trabajo de clinica quirurgica

1. APPENDICITIS
Clinical Surgery Department
Dr. Benjamin Robles Madrigal
Dr. Héctor Manuel Virgen Ayala
Alumno Javier Cosío Cardenas

2. Anatomy and fisiology
the appendix is a diverticulo ovni in the iota of
the blind approximately 2.5 cm below the
ileocecal valve

4. Appendix acute
fibrous bands, Lymphoid Hyperplasia, fecalitos,
calculations y parasites
the main cause is
infectious

5. PHASE
Inflammatory edematous (invasion of the wall)
suppurative (exudate and filtration)
gangrenous (necrosis)
Drilling (release 48Hrs in 80%)

6. Dx and Dx differential
Clinic
Lab (protein C. leucocitosis)
USG
pelvica inflammatory disease and other ailments
ginecologicos

7. Cx clinic
trouble half abdominal
anorexia
Nausea 50 -60 %
mild colicos
localized pain

8. Phisical exploration
sensitivity to palpation
pain on the drums
peristalsis normal or slightly reduced
temperature 37.8

9. Aaron
Mc burney
Psoas
Talopercusion
robsin

10. Appendicitis chronic
pain for three weeks
fibrotico appendix,USG
laparoscopy of preference,
Rx with barium

11. Appendicitis and pregnancy
fever less common, typical Leukocytosis, most
early the drilling, diffuse peritonitis in less
time
apendicectomia, pneumoperitoneum, death has
been reduced in women .5% and foetus 10%

12. common errors in the diagnostic
digital rectal
appendix retrocecal
appendix in upper right quadrant
discard an appendicitis
situs inversus

13. drilling
Pain more severe
fever 38.3
generalized peritonitis
or abscess

14. peritonitis
sensivility, stiffness,
abdominal distension,
paralizad ileus

15. abscess
• discectomy ultrasound guided aspiration
antibiotic and apendicectomia 6 weeks after
or apendicectomia immediate

16. pileflebitis
is a festering thrombophlebitis of the venous
system portal
TAC thrombosis gas in the vein of portal

17. Rx
levels of air-liquid
density +++
air free ---

19. TAC
further definition of the wall
thickening
enlarged
less reliable findings

20. ultrasound
differentiation of abscess and phlegm pericecal

21. prevention
nothing

22. tx
Apendicectomia: laparoscopy or cut open.
antibiotic
abdominal drain

23. prognosis
index of death of. 1%, reduction of 5%
replacement of liquids and a postoperative
infection in 30% of cases