UHS Lao PDR MD 6 Gen 47th

1. Miss OulaiOUDOMMIXAY
Miss Phonekham NGERNCHAI
Miss Soutsada THONGSAVATH
Miss NibangonINPENGMANY
Topic
Appendicitis
Abdominal Surgery ward, MAHOSOTHospital

2. Table of contents:
1.Definition
2.Anatomy
3.Epidemiology
4.Classification
5.Staging
6.Cause
7.Risk factor
8.Pathology
9.Sign
10.Symptom
11.Physical
Examination
12.Diagnosis
13.Complication
14.Investigation
15.Management
16.Journal

3. 1Definition.
1492 Leonardo da Vinci depicted the
appendix in his anatomic drawings.
Appendicitis is inflammation of the
appendix. Appendicitis is the most
common of emergency abdominal
operations.

4. 2Anatomy.
The appendix is a fingerlike pouch
attached to the large intestine in the
lower right area of the abdomen. In the
adult, the average length of the appendix
is 6-9cm, the outer diameter varies
between 3-5 mm. The appendix receives
its arterial supply from the appendicular
branch of the ileocolic artery.

5. Blood supply:

6. Layers:

7. Nerves supply:

8. 3Epidemiology.
Appendicitis is more common among men (Male-Female ratio 1,4:1),
who have a lifetime incidence of 8,6% compared with 6,7% for
women. The incidence of perforated appendicitis has been
increasing despite a decline in the overall incidence of acute
appendicitis. Men are more likely to have perforated appendicitis
than women (31vs 25per 100,000persons-years).

9. 4 Classification.
• Simple (Catarrhal).
• Phlegmonous.
• Gangrenous.
• Perforated.

10. 5Staging.
• Simple (Catarrhal).
• Phlegmonous.
• Gangrenous.
• Perforated.

11. 6Cause.
• Fecalith.
• LymphoidHyperplasia.
• Foreign bodies.
• Parasites.
• Vascularization.

12. 7Rickfactor.
• Infection, possibly stomach infection that has traveled to theside
of appendix.
• Obstruction such as a hard piece of stool getting trapped in the
appendix leading to the infection ofthe appendix.
• Extreme of age.
• Previous abdominalsurgery.

13. 8 Pathology.

14. 9Sign.
• Rigidity 1
0
%
.
• Obturator sign5-10%.
• Rovsing’s sign 5
%
.
• Psoas sign3-5%.
• Palpable mass<5
%
.
• Abdominal tenderness>95%.
• Right lower quadrant tenderness>90%.
• Rebound tenderness30-70%.
• Rectal tenderness30-40%.
• Cervical motion tenderness30%.

15. 1
0Symptom.
• Abdominal pain>95%.
• Anorexia >70%.
• Nausea Vomiting > 65%.
• Migration of pain to right lower quadrant 50-60%.
• Fever 10-20%.
• Constipation 4-16%.
• Diarrhea 4-16%.

16. 1
1PhysicalExamination.
• Rovsing’s sign: by applying
hand pressure to the lower
left side of the abdomen. Pain
felt on the lower right side of
the abdomen upon the
release of pressure on the
left side indicates the
presence of Rovsing’ssign.

17. • Rebound Tenderness: by
applying hand pressure to a
person’s lower right abdomen
and then letting go. Pain felt
upon the release of the
pressure indicates rebound
tenderness and is a sign the
appendix is inflamaed.

18. • Psoas sign: the right psoas
muscle runs over the pelvic
near the appendix, can check
by applying resistance to the
right knee as the patient tries
to lift the right thigh while
lying down.

19. • Obturator sign:
obturator muscle
the right
also runs
near the appendix, can check
by asking the patient to lie
down with the right leg bent
at the knee. Moving the bent
knee left and right requires
flexing the obturator muscle
and will cause abdo pain if the
appendix is inflamed.

20. • Guarding: occurs when a
person subconsciously tenses
the abdominal muscles during
an exam. Voluntary guarding
occurs the moment by hand
touches the abdomen,
involuntary guarding occurs
before makes contact and is a
sign the appendix isinflamed.

21. 1
2
Diagnosis.
• Clinical Manifestations.
• Finding on physicalexamination.
• Laboratory tests.
• Imaging (Ultrasound, CTscan).
• Clinical scale (Alvarado score, RIPASA score).

22. Alvarado Score

23. RIPASA Score

24. 1
3
Complication.
Short:
• Hemorrhage.
• Moyen-Appendicitis stamp.
• Peritonitis.
• Abdo pain.
• Sepsis.
Long:
• Evacuation.
• Obstruction.
• Hernia.

25. 1
4Investigation.
• Complete Blood Cell Count: Demonstrates an elevated WBC, the
Leukocyte count may exceed 10,000 cells/ 𝑚𝑚3 , and the
Neutrophill count may exceed75%.
• Ultrasound: A peristaltic, non-compressible, dilated appendix >
6mm outer diameter (Normal size3-5mm). Distinct appendiceal
wall layers, and peri appendiceal fluid collection/enlargement.
• CTscan:Dilated appendix with distended lumen >6mm.Thickened
and enhancing wall. Thickening of the caecal apex up to 80%.

26. 1
5Management.
• Appendectomy:
open appendectomy and laparoscopic appendectomy.
• Antibiotic:
Cefotaxime, Levoflotaxime, Metronidazole.
• Antalgic:
Morphine sulphate.

27. 1
6Journal.

31. References:
• American Medical Association, JAMA(2021)
• Pubmed.gov
• Mayoclinic.org
• niddk.nih.gov

32. Thank
you