presented by : sara shokri moghaddam. anatomy & function of appendix the three taeniae coli...
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ACUTE APPENDICITIS
Presented by :Sara Shokri Moghaddam
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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.
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Anatomy & Function of appendix
Appendix is an immunologic organ that participate in the secretion of IGs., specially IgA.
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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.
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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.
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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
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Distention of appendix N/V occlusion of capillaries
vascular congestion involvement of the serosa involvement of parietal
peritoneum SHIFT in the PAIN to RLQ
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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.
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AB prophylaxis
Effective in prevention of wound infection and abcesses.
24-48h in non perforated appendicitis.7-10D in perforated appendicitis.
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Clinical manifestations
SYMPTOMS:• Abdominal pain• Shifting of pain to the RLQ• Anorexia• N/V• Sequence of symptoms: anorexia pain N/V(if accours)
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Clinical manifestations
SIGNS:Tendernes around Mcburney pointRebound tendernessRovsing signGuardingObturator signPsoas sign
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Laboratory findings
Mild leukocytosis (10000 to 18000)Several RBC or WBC can be present from
ureteral or bladder irritation
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Imaging studies
Plain films of the abdomenBarium enema examination and radioactively
labeled leukocyte scansCompression sonographyHigh resolution helical CT
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Differential Diagnosis
Acute mesenteric adenitisPIDRuptured graffian follicleTwisted ovarian cystRuptured EPAcute gastroentritisMeckle’s diverticulitisCrohn’s entritisColonic lesions Other diseas
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Treatment
Open appendectomyLaparoscopic appendectomyNatural orifice transluminatiom endoscopic
surgeryAntibioticsInterval appendectomy
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Incidental appendectomy
Childrens about to undergo chemotherapyDisabled patientPatients with crohn’s diseaseThe indivisual who are about to travel to
remote places