1) Acute appendicitis is an inflammation of the appendix that can spread and cause destruction. It commonly affects people ages 10-30 and is one of the most frequent reasons for abdominal surgery.
2) Symptoms can vary depending on the appendix's position but commonly include abdominal pain migrating to the right lower quadrant, nausea, loss of appetite, and fever.
3) Diagnosis involves physical exam, blood tests showing elevated white blood cells, and imaging like CT or ultrasound. Treatment is surgical removal of the appendix (appendectomy).
Wasim,Shreeja Symptomatology of acute surgery disease of the abdominal cavity...BHARGAVKINI
1. The document discusses the symptomatology of acute surgical diseases of the abdominal cavity, including acute appendicitis, peritonitis, acute cholecystitis, acute pancreatitis, and acute intestinal obstruction.
2. For each disease, general symptoms like abdominal pain, nausea, and fever are outlined. Localized symptoms are also provided that help indicate the specific location of issues like appendicitis.
3. Multiple examination techniques are described that can elicit pain and be used in diagnosing the diseases, such as pressing or tapping on certain areas of the abdomen.
1. Acute appendicitis is caused by obstruction of the appendix, most commonly from lymphoid hyperplasia or fecaliths. It presents with migrating pain from the epigastric to right lower quadrant along with nausea, vomiting, and fever.
2. Diagnosis is based on history and physical exam findings like rebound tenderness. Differential diagnosis includes other abdominal and gynecological conditions. Complications include perforation and peritonitis if not treated surgically.
3. Appendectomy remains the standard treatment, though diagnosis can be challenging in atypical cases like retrocecal or pelvic appendicitis or in children and elderly patients where symptoms may be milder
Acute appendicitis is an inflammation of the vermiform appendix caused by purulent microflora. Approximately 7% of the population will experience appendicitis in their lifetime, most commonly between ages 10-30. Despite advances in diagnosis, it is still based on history and physical exam. Prompt diagnosis and surgery can reduce risks of perforation and complications. Obstruction of the appendix lumen initiates appendicitis, which has multiple causes including lymphoid hyperplasia, fecaliths, parasites, and others. Differential diagnosis includes conditions affecting the gastrointestinal, genitourinary, pulmonary, and gynecological systems. Surgical removal of the appendix is usually required to treat appendic
Acute appendicitis is an inflammation of the appendix that can lead to necrosis or perforation. It is one of the most common surgical conditions of the abdomen. The presentation can vary greatly from mild abdominal pain to symptoms mimicking many other conditions. A definitive diagnosis can be difficult without imaging or surgery. Treatment is an appendectomy, though the surgical approach may vary. Complications can include appendiceal masses, abscesses, and peritonitis if not treated surgically. Both pre-operative and post-operative complications are possible if perforation or infection occurs.
This document provides information about acute appendicitis, including its anatomy, etiology, pathology, clinical diagnosis, signs and symptoms, differential diagnosis, and special considerations for different patient populations like infants, the elderly, pregnant women, and children. Acute appendicitis is caused by obstruction of the appendix lumen, usually by a fecalith, leading to bacterial infection and inflammation. The classic presentation involves initially diffuse abdominal pain that localizes to the lower right abdomen. Diagnosis is based on clinical examination finding localized tenderness at McBurney's point with rebound tenderness. Differential diagnosis varies depending on patient age but includes conditions like diverticulitis, intestinal obstruction, and ovarian cysts.
This document discusses acute appendicitis, including:
- It is a nonspecific bacterial inflammatory disease of the appendix that most commonly occurs in people aged 20-40.
- It is classified into different types including acute, suppurative, gangrenous.
- Risk factors include obstructive agents like foreign bodies or lymphoid hyperplasia, and infectious agents.
- Clinical diagnosis involves examination, symptoms like abdominal pain, and tests like blood work and ultrasound.
- Treatment is through open or laparoscopic appendectomy surgery.
This document summarizes information about appendicitis, including:
1. Acute appendicitis is a nonspecific bacterial inflammatory disease of the appendix that most commonly occurs between ages 20-40.
2. Appendicitis is classified into different types including acute, suppurative, gangrenous, and necrotizing forms.
3. Surgical treatment of appendicitis includes open appendectomy or laparoscopic surgery to remove the infected appendix. Postoperative complications can include bleeding, infection, and bowel obstruction.
1) Acute appendicitis is an inflammation of the appendix that can spread and cause destruction. It commonly affects people ages 10-30 and is one of the most frequent reasons for abdominal surgery.
2) Symptoms can vary depending on the appendix's position but commonly include abdominal pain migrating to the right lower quadrant, nausea, loss of appetite, and fever.
3) Diagnosis involves physical exam, blood tests showing elevated white blood cells, and imaging like CT or ultrasound. Treatment is surgical removal of the appendix (appendectomy).
Wasim,Shreeja Symptomatology of acute surgery disease of the abdominal cavity...BHARGAVKINI
1. The document discusses the symptomatology of acute surgical diseases of the abdominal cavity, including acute appendicitis, peritonitis, acute cholecystitis, acute pancreatitis, and acute intestinal obstruction.
2. For each disease, general symptoms like abdominal pain, nausea, and fever are outlined. Localized symptoms are also provided that help indicate the specific location of issues like appendicitis.
3. Multiple examination techniques are described that can elicit pain and be used in diagnosing the diseases, such as pressing or tapping on certain areas of the abdomen.
1. Acute appendicitis is caused by obstruction of the appendix, most commonly from lymphoid hyperplasia or fecaliths. It presents with migrating pain from the epigastric to right lower quadrant along with nausea, vomiting, and fever.
2. Diagnosis is based on history and physical exam findings like rebound tenderness. Differential diagnosis includes other abdominal and gynecological conditions. Complications include perforation and peritonitis if not treated surgically.
3. Appendectomy remains the standard treatment, though diagnosis can be challenging in atypical cases like retrocecal or pelvic appendicitis or in children and elderly patients where symptoms may be milder
Acute appendicitis is an inflammation of the vermiform appendix caused by purulent microflora. Approximately 7% of the population will experience appendicitis in their lifetime, most commonly between ages 10-30. Despite advances in diagnosis, it is still based on history and physical exam. Prompt diagnosis and surgery can reduce risks of perforation and complications. Obstruction of the appendix lumen initiates appendicitis, which has multiple causes including lymphoid hyperplasia, fecaliths, parasites, and others. Differential diagnosis includes conditions affecting the gastrointestinal, genitourinary, pulmonary, and gynecological systems. Surgical removal of the appendix is usually required to treat appendic
Acute appendicitis is an inflammation of the appendix that can lead to necrosis or perforation. It is one of the most common surgical conditions of the abdomen. The presentation can vary greatly from mild abdominal pain to symptoms mimicking many other conditions. A definitive diagnosis can be difficult without imaging or surgery. Treatment is an appendectomy, though the surgical approach may vary. Complications can include appendiceal masses, abscesses, and peritonitis if not treated surgically. Both pre-operative and post-operative complications are possible if perforation or infection occurs.
This document provides information about acute appendicitis, including its anatomy, etiology, pathology, clinical diagnosis, signs and symptoms, differential diagnosis, and special considerations for different patient populations like infants, the elderly, pregnant women, and children. Acute appendicitis is caused by obstruction of the appendix lumen, usually by a fecalith, leading to bacterial infection and inflammation. The classic presentation involves initially diffuse abdominal pain that localizes to the lower right abdomen. Diagnosis is based on clinical examination finding localized tenderness at McBurney's point with rebound tenderness. Differential diagnosis varies depending on patient age but includes conditions like diverticulitis, intestinal obstruction, and ovarian cysts.
This document discusses acute appendicitis, including:
- It is a nonspecific bacterial inflammatory disease of the appendix that most commonly occurs in people aged 20-40.
- It is classified into different types including acute, suppurative, gangrenous.
- Risk factors include obstructive agents like foreign bodies or lymphoid hyperplasia, and infectious agents.
- Clinical diagnosis involves examination, symptoms like abdominal pain, and tests like blood work and ultrasound.
- Treatment is through open or laparoscopic appendectomy surgery.
This document summarizes information about appendicitis, including:
1. Acute appendicitis is a nonspecific bacterial inflammatory disease of the appendix that most commonly occurs between ages 20-40.
2. Appendicitis is classified into different types including acute, suppurative, gangrenous, and necrotizing forms.
3. Surgical treatment of appendicitis includes open appendectomy or laparoscopic surgery to remove the infected appendix. Postoperative complications can include bleeding, infection, and bowel obstruction.
This document provides information about appendicitis, including:
1. The history of appendicitis diagnosis and treatment from da Vinci's drawings in 1492 to the first successful appendectomy in 1735 to modern laparoscopic procedures.
2. The normal anatomy and variations of the appendix, including its embryonic development, typical size and position, blood supply, and lymphatic drainage.
3. The etiology, pathology, clinical features, scoring systems, and special considerations for acute appendicitis depending on the position of the appendix or patient age. Key signs include migration of pain, anorexia, nausea, and localized tenderness at McBurney's point.
- Acute appendicitis is a common condition with an incidence of about 5 cases per 1000 people in Europe. It most often presents with localized right lower quadrant abdominal pain, anorexia, nausea, and tenderness over McBurney's point. Leukocytosis is also common.
- Diagnosis can sometimes be difficult, especially in women, children, elderly patients, and pregnant women where symptoms may be atypical. Observation over several hours is recommended in equivocal cases. Imaging like ultrasound and CT scans can help in diagnosis but are not always necessary.
- Untreated acute appendicitis can lead to complications like appendicular abscess or generalized peritonitis. Early appendectomy remains the standard treatment
Seminar Presentation On Appendicitis (1).pptxRebiraWorkineh
This document provides information about appendicitis through a seminar presentation outline. It discusses the anatomy and physiology of the appendix, introduces appendicitis, and covers the epidemiology, risk factors, etiologies, types, pathophysiology, signs, and complications of appendicitis. It also discusses the assessment, investigations including differential diagnosis, and management including medical and surgical approaches like appendectomy.
Acute appendicitis is an inflammation of the appendix that is most common in teenagers and young adults. The cause is often obstruction of the appendix leading to infection. Symptoms include abdominal pain localized to the lower right side, nausea, vomiting, and loss of appetite. A physical exam may reveal abdominal tenderness, and tests like a CT scan or bloodwork can help in diagnosis. Treatment is an appendectomy to remove the infected appendix. With prompt surgical treatment and antibiotics, complications are rare and long-term outcomes are usually good.
01.Acute appendicitis and chronic appendicitis.pdfravananusmf
1. Acute appendicitis is an inflammation of the appendix that can range from mild to severe. It is most commonly caused by an obstruction in the appendix, often by a fecalith.
2. The symptoms of acute appendicitis include sudden onset of abdominal pain localized to the right lower quadrant, nausea, vomiting, and low-grade fever. On examination, tenderness may be found at McBurney's point.
3. Diagnosis is usually made clinically but can be supported by blood tests, ultrasound, or CT scan. Treatment involves surgical removal of the appendix (appendectomy) to prevent complications like perforation and peritonitis. Differential diagnoses include other abdominal conditions presenting with similar symptoms
This document provides an overview of acute appendicitis, including:
1. The anatomy of the appendix, which varies in length and position but has a constant base near the cecum.
2. The pathogenesis of appendicitis, which is usually caused by luminal obstruction leading to intraluminal distention and inflammation.
3. The clinical features of appendicitis, including initial periumbilical pain shifting to the right lower quadrant, anorexia, nausea, and tenderness at McBurney's point. Diagnosis can be difficult and is aided by clinical scoring systems.
- Acute appendicitis is a nonspecific bacterial inflammatory disease of the appendix that most commonly occurs between ages 20-40. It is the most common disease of the appendix.
- It is classified based on whether it is acute, suppurative, gangrenous. Surgical treatment involves an open or laparoscopic appendectomy to remove the infected appendix.
- Complications can include bleeding, abscesses, and bowel obstruction. All patients suspected of having acute appendicitis should be hospitalized for observation and laparoscopy may be used for diagnostic uncertainty.
Peritonitis is inflammation of the peritoneum lining the abdominal cavity. It can be caused by infection, injury, or chemical irritation. Acute peritonitis requires prompt treatment to eliminate the infectious source and reduce bacterial load. Treatment involves intravenous antibiotics, surgery to resolve the underlying cause, and intensive care as needed. Prognosis depends on the severity and cause of peritonitis. More severe or generalized cases with organ dysfunction carry a high risk of complications and mortality.
This document discusses diseases of the gallbladder, specifically gallstone disease (cholelithiasis). It covers the prevalence of gallstone disease, risk factors, stages of formation, clinical presentation, diagnostic tools including ultrasound, and treatment options ranging from conservative care, surgical procedures like cholecystectomy, to laparoscopic techniques. Surgical interventions are classified based on timing from emergency to planned operations. Complications of acute cholecystitis and their surgical management are also outlined.
The document provides information about acute appendicitis including:
1. Appendicitis is an inflammation of the appendix and remains a common acute surgical condition. It has a lifetime occurrence of approximately 12% in men and 25% in women.
2. The cause is unclear but obstruction is thought to play a main role by causing inflammation. This can lead to perforation or gangrene if not treated.
3. The diagnosis is typically based on the patient's history and symptoms of abdominal pain migrating to the lower right quadrant, as well as signs on examination like tenderness at McBurney's point. Imaging studies like CT scans can help diagnose unclear cases.
This document provides background information and summarizes key principles regarding acute appendicitis. It begins by discussing the appendix's role in the digestive system and risk factors for appendicitis. The anatomy and pathophysiology of appendicitis are then described, noting that obstruction of the appendix is the underlying cause. Common presenting symptoms are reviewed, emphasizing that the classic presentation is seen in less than 50% of cases, making diagnosis challenging. Differential diagnoses and the role of laboratory tests, imaging, and clinical assessment in evaluation are also summarized. Throughout, it is stressed that diagnosis relies on integrating multiple factors rather than any single finding.
1. Acute appendicitis is a common condition that usually presents with abdominal pain that starts around the navel and shifts to the lower right abdomen. Other common symptoms include anorexia, nausea, and vomiting.
2. A clinical examination often reveals tenderness at McBurney's point with guarding and rebound tenderness. Special tests like Rovsing's sign may also indicate appendicitis. Differential diagnoses include other abdominal conditions.
3. The diagnosis is usually made based on history and clinical exam findings. Laboratory tests are not usually required but may include a CBC and urinalysis. Imaging tests like ultrasound or CT scans can help in unclear cases. Prompt diagnosis and treatment is important to
1. Abdominal pain is the primary symptom of acute appendicitis, which typically begins in the lower abdomen and migrates to the right lower quadrant. Diagnosis is based on clinical signs and symptoms, and may be supplemented by imaging or bloodwork.
2. Treatment for acute appendicitis is surgical removal of the appendix, either through open appendectomy or laparoscopic appendectomy. Antibiotic administration before and after surgery can help prevent surgical site infections.
3. The differential diagnosis of right lower quadrant pain includes conditions like mesenteric adenitis, pelvic inflammatory disease, ovarian cysts, and intestinal illnesses. Timely diagnosis and treatment are important to prevent complications from appendiceal rupture
This document discusses appendicitis, including its signs, symptoms, diagnostic tests, differential diagnosis, and treatment options. Appendicitis has a 7% lifetime risk and commonly affects people aged 10-30. Diagnosis involves physical exam findings like the Dunphy sign as well as imaging like CT scans or ultrasounds to identify an enlarged appendix. Treatment is typically open or laparoscopic appendectomy, with laparoscopic offering benefits like shorter recovery for uncomplicated cases. Chronic appendicitis presents with long-term localized pain but fewer systemic symptoms.
This document discusses the acute abdomen and provides details on:
- The definition and primary symptom (abdominal pain) of an acute abdomen.
- The quadrants and regions of the abdomen.
- Types of abdominal pain and clinical presentation of abdominal problems.
- Specific diseases including acute gastritis, perforated peptic ulcer, acute cholecystitis, cholelithiasis, ascending cholangitis, acute pancreatitis, abdominal aortic aneurysm, intestinal obstruction, and acute mesenteric ischemia.
- For each disease, it discusses the pathology, history, physical exam findings, investigations, management, and complications.
02. Purulent-inflammatory diseases of abdominal cavity_d38fe14abb13872ba8f006...ssuserca828a
This document provides information on acute appendicitis, including:
1) The anatomy of the appendix and pathophysiology of acute appendicitis from early to late stages.
2) Clinical presentation of acute appendicitis including signs, symptoms, and diagnostic testing.
3) Surgical techniques for open and laparoscopic appendectomy.
4) Post-operative care and complications of acute appendicitis.
Inflammatory bowel disease (IBD) can manifest as either Crohn's disease or ulcerative colitis. Crohn's disease causes transmural inflammation that can affect any part of the gastrointestinal tract, most commonly the terminal ileum. Ulcerative colitis only involves the colon and rectum in a continuous pattern. Both diseases present with diarrhea, abdominal pain, and possible extraintestinal symptoms. Diagnosis involves endoscopy and biopsy to distinguish between the two based on involvement patterns and disease characteristics. Complications can include strictures, fistulas, abscesses, and increased cancer risk if the conditions are not well controlled.
This document discusses appendicitis, providing information on its anatomy, etiology, clinical presentation, diagnosis, treatment, and complications. Key points include:
- Appendicitis most commonly affects adolescents and is caused by obstruction of the appendix.
- Diagnosis is based on physical exam findings like localized tenderness and scoring systems. Imaging like ultrasound can also help.
- Treatment is typically an appendectomy, which can be open or performed laparoscopically.
- Complications include wound infections, abscesses, and obstruction, but mortality is now near zero with antibiotic use.
1. The document provides an overview of hernias, including definitions, anatomy, types, clinical features, and management. It describes the anatomy of the inguinal canal and femoral canal.
2. Common types of hernias are discussed, including indirect and direct inguinal hernias, femoral hernias, umbilical hernias, and incisional hernias. Predisposing factors, signs and symptoms, and examination findings are outlined for each type.
3. Management approaches are summarized, including preoperative assessment, hernia reduction techniques, surgical repair options like tissue approximation or mesh placement, and specific procedures for inguinal and femoral hernia repair.
This document provides information about appendicitis, including:
1. The history of appendicitis diagnosis and treatment from da Vinci's drawings in 1492 to the first successful appendectomy in 1735 to modern laparoscopic procedures.
2. The normal anatomy and variations of the appendix, including its embryonic development, typical size and position, blood supply, and lymphatic drainage.
3. The etiology, pathology, clinical features, scoring systems, and special considerations for acute appendicitis depending on the position of the appendix or patient age. Key signs include migration of pain, anorexia, nausea, and localized tenderness at McBurney's point.
- Acute appendicitis is a common condition with an incidence of about 5 cases per 1000 people in Europe. It most often presents with localized right lower quadrant abdominal pain, anorexia, nausea, and tenderness over McBurney's point. Leukocytosis is also common.
- Diagnosis can sometimes be difficult, especially in women, children, elderly patients, and pregnant women where symptoms may be atypical. Observation over several hours is recommended in equivocal cases. Imaging like ultrasound and CT scans can help in diagnosis but are not always necessary.
- Untreated acute appendicitis can lead to complications like appendicular abscess or generalized peritonitis. Early appendectomy remains the standard treatment
Seminar Presentation On Appendicitis (1).pptxRebiraWorkineh
This document provides information about appendicitis through a seminar presentation outline. It discusses the anatomy and physiology of the appendix, introduces appendicitis, and covers the epidemiology, risk factors, etiologies, types, pathophysiology, signs, and complications of appendicitis. It also discusses the assessment, investigations including differential diagnosis, and management including medical and surgical approaches like appendectomy.
Acute appendicitis is an inflammation of the appendix that is most common in teenagers and young adults. The cause is often obstruction of the appendix leading to infection. Symptoms include abdominal pain localized to the lower right side, nausea, vomiting, and loss of appetite. A physical exam may reveal abdominal tenderness, and tests like a CT scan or bloodwork can help in diagnosis. Treatment is an appendectomy to remove the infected appendix. With prompt surgical treatment and antibiotics, complications are rare and long-term outcomes are usually good.
01.Acute appendicitis and chronic appendicitis.pdfravananusmf
1. Acute appendicitis is an inflammation of the appendix that can range from mild to severe. It is most commonly caused by an obstruction in the appendix, often by a fecalith.
2. The symptoms of acute appendicitis include sudden onset of abdominal pain localized to the right lower quadrant, nausea, vomiting, and low-grade fever. On examination, tenderness may be found at McBurney's point.
3. Diagnosis is usually made clinically but can be supported by blood tests, ultrasound, or CT scan. Treatment involves surgical removal of the appendix (appendectomy) to prevent complications like perforation and peritonitis. Differential diagnoses include other abdominal conditions presenting with similar symptoms
This document provides an overview of acute appendicitis, including:
1. The anatomy of the appendix, which varies in length and position but has a constant base near the cecum.
2. The pathogenesis of appendicitis, which is usually caused by luminal obstruction leading to intraluminal distention and inflammation.
3. The clinical features of appendicitis, including initial periumbilical pain shifting to the right lower quadrant, anorexia, nausea, and tenderness at McBurney's point. Diagnosis can be difficult and is aided by clinical scoring systems.
- Acute appendicitis is a nonspecific bacterial inflammatory disease of the appendix that most commonly occurs between ages 20-40. It is the most common disease of the appendix.
- It is classified based on whether it is acute, suppurative, gangrenous. Surgical treatment involves an open or laparoscopic appendectomy to remove the infected appendix.
- Complications can include bleeding, abscesses, and bowel obstruction. All patients suspected of having acute appendicitis should be hospitalized for observation and laparoscopy may be used for diagnostic uncertainty.
Peritonitis is inflammation of the peritoneum lining the abdominal cavity. It can be caused by infection, injury, or chemical irritation. Acute peritonitis requires prompt treatment to eliminate the infectious source and reduce bacterial load. Treatment involves intravenous antibiotics, surgery to resolve the underlying cause, and intensive care as needed. Prognosis depends on the severity and cause of peritonitis. More severe or generalized cases with organ dysfunction carry a high risk of complications and mortality.
This document discusses diseases of the gallbladder, specifically gallstone disease (cholelithiasis). It covers the prevalence of gallstone disease, risk factors, stages of formation, clinical presentation, diagnostic tools including ultrasound, and treatment options ranging from conservative care, surgical procedures like cholecystectomy, to laparoscopic techniques. Surgical interventions are classified based on timing from emergency to planned operations. Complications of acute cholecystitis and their surgical management are also outlined.
The document provides information about acute appendicitis including:
1. Appendicitis is an inflammation of the appendix and remains a common acute surgical condition. It has a lifetime occurrence of approximately 12% in men and 25% in women.
2. The cause is unclear but obstruction is thought to play a main role by causing inflammation. This can lead to perforation or gangrene if not treated.
3. The diagnosis is typically based on the patient's history and symptoms of abdominal pain migrating to the lower right quadrant, as well as signs on examination like tenderness at McBurney's point. Imaging studies like CT scans can help diagnose unclear cases.
This document provides background information and summarizes key principles regarding acute appendicitis. It begins by discussing the appendix's role in the digestive system and risk factors for appendicitis. The anatomy and pathophysiology of appendicitis are then described, noting that obstruction of the appendix is the underlying cause. Common presenting symptoms are reviewed, emphasizing that the classic presentation is seen in less than 50% of cases, making diagnosis challenging. Differential diagnoses and the role of laboratory tests, imaging, and clinical assessment in evaluation are also summarized. Throughout, it is stressed that diagnosis relies on integrating multiple factors rather than any single finding.
1. Acute appendicitis is a common condition that usually presents with abdominal pain that starts around the navel and shifts to the lower right abdomen. Other common symptoms include anorexia, nausea, and vomiting.
2. A clinical examination often reveals tenderness at McBurney's point with guarding and rebound tenderness. Special tests like Rovsing's sign may also indicate appendicitis. Differential diagnoses include other abdominal conditions.
3. The diagnosis is usually made based on history and clinical exam findings. Laboratory tests are not usually required but may include a CBC and urinalysis. Imaging tests like ultrasound or CT scans can help in unclear cases. Prompt diagnosis and treatment is important to
1. Abdominal pain is the primary symptom of acute appendicitis, which typically begins in the lower abdomen and migrates to the right lower quadrant. Diagnosis is based on clinical signs and symptoms, and may be supplemented by imaging or bloodwork.
2. Treatment for acute appendicitis is surgical removal of the appendix, either through open appendectomy or laparoscopic appendectomy. Antibiotic administration before and after surgery can help prevent surgical site infections.
3. The differential diagnosis of right lower quadrant pain includes conditions like mesenteric adenitis, pelvic inflammatory disease, ovarian cysts, and intestinal illnesses. Timely diagnosis and treatment are important to prevent complications from appendiceal rupture
This document discusses appendicitis, including its signs, symptoms, diagnostic tests, differential diagnosis, and treatment options. Appendicitis has a 7% lifetime risk and commonly affects people aged 10-30. Diagnosis involves physical exam findings like the Dunphy sign as well as imaging like CT scans or ultrasounds to identify an enlarged appendix. Treatment is typically open or laparoscopic appendectomy, with laparoscopic offering benefits like shorter recovery for uncomplicated cases. Chronic appendicitis presents with long-term localized pain but fewer systemic symptoms.
This document discusses the acute abdomen and provides details on:
- The definition and primary symptom (abdominal pain) of an acute abdomen.
- The quadrants and regions of the abdomen.
- Types of abdominal pain and clinical presentation of abdominal problems.
- Specific diseases including acute gastritis, perforated peptic ulcer, acute cholecystitis, cholelithiasis, ascending cholangitis, acute pancreatitis, abdominal aortic aneurysm, intestinal obstruction, and acute mesenteric ischemia.
- For each disease, it discusses the pathology, history, physical exam findings, investigations, management, and complications.
02. Purulent-inflammatory diseases of abdominal cavity_d38fe14abb13872ba8f006...ssuserca828a
This document provides information on acute appendicitis, including:
1) The anatomy of the appendix and pathophysiology of acute appendicitis from early to late stages.
2) Clinical presentation of acute appendicitis including signs, symptoms, and diagnostic testing.
3) Surgical techniques for open and laparoscopic appendectomy.
4) Post-operative care and complications of acute appendicitis.
Inflammatory bowel disease (IBD) can manifest as either Crohn's disease or ulcerative colitis. Crohn's disease causes transmural inflammation that can affect any part of the gastrointestinal tract, most commonly the terminal ileum. Ulcerative colitis only involves the colon and rectum in a continuous pattern. Both diseases present with diarrhea, abdominal pain, and possible extraintestinal symptoms. Diagnosis involves endoscopy and biopsy to distinguish between the two based on involvement patterns and disease characteristics. Complications can include strictures, fistulas, abscesses, and increased cancer risk if the conditions are not well controlled.
This document discusses appendicitis, providing information on its anatomy, etiology, clinical presentation, diagnosis, treatment, and complications. Key points include:
- Appendicitis most commonly affects adolescents and is caused by obstruction of the appendix.
- Diagnosis is based on physical exam findings like localized tenderness and scoring systems. Imaging like ultrasound can also help.
- Treatment is typically an appendectomy, which can be open or performed laparoscopically.
- Complications include wound infections, abscesses, and obstruction, but mortality is now near zero with antibiotic use.
1. The document provides an overview of hernias, including definitions, anatomy, types, clinical features, and management. It describes the anatomy of the inguinal canal and femoral canal.
2. Common types of hernias are discussed, including indirect and direct inguinal hernias, femoral hernias, umbilical hernias, and incisional hernias. Predisposing factors, signs and symptoms, and examination findings are outlined for each type.
3. Management approaches are summarized, including preoperative assessment, hernia reduction techniques, surgical repair options like tissue approximation or mesh placement, and specific procedures for inguinal and femoral hernia repair.
Similar to M Hussnain Raza, Acute appendicitis.pptx (20)
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
🔥🔥🔥🔥🔥🔥🔥🔥🔥
إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
🔥🔥🔥🔥🔥🔥🔥🔥🔥
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
3. Appendicitis is defined as an inflammation of the inner lining
of the vermiform appendix that spreads to its other parts.
Statistics
The most frequent of the abdominal surgical pathologies.
4 — 5 cases out of 1000 persons a year.
During the whole life 6% of the planet’s population have
an acute appendicitis.
Lethality – 0,1% (1 person out of 1000 patients).
At any age, more frequently at 10—30 years, man or
woman.
The most frequent cause of the generalized peritonitis
5. Anatomical variants
А – типичное (antecolica);
Б – тазовое;
В – ретроцекальное,
ретроперитонеальное;
Г – мезоцекальное
(медиальное)
NB! Localisation gives all the symptoms
– «monkey» of all the diseases
appendicitis
6. Appendix vessels
NB! Venous flow:
v. appendicularis
v. ileocolica
v. mesenterica superior
v. portae
Portal way of the infection spread –
pilephlebitis (fatal comlication of
appendicitis)
7. Innervation
sympathic system– celiac and upper mesenteric
plexus
Parasympathic - fibers of the nervus vagus
NB! Nociceptive (pain)
afferent impulsation goes by
the sympathetic fibers
NB! Celiac plexus – server
station of the sympathetic
innervation of the abdominal
cavity - frequently the pain
begins in the epigastrium
8. Classification – on the stage of destructive changes
I. Acute appendicitis
1. Acute simple (catharral) appendicitis.
2. Acute destructive appendicitis:
- Flegmonous;
- Gangrenous;
- Gangreno-perforative.
3. Complications of the acute appendicitis:
- Peritonitis - localized, generalized;
- Appendicular infiltrat;
- Appendicular abscess;
- Pilephlebitis;
II. Chronic appendicitis – result of the not operated resolved
acute appendicitis.
9. Etiology and pathogenesis
1. Mechanical reason - obturation of the appendix lumen
(coprolythiase, bending , foreign body)
luminal hypertension
vessels’ compression, interruption of the venous and lymphatic
outflow, oedema of the organ’s wall, vessels’ thrombosis
loss of the barrier function of the mucous
penetration of the intestinal flora into the wall of the appendix
mural destruction
10. Etiology and pathogenesis
2. Vascular reason– interruption of the blood flow in the
appendix’ wall (appendix infarction)
Necrosis of the wall of the organ
loss of the mucous’ barrier function
penetration of the intestinal flora into the appendix wall
Causes:
1. atherosclerosis, thrombosis of mesenteric vessels
2. emboly of the mesenteric vessels
3. systemic vasculitis
NB! primitively-gangrenous (fulminant) appendicitis
11. Etiology and pathogenesis
3. Infectious reason – some infections (typhoid
fever, yersiniosis, TB, parasite infections,
amoebiase, salmonellosis) give acute
appendicitis as their complications.
NB! In other causes (mechanical, vascular)
infection is only secondary
12. Symptoms
Can vary a lot, considering anatomical variations
of the appendix position
13. Symptoms
Abdominal pain (100%) constant, moderately intensive.
40-50% epigastric phase: first pain in epigastric or ombilical region
or more rarely all over the abdomen (in children), after a couple of
hours the pain migrates to the right iliac region – symptom of pain
migration Kocher’s-Wolkowitch’s (only almost pathognomonic
symptom of appendicitis).
50-60% pain right away in the right iliac region.
14. Symptoms
Pain irradiations
into the perineum – if pelvic localisation;
right lumbar region - if retroperitoneal localisation;
right flank, right hypochondrium – if retrocecal
localisation
in mesogastrium - if median localisation
15. Symptoms
Anorexy 100%;
Nausea, vomitting (40-50%) 1-2 times, comes after
pain, reflectory. can be absent;
NB! if nausea or vomitting before pain - not a
appendicitis characteristic;
Tongue firstly wet, then dry.
NB! if dry tongue - sign of dehydration.
16. Клиника
Stool – no specific signs. But!
can be liquid if pelvic (rectum’s irritation) or retrocecal
(right colon irritation) localisations.
If generalized peritonitis, there is no stool because of
the intestinal paralysis.
Urination is not disturbed. But!
If pelvic (irritation of the bladder) and retroperitoneal
(irritation of right kidney and ureter) localisations
frequent painful urination
17. Symptoms
Tachycardia (100%) и hyperthermia (≈ 40%) - inflammation
process’ consequence
t ≈ 37,0 – 37,5
t ≈ 37,5 – 38,5
t ≈ 38,5 and >
Catharral appendicitis ≈ up to 90
Flegmonous ≈ до 110
Gangrenous ≈ > 110
NB! Tachycardia – intoxication sign
NB! normally if 1 degree elevation, 10 heart beats elevation
Hyperthermia is not constant and can be absent in elderly
patients
NB! if not adequation of heart rate and body temperature (tachycardia
if normal t) – first toxic scissors
18. Symptoms:
NB! Peritoneal symptoms – universal symptoms of peritoneal irritation.
There is a lesson about peritonitis .
Local symptoms of
appendicitis (more than
100)
Peritoneal symptoms
(4 main symptoms)
19. Peritoneal symptoms
1. Woskresensky symptom – pain (skin
hyperestesia) above the pathological source during
fast sliding hand movements on the abdominal
wall.
Segmentary body innervation
Lines of Gued
21. Peritoneal symptoms
3. Blumberg’s symptom - The abdominal wall is
compressed slowly and then rapidly released.
A positive sign is indicated by presence of pain
upon removal of pressure on the abdominal
wall.
22. Peritoneal symptoms
4. Anterior abdominal wall’s
muscular guarding (defense
musculaire)
The main peritoneal symptom
Maximal expression – desk-
like abdomen
can be absent in multipares,
in overwight, in elderly
patients
23. Local symptoms
NB! No pathognomonic signs
1. Kokher-Wolkowitch’s sign – see before – only one
almost pathognomonic.
But! Can be simulated if perforative gastroduodenal
ulcer
27. Local symptoms
5. Krymov’s symptom– pain in right iliac region during
finger examination of the external opening of the inguinal
canal;
6. Dumbadze’s symptom – pain if ombilical palpation.
7. Yaure-Rosanoff’s symptom — pain if finger pression in
the Petit’s triangle (if retroperitoneal localisation of the
appendix).
8. Gabay’s symptom – positive Blumberg’s symptom in
the Petit’s triangle (if retroperitoneal localisation).
28. Local psoas symptoms
9. Obrastsov’s
symptom – pain
increasing during
pressure on the
caecum and in
the same time
raising
straightened in
the knee leg
29. Local psoas symptoms
10. Ostrovsky’s symptom – the patient raises his straighned
right leg. The surgeon quickly unbends it and puts it
horizontally. Pain in the right iliac region.
11. Koul’s symptom 1 – presence of pain in ileocecal region
if unbending of right hip.
12. Koul’s symptom 2 – increasing of the right iliac pain if
right hip rotation (if pelvic localisation).
30. Laboratory diagnosis
Leucocytosis with neutrophilic shift (PNN) increase.
Increases if process’ progression
NB! Leucocytosis doesn’t have its own meaning.
NB! normal or decreased leucocytes count with PNN – 2
toxic scissors (if hypoallergic immune response,
inclusing elderly patients; if toxic and terminal stages of
peritonitis)
Always look at the leucocytes formula
31. laboratory diagnosis
Urine analysis – no specific changes But!
Important meaning:
1. if retroperitoneal or pelvic localisation of appendix
(hematurea, leucocyturea);
2. in differential diagnosis of the urinary tract
pathology.
32. Instrumental diagnosis
1. Palpation, percussion, auscutation.
2. PR if men PV if women – «Douglasses cry»
(effusion), differential diagnosis with internal sexual
organs pathology in women
33. Instrumental diagnosis
3. US – effective and not expensive method that doesn’t have a big
popularity in our region yet
local mural lesioins of the appendix (local loss of
the sub-mucous echogenous layer), that
shows the transmural lesion.
difficulty in determination of the top of the
appendix (blurred contours and loss of
echogenous sub-mucous layer
34. Instrumental diagnosis
4. Computer tomography -
highly effective method,
but expensive and
though not highly popular
in our region.
Thickened appendix
35. Instrumental diagnosis
5. Laparoscopy – invasive method, that allows to
visualise the abdominal cavity, evaluate the
appendix condition and to treat the
appendicitis surgically.
36. Differential diagnosis
Appendicitis – monkey of all diseases.
NB! Well constructed anamnesis – 50% of diagnosis.
1. pathology of right kidney and ureter;
2. intestinal infection;
3. genital pathology (in women);
4. acute pancreatitis;
5. covered gastroduodenal perforation;
6. Crohn’s disease;
7. Meckel’s diverticulitis;
8. Acute gastritis.
37. Differential diagnosis
Pathology of right kidney and ureter (kidney colic,
pyelonephritis):
obturated
pain in the right lumbar region with the irradiation to the
right half of the abdomen;
Sometimes nausea, vomiting;
Changes in the urine: hematurie if kidney colic,
leucocytes and bacteries if pyelonephritis;
Intoxication in pyelonephritis;
Not treated and not resolved kidney colic
pyelonephritis.
US!
39. Differential diagnosis
Genital pathology in women (very difficult):
1. Adnexitis – inflammatory signs, simulaiton of the appendicitis
symptoms + vaginal discharge.
2. disturbed tubal pregnancy, ovary apoplexy (hemorragic form),
broken ovary cyst – and also blood loss signs.
3. Ovary apoplexy (painful form) – middl of the cycle, only pain
without blood loss signs.
NB! every woman with appendicitis suspicion should be seen by a
gynecologist.
40. Differential diagnosis
Acute pancreatitis – strong, frequently belting pain in
superior regions of the abdomen, multiple vomiting.
Sometimes epigastric phase of acute appendicitis is
falsely taken for an acute pancreatitis
Covered gastroduodenal perforation – a little quantity
of effusion in the superior regions give epigastric
pain, then goes to the right iliac region – simulation
of the Kokher-Wolkowitch symptom.
41. Differential diagnosis
Crohn’s disease in its acute form is almost
identical to the acute appendicitis
symptomatology.
Meckel’s diverticulitis – identical symptoms
Acute gastritis – can simulate the epigastric
phase of acute appendicitis
NB! Epigastric phase’s lenght - 2-3 hours, max
1 day.
42. Retrocecal (retroperitoneal) acute appendicitis (5-7%)
Pain in the right lumbar region.
Dysuria (irritation of the ureter,
lidney).
liquid stool (irritation of the
caecum, right colon).
Urine analysis – hematuria,
leucocyturia.
Blood analysis – lucocytosis with
PNN increased
Psoas-symptoms, s. of Gabay, s.
Yaure-Rosanoff’s
44. Sub hepatic localisation (rare)
right hypochondrium pain
simulating acute
cholecystitis pain
US
45. Left appendix localisation (rare)
1. situs viscerum inversus;
2. caecum mobile.
Acute appendicitis symptoms on the left side
46. Acute appendicitis in pregnant women (1%)
pregnant uterus moves the
caecum and appendix up;
Pain is not expressed;
no expression of local
symptoms (uterus covers the
caecum);
No expression of the
peritoneal symptoms (over
extension of the anterior
abdominal wall).
47. Acute appendicitis in pregnant women (1%)
one of the difficult diagnostic problems:
1. Possibility of the physiological pain beкcase of the ligament
system of the uterus extension and its hypertonus;
2.possibility of the pregnancy dyspepsia (nausea, vomiting, stool
problems);
3. possibility of the physiological luecocytosis;
4. atypical symptoms, especially during the second half of the
pregnancy.
5. impossibility of the laparoscopy during late pregnancy period.
6. anamnesis, US, exclude pyelonephritis and the risk of the
pregnancy interruption.
48. Acute appendicitis in children
Particularities of children organism
1. Hyperergic response – fulminant symptoms;
2. Short big omentum – no limitations;
3. the child can not sometimes well relate the
anamnesis.
49. Acute appendicitis in children
Symptom’s particularities
1. pain can be not localized, contraction-like;
2. Multiple vomiting;
3. Frequent stool;
4. Quickly febrile hyperthermia;
5. Quickly fast leucocytosis;
6. Symptom of the leg lifting;
7. Symptom of the surgeon’s hand repulsion;
50. Acute appendicitis in elderly patients
Particularities of the elderly patients’ organism
1. Hypoergic response, reduced symptoms;
2. Atherosclerosis of the vessels – fast ischemia and
necrosis (primarily-gangrenous appendicitis);
3. Diabetes mellitus – fast destruction.
Abundance of the complicated appendicitis forms
51. Acute appendicitis in elderly patients
Symptoms particularities
1. Reduced pain syndrom;
2. Reduces local and peritoneal symptoms;
3. First and second toxic scissors.
52. Treatment
Hospitalisation in surgery department.
If diagnosis not clear (table 0, IV, once intramuscular
spasmolytic (но-шпа, папаверин).
Without positive dynamics during 2 hours (laparoscopy or
laparotomy).
If diagnosis acute appendicitis is established, it is an absolute
surgery indication.
contraindication –agonic patient’s condition.
pain-killers – general anesthesia
56. Operation features
In pregnant women - incision higher with the
pregnancy length.
In children– ligature method without purse-string
and Z-stitches (thin wall of the caecum, riskof the
ileocaecalis involvement in the stitches).
If laparoscopy – only ligature method.
58. Laparoscopic appendectomy
Conditions
1. Presence of necessary mechanisms
(endosurgical stand);
2. Surgeon’s preparation;
3. Possibility of the laparoscopy (not in every case)
59. Russian surgeon L.I. Rogozov have done an appendectomy on himself in Antarctic in 1961
60. Complications’ classification
I. Early:
1. Before the operation:
-
-
-
-
-
Appendicular infiltat;
Appendicular abscess;
Peritonitis - local, generalized;
retroperitoneal flegmona (if retroperitoneal localisation)
pylephlebitis.
2. Post-surgical complications:
-
-
-
-
-
-
-
Intraperitoneal hemorrage;
failure of the appendix stump;
Local infiltrat and abscess of the peritoneal cavity;
suoouration of the wound;
post-surgical peritonitis (tertiary peritonitis);
Intestinal paralysis;
early adhesive intestinal blockage.
II. Late:
-
-
-
Ligature fistulas;
Adhesive intestinal blockage;
Post-surgical ventral hernia.
III. Involving other systems and organs:
-
-
-
Pneumonia, pleuritis, lung abscess;
Myocardial infarction, acute failure of brain circulation.
Thrombosis of the deep veines of the shin, lung emboly
61. Progression of not-operated appendicitis
Appendicular infiltrat
peritonitis
Resolution destruction
(abscesses)
Chronic
appendicitis
local
generalized
intestinal
lumen
Break into the Break into the
retroperitoneal
space
break through the
anterior abdominal
wall
l
break into the abdomina
cavity
62. Appendicular infiltrat (1-3%)
Inflammatory tumor, Inflammatory tumor, conglomerate of losely fixed to
one another tissues around the appendix with participation of parietal
peritoneum, big omentum, caecum, small intestin.
• Infiltrat – limitation, protection reaction in order to limitate the inflammation
1. Formation (loose) of infiltrat – 3-4 days;
2. Formed (dense) infiltrat – after 5 days.
63. Appendicular infiltrat
Symptoms:
• Less abdominal pain;
• Better general patient’s condition;
• Dense, not painful, fixed formation in the right iliac
region,
• Infiltrate’s size can vary a lot, can occupy all the right
iliac region;
• There can be positive local symptoms and peritoneal
symptoms - negative;
• Mild leucocytosis with PNN, sub febrile body
temperature
64. Appendicular infiltrat
NB! it’s localisaiton (abscess)
depends on the initial
appendix’ localisation, it can be
localized in the pelvis, in
mesogastrium, in sub hepatic
space.
67. Appendicular infiltrat
Conservative treatment
1. Table 0 with IV infusions 30 ml/kg, then 1А;
2. Cold on abdomen;
3. Bed regimen;
4. Antibacterial therapy;
5. Physical treatment on the infiltrat region
6. No surgical indication (risk of organs participating
in infiltrat damage)
68. Appendicular infiltrat
Results:
1. Resolution: pain decreases, infiltrat resorbs,
temperature normalizes discharge
with planned hospitalisation in 3 month for a
planned appendectomy
2. abscess
Pain increase
Hyperthermia
Leucocytosis
operation
even if one of these sign
69. Interventions variants
Wolkowitch-Diakonov’s Laparotomy
Pirogov’s method (extraperitoneal);
Punction drainage under US control;
Laparoscopy (risk!).
No obligation of appendectomy, appendix can be
removed if well visualised Risk of organ damage
(organs that participate in the pyogenic capsule)
72. Pilephlebitis
Septic thrombophlebitis of the portal veine –
rare, but fatal.
Necrotic prosess that invades appendix
mesentery and its vessels.
then invasion of the vessels of the ileocecal
angle.
in 2-3 days goes to the portal veine and
hepatic veines
then retrograde invasion of the splenic and
other mesenteric veines.
73. Пилефлебит
Клиника:
1. Бурно развивающаяся картина системной
воспалительной реакции (фебрильная
гипертермия);
2.Усиление боли в животе (правая половина);
3.Желтуха;
портальная гипертензия
4.Гепатоспленомегалия;
5.Асцит;
6.Прогрессирующая
недостаточность.
печеночно-почечная
74. Pilephlebitis
Treatment:
1. Maximal section of the appendix
mesentery;
2. ligature v. ileocolica;
3. resection of the ileocecal angle;
4. Massive antibacterial therapy;
5. Masive infusion-detox therapy;
75. Abscesses of the abdominal cavity
Appendicitis complication after surgery;
Universal complication;
Reasons:
1. Not adequate sanation of the abdominal
cavity;
2. suppuration of hematomas after not
adequate hemostasis;
Typical localisation:
- pelvic (Douglass’ space);
- iliac;
- between loops;
- sub hepatic;
- subphrenic.
76. General signs of the abdominal abscesses
Clear laps of time – better general condition after operation
progressive symptoms with 7-8 day pic:
1. Growing hyperthermia
Appendectomy abscess break
then
ССВР
SIRS
2. Progressive dehydration;
3. Leucocytosis with PNN growth;
4. Infiltrat’s palpation (not always);
5. Local abscess symptoms.
77. Local clinic of the abdominal abscess
Douglass’ abscess:
1. Pubic pain with perineum irradiation;
2. Dysuria (bladder’s irritation);
3. tenesms (rectum’s irritation).
Intestinal abscess:
1. pain in mesogastrium;
2. frequent liquid stool (small intestins irritation);
Subhepatic abscess:
1. Pain in right hypochondrium;
2. Cholecystitis symptoms (Кера, Ортнера, Мерфи, Мюсси)
3. Frequent liquid stool (colon’s irritation);
78. Local clinic of the abdominal abscess
Subhepatic abscess – the most difficult
diagnostically and for the therapy
Classificaiton:
1.right-side, left-side, median;
2.one side, both side;
3.anterior, posterior;
4.superior, inferior.
79. Local symptoms of the abdominal abscess
Symptoms of the sb phrenic abscess
1.inferior thoracic region pain with shoulder irradiation (с.
Мюсси, Элекера);
2.Senator’s syndrom – body’s rigidness;
3.thorax is late for the breathing;
4.pleural effusion signs;
5.inferior lobe pneumonia
6.Signs of SIRS (sometimes the only symptom).
80. One of the reasons – sucking action of the
diaphragm.
Law: after operation the patient must be with raised
head position (Fowler’s position). Douglass’
abscess is less difficult to treat than sub phrenic.
81. Retrouperitoneal flegmona
1. Right lumbar pain;
2. Irradiation to the right half of the abdomen;
3. Positive psoas symptoms;
4. softness of the tissues in the lumbar region
(possible);
5. dysuria;
6. Changes in urine analysis;
7. Signs of SIRS – hyperthermy, leucocytosis, etc.
82. Diagnosis
US – method of choice;
CT – method of choice;
X-rays (for sub phrenic abscess);
PR! (Douglass);
White blood (leucocytes elevation).
NB! abscess’ localisation depends on the appendix
localisation.
83. Surgical treatment
Laparotomy;
laparoscopy (risk);
Punction drainage under US control (method of
выбchoiceора);
Pelvic abscess – transvaginally or transrectally;
Sub phrenic
transthoracic
anachronism.
abscess – Clermond’s method;
acces (transpleural, extrapleural) –
84. Punction drainage under US control
Video
Features:
1. Effectiveness 60-70%;
2. if no positive dynamics for 2-3 days
laparotomy;
3. Risk of organs damage.
89. Section of the pelvic abscess
vaginal access rectal access
90. intraperitoneal hemorrage
Causes:
1. ligature’s slipping
2. abdominal organ’s damage during revision (omentum, intestinal mesentery, liver,
spleen).
symptoms (during the first hours and depends on blood loss abundance):
1. General blood loss signs (skin palour, hypotony, tachycardia, diziness,
weakness);
2. frequent signs of the intraabdominal hemorrage (increasing pain in the abdomen
during palpation, с. Куленкампфа).
Diagnosis:
1. Blood analysis – Hb decrease, Ht, erythrocytes;
2. US – free liquid in the abdominal cavity.
Strategy – urgent median relaparotomy, blood loss stop.
Prophylaxy – attentive hemostase and its control during the primary operation
91. Insufficiency of the appendix stump
causes:
1. defects of the operative technique;
2. Tiphlitis (inflammation of the caecum’s wall).
Symptoms (from 3-4 days), process can be limited
(abscess formaiton) and generalized (peritonitis):
3. Increasing pain and its generalization;
4. Peritoneal symptoms;
5. SIRS.
Strategy – relaparotomy, punction drainage (if abscess).
92. Suppuration of the wound
cause:
1. operation technique violation (trauma, unsufficient hemostase, pouches left):
hematoma
cavity
suppuration.
then suppuration.
2. Appendectomy – «dirty» operation risk of infection of operative wound
.
Mechanical protection necessary (limitation of the wound, wound wash).
Perioperational antibiotherapy obligatory.
symptoms: (tumor, rubor, calor, dolor, functio laesa):
painful wound infiltrat, skin hyperhemia, SIRS.
NB! If source is very deep, local symptoms can be absent.
Treatment: revision and drainage of the wound.
