![Page 1: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/1.jpg)
Diseases of the Appendix
דמה אברהם יונתן
ד" בס
![Page 2: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/2.jpg)
Appendicitis
> Disease of the young> Incidence> Rare in very young children and elderly> Overall mortality 0.25%> Higher mortality in age extremes
![Page 3: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/3.jpg)
Plan
1. Introduction
2. Diagnosis
3. Treatment preop, op and post op
4. Special consideration
5. Complication
6. Neoplasm
![Page 4: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/4.jpg)
Introduction
> Embryology> Normal anatomy> Pathophysiology> Bacteriology
![Page 5: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/5.jpg)
Embryology
![Page 6: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/6.jpg)
Embryology
![Page 7: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/7.jpg)
Anatomy
![Page 8: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/8.jpg)
Anatomy
![Page 9: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/9.jpg)
Pathophysiology
![Page 10: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/10.jpg)
Diagnosis
> Clinical
> History
> Physical examination
> Laboratory > Imaging
> Plain abdominal film
> US
> CT
![Page 11: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/11.jpg)
History
> 1889: Chester McBurney> History 24-36 hours> Abdominal pain: (diffuse and periumbilical, localizing to the RLQ)> Anorexia (almost always).> Vomiting (75%).> Low grade fever.> If >38 suspect perforation
> Only 55% have classical features.
![Page 12: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/12.jpg)
Physical exam
![Page 13: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/13.jpg)
Peritoneal inflamation sign
> Dunphy's sign> Rovsing's sign> Guarding> Rebound sign> Obturator sign> Psoas sign
![Page 14: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/14.jpg)
Dunphy
![Page 15: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/15.jpg)
Rovsing
![Page 16: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/16.jpg)
Guarding
![Page 17: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/17.jpg)
Rebound
![Page 18: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/18.jpg)
Obturator
![Page 19: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/19.jpg)
Psoas
![Page 20: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/20.jpg)
Diffuse Peritonitis
מתקדם כשהמצב
![Page 21: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/21.jpg)
Laboratory settings
> WBC> Urinalysis
![Page 22: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/22.jpg)
היא בתוספתן דלקת של אבחנהקלינית כל קודם
![Page 23: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/23.jpg)
Scoring
![Page 24: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/24.jpg)
בטוחים לא אנחנו עם ....אבל
![Page 25: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/25.jpg)
Diagnosis - US
> Noninvasive> Available> Operator dependant> Sensitivity 80%> Specificity 90%> Positive Findings
• Noncompressible tubular structure
• >7 mm
• Fluid
• appendicolith
![Page 26: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/26.jpg)
CT
> Requires contrast - oral and IV> Radiation> Sensitivity 90-95%> Specificity 90%> Findings
> Nonfilling tubular structure (target)> >7 mm> Pericecal inflammation and Fluid> appendicolith
![Page 27: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/27.jpg)
Target
![Page 28: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/28.jpg)
מ" 7< מ
![Page 29: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/29.jpg)
Fecalith
![Page 30: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/30.jpg)
DD
> Go by organ systems or by category> Consider symptoms, Age and Sex> Concomitant conditions
![Page 31: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/31.jpg)
Differential diagnosis
![Page 32: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/32.jpg)
Diagnostic laparoscopy
If you are not sure…
![Page 33: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/33.jpg)
Treatment
> Medical > Periappendicular abscess> Surgical
![Page 34: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/34.jpg)
Surgical Treatment
> Appendectomy : Laparoscopic versus open Sex Habitus Diagnostic uncertain NOTES, SILS, Lap assisted
![Page 35: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/35.jpg)
Lap versus open appendectomy
![Page 36: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/36.jpg)
After the surgery
![Page 37: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/37.jpg)
Complication
In op:>Lap converted to open>Bowel resection
Post op:>Wound infection>Deep space infection/abcess>Small bowel obstruction>Infertility>Enterocutaneous Fistula
![Page 38: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/38.jpg)
Special issues
> Normal appearing appendix> Meckels diverticulum> Interval appendectomy> Chronic or recurrent appendicitis> Children> Pregnancy> Crohns dis> FMF
![Page 39: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/39.jpg)
Neoplasms
> Rare
> Mucocele
> benign, malignant, pseudomyxoma
> Treatment (Rt colectomy vs appendectomy)
> Survival rate 55% vs 20%> Adenocarcinoma> Carcinoid
> Treatment: size, location
> Survival
![Page 40: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/40.jpg)
Laparoscopic Appendectomy
![Page 41: Diseases of the Appendix יונתן אברהם דמה בס"ד. Appendicitis > Disease of the young > Incidence > Rare in very young children and elderly > Overall mortality](https://reader035.vdocument.in/reader035/viewer/2022062516/56649d6e5503460f94a4ebbd/html5/thumbnails/41.jpg)
תודה