acute appendicitis
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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