaminationLow-grade fever is common(38).Diminished bowel sounds Focal tenderness (commonly at McBurneys point ) -located one third of the dis

14、tance along a line drawn from the anterior superior iliac spine to the umbilicus Rebound tendernessVoluntary guardingPhysical ExaminationLow-grade Physical ExaminationDunphys sign -coughing cause increased pain Rovsings sign -pain in the right lower quadrant during palpation of the left lower quadra

15、nt Physical ExaminationDunphys sPhysical ExaminationPsoas sign -pain on extension of the right hip (retrocecal appendix) Obturator sign -pain on internal rotation of the hip (pelvic appendix) Physical ExaminationPsoas signLaboratory StudiesThe average leukocyte count is 15*109/L,and 90% of patient h

16、ave count over 10*109/LMore than 75% neutrophils in of patients.A completely normal leukocyte count and differential is found in about 10% of patients. Laboratory StudiesThe average Imaging studiesPlain abdominal films:may be useful for the detection of ureteral calculi, small bowel obstruction, or

17、perforated ulcer, but such conditions are rarely confused with appendicitis.Ultrasonography and CT scan: be helpful in patients with atypical symptoms ,such as children and elderly person. Imaging studiesPlain abdomina急性闌尾炎英文課件綜述A, CT scan of the abdomen demonstrates an edematous, thickened appendix

18、 (arrow) with obstructing appendicolith (arrowhead). B, CT scan of abdomen demonstrates a perforated appendix with a complex abscess and pelvic fluid collection (arrow). BL, bladder; UT, uterus.A, CT scan of the abdomen demoEssentials of diagnosisAbdominal migratory pain Anorexia,nausea and vomiting

19、Localized abdominal tendernessLow-grade feverLeukocytosis Essentials of diagnosisAbdominDifferential DiagnosesSometimes,the diagnosis of appendicitis may be difficult.Mesenteric lymphadenitis,gastrointestinal ulcer perforationMeckels diverticulitis, ectopic pregnancy,pelvic inflammatory diseaseDifferential DiagnosesSometimeSpecial category of appendicitisin infants，in children，in wemen during pregnancy，in elderly people in patients infected with HIVSpecial category of appendicitComplicatio