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ACUTE APPENDICITIS.pptx
- 1. UTH SURGERY DEPARTMENT BLUE FIRM PRESENTER:DR.GALATIYA SUPERVISOR:DR.CHIPALABWE
- 3. WHAT IS APPENDICITIS? ACUTE INFLAMMATION OF THE APPENDIX DUE TO AN OBSTRUCTION IN THE APPENDICLE LUMEN
- 4. AN APPENDIX IS A PART OF DIGESTIVE TRACT WHICH LIES IN THE RIGHT LOWER QUADRAT OF THE ABDOMEN,MEASURING ABOUT 2 to 20 CM.
- 5. SURGICAL ANATOMY OF THE APPENDIX • -THE APPENDIX IS ATTACHED TO THE PART OF CONVERGENCE OF THE 3 TAENIA COLI OF THE CAECUM ON THE POSTERIOR WALL • -COMMONLY BEHIND THE CAECUM (RETROCAECAL) • -RARELY PRE-ILEAL • -POST ILEAL
- 7. CAUSES 1-OBSTRUCTIVE BODIES :THREAD WORMS,ROUND WORMS : FEACALITH ( MOST COMMON) :LYMPHOIDE HYPERPLASIA 2-INFECTIOUS CAUSES: CAUSING PRESSURE ON THE OBSTRUCTED AGENT LEADING TO EPITHEIAL EROSION AND BACTERIA GAINING ENTRY INTO THE WALL.
- 8. PATHOPYSIOLOGY 1-OBSTRUCTION IN THE APPENDICLE LUMEN | 2-BUILD UP OF MUCUS IN THE APPENDIX | 3-INCREASED APPENDICAL LUMEN PRESSURE | 4-REDUCED BLOOD FLOW AND O2 DELIVERY TO APPENDIX | 5-ULCERATION OF THE APPENDIX | 6-MICROBE INVASION | 7-INFLAMMATION AND SWELLING OF THE APPENDIX | 8-APPENDICITIS
- 9. CLINICAL PRESENTATION LOCAL TENDERNESS IS ELICITED AT McBURNEYS POINT PATIENT WILL LIE ON THE SIDE WITH KNEES FLEXED
- 10. SIGNS • 1-ROVSIN SIGN[palpate the llq and pain is felt in rlq] • 2-PSOAS AND OBTURATOR SIGN (pain on internal rotation of the thigh) • 3-DUNPHYS SIGN(pain in rlq when coughing) • 4-ILIOPSOAS SIGN (pain when extending the right hip) • 5-REBOUND TENDERNESS SYMPTOMS • 1-ABDOMINAL PAIN(starts from umbilicus to RLQ) • 2-FEVER • 3-CONSTIPATION • 4-NAUSEA AND VOMITING • 5-DIARRHEA
- 12. DIAGNOSIS Acute appendicitis is more of a clinical diagnosis,the following are supportive diagnostic measures 1-BASE LINES : FBC,U&ES, NOTE:INCREASE WBC MAYBE INCREASED LEUKOCYT AND NEUTROPHILS. 2-IMAGING:a) x-ray and ultrasound of abdomen (dilated appendix) b)CT SCAN:dilated appendix ,thick and enhancing wall of appendix 3-ALVARADO SCORE
- 14. APPENDICULAR MASS AN APPENDICEAL MASS IS AN INFLAMMATORY TUMOR CONSISTING OF THE INFLAMMED APPENDIX.
- 15. COMPONENTS OF THE MASS 1-APPENDIX 2-ADJACENT VISCERA 3-GEATER OMENTUM
- 16. TREATMENT Treatment can be none operative or operative management.
- 17. TREATMENT NON OP (OCHNER SHERREN REGIMEN) • IV FLUIDS • ANTIBIOTICS • MONITORING VITALS • NPO • Frequent abdominal ultrasound scans to monitor the size of the appendicular mas • In most patients mass would resolve with no complicatons
- 18. OPERATIVE MANAGEMENT surgery is indicated if size of the appendicular does not decrease in size.The intervention is called APPENDICECTOMY _the surgery is done under general or spinal anasthesia,with a low abdominal incision or by laparascopy.
- 19. DIFFERENTIAL DIAGNOSIS 1-Intestinal obstruction 2-Acute pancreatits 3-Acute cholecystitis 4-Perforated peptic ulcer IN CHILDREN 1-Intussusception 2-Urinary tract infection 3-Hernia IN WOMEN 1Pelvic inflammatory disease 2-urinary tract infection 3-Ectopic pregnancy 4-Twisted ovarian cyst
- 20. COMPLICATIONS 1-Peritonitis 2-Abscess formation on appendix 3-Peritonitis 4-Small bowel obstruction
- 21. THANK YOU SO MUCH FOR YOUR ATTENTION