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Acute appendicitis
1.
2. 1 STARTING WITH DEFINITION ??
2 SURGICAL ANATOMY
3 ETIOLOGY AND PATHOPHYSIOLOGY
4 TYPES
5 CLINICAL FEATURES
6 OUTCOME
7 DIFFERENTIAL DIAGNOSIS
8 SCORING SYSTEM
9 INVESTIGATIONS
10 MANAGEMENT PLAN
11 COMPLICATIONS
12 VIDIO DEMONSTRATION
3. Appendicitis is inflammation of the appendix and is a
medical emergency.
Many cases of appendicitis require removal of the
inflamed appendix due to the high mortality associated
with rupture of the appendix, which may lead to severe
complications such as peritonitis and sepsis.
Appendicitis was first described by Reginald Fitz in 1886
and is today recognized as one of the most common and
significant causes of severe acute abdominal pain
worldwide.
5. .DIETARY FACTOTRS
.FAMILIAL SUSCEPTIBILITY
.OBSTRUCTION OF LUMEN OF APPENDIX
Obstruction may be caused by 1:
•lymphoid hyperplasia : ~ 60%
•appendicolith : ~ 33%
•foreign bodies : ~ 4%
.OBSTRUCTION OF APPENDICIAL ORIFICE
.ABUSE OF PURGATIVES
.BACTERIAL INFECTION
RISK FACTORS FOR PERFORATION OF
APPENDIX LEADING TO PERITONITIS ?
.EXTREMES OF AGE
.IMMUNOSUPPRESSION
.DIABETES MELLITUS
.FAECOLITH OBSTRUCTION
.PELVIC APPENDIX
.PREVIOUS ABDOMINAL SURGERY
12. Tzanakis Scoring
Tzanakis and colleagues, in 2005 published a simplified system, now
called the Tzanakis scoring system for appendicitis, to aid the diagnosis
of appendicitis. It incorporates the presence 4 variables made up of
specific signs and symptoms.
.presence of right lower abdominal tenderness = 4 points
and rebound tenderness = 3 points
.laboratory findings: presence of white blood cells greater than 12,000
in the blood = 2 points
.ultrasound finding: presence of positive ultrasound scan findings of
appendicitis = 6 points
A total score of 15 is the maximum that can be scored. Where a patient
scores 8 or more points, there is greater than 96 percent chance that
appendicitis exists..
13. 1: ROUTINE
FULL BLOOD COUNT
URINANALYSIS
2: SELECTIVE
PREGNANCY TEST
UREA AND ELECTROLYTES
SUPINE ABDOMINAL RADIOGRAPH
ULTRASOUND ABDOMEN/PELVIS
CONTRAST ENHANCED CT SCAN ABDOMEN
14. ULTRASOUND Findings supportive of the
diagnosis of appendicitis include
•aperistaltic, noncompressible, dilated
appendix ( > 6mm outer diameter)
•distinct appendiceal wall layers
•target appearance (axial section)
•Appendicolith
•periappendiceal fluid collection
•echogenic prominent pericaecal fat
•confirming that the structure visualised is the
appendix is clearly essential and requires
demonstration of it being blind ending and
arising from the base of the caecum
15. KEEP NPO
START IV FLUIDS
GIVE ANALGESIA FOR SEVER PAIN
ROLE OF ANTIBIOTICS
PLAN SURGERY
CONVENTIONAL APPENDICECTOMY
LAPROSCOPIC APPENDICECTOMY
16. BASIC STEPS
.G/A GIVEN
.ABDOMEN PREPARED AND DRAPED
INCISION GIVEN OVER McBurney’s
point ( GRID IRON INCISION)
.VARIOUS LAYERS OF ABDOMINAL
WALL OPENED
.MUSCLES SPLIT ALONG LINE OF
ITS FIBERS
.ON ENTERING PERITONEUM
APPENDIX IDENTIFIED ..MOBILIZED
THEN LIGATED AND DIVIDED AT ITS
BASE
.LAYERS OF ABDOMINAL WALL THEN
CLOSED IN TURN
SKIN CLOSSED AND DRESSING DONE
17. Over the past decade, the outcomes of laparoscopic
appendectomies have compared favorably to those for open
appendectomies because of decreased pain, fewer
postoperative complications, shorter hospitalization, earlier
mobilization, earlier return to work, and better cosmesis.
However, despite these advantages, efforts are still being
made to decrease abdominal incision and visible scars after
laparoscopy
