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Appendicitis

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  • Acute appendicitis is the most common acute surgical condition of the abdomen. So all physicians should have a thorough knowledge of appendicitis, including the anatomy, pathophysiology, clinical manifestation, diagnosis and the principles of treatments. In this class we will focus our attention on the pathophysiology and clinical diagnosis of the acute appendicitis.

Transcript

  • 1. Acute Appendicitis
    • The most common acute surgical condition of the abdomen
    • Anatomy , Pathophysiology , Clinical Diagnosis and Principles of Treatments
  • 2. Anatomy Rises from cecum 6 to 10 cm Vermiform Right lower quadrant Mesoappendix Appendicular A. & V. Many lymph follicles
  • 3. Anatomy (various position)
    • Pelvic
    • Retrocecal
    • Retroileal
    • Left lower quadrant
    • Right lower quadrant
  • 4. Etiology and Pathogenesis
    • Obstruction of the lumen
    Hypertrophy of lymphoid follicles Fecaliths Foreign bodies Inflammatory strictions Others Fever, tachycardia, and leukocytosis Vein Continuing secretion & Bacteria multiplication Intraluminal pressure increases Impairment of blood supply & endotoxins Pain Distention Artery Engorgement Mucosa damaging Bacterial invasion Serosa involved Ellipsoidal infarcts Characteristic shift in pain to RLQ Perforation Abscess Generalized peritonitis Nausea & vomiting
  • 5.
    • History
    • Physical findings
    • Laboratory examinations
    Clinical Diagnosis
  • 6. Clinical Diagnosis very constant after the onset of pain
    • The sequence of symptoms
    • Abdominal pain->Anorexia & Vomiting (if happens)
    • Obstipation, Diarrhea
    Variations Left lower quadrant Long appendix Flank or back pain Retrocecal appendix Suprapubic pain Pelvic appendix Testicular pain Retroileal appendix Malrotation puzzling pain patterns
    • Symptoms
    • Abdominal pain
    • Typical shifting abdominal pain
    • Anorexia
    • Vomiting
    Generalized Lower epigastrium Umbilical area Right lower quadrant
  • 7. Clinical Diagnosis
    • Signs
    • Vital signs T, P normal or slightly elevated
    • Somatic Position lie supine, thighs drawn up
    • Classic RLQ signs
      • Tenderness at or around McBurney’s point
      • Rovsing’s sign
      • Psoas sign
      • Obturator sign
      • Rectal examination
      • Rebound tenderness
      • Cutaneous hyperesthesia
      • Muscular resistance
    • Variations
  • 8. Clinical Diagnosis
    • Laboratory Findings
      • Leukocytosis
      • Urinalysis
      • Radiographic studies
        • Plain films of the abdomen
        • Ultrasonography
        • CT
      • Laparoscopy
  • 9. Essentials of Diagnosis
    • Shifting abdominal pain
    • Gastrointestinal symptoms
    • Localized abdominal tenderness
    • Leukocytosis
    • Systemic symptoms
  • 10. Differential Diagnosis
    • Adult
      • Acute gastroenteritis
      • Cholecystitis
      • Pyelitis
      • Salpingitis
      • Tubo-ovarian abscess
      • Ruptured ovarian cyst
    • Young children
      • Mesenteric adenitis
      • Intussusception
  • 11. Principles of Treatments
    • Appendectomy
    • Antibiotics
    • Laparoscopic Appendectomy
    • Nonoperative therapy
  • 12. Acute Appendicitis
    • Anatomy
    • Pathophysiology
    • Clinical Diagnosis
    • Principles of Treatments
  • 13. Thank you