Appendix Prepared by , Dr. - PowerPoint Presentation

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Appendix

Prepared by ,

Dr.

Panchajani.R

APPENDIX

Anatomy

Narrow hollow tube , closed at one end

situated

in the right

illiac

fossa

and that protrudes from the

postero medial

aspect of

caecum

2cm below the insertion of the

illeum

in to

caecum

.

3 -4 inches (8-10cm) long

it

has mucosal ,

submucosal

, muscular and serous layers .

At

birth it is short and broad , tubular structure by about the age of

2

in

childhood it continue to grow of the

caecum

and commonly rotates the Appendix in to

retrocaecal

position

at

the base of the Appendix is constant.

APPENDIX

Various positions:-

Retrocaecal-74%, pelvic - 21%,.

Subcaecal

-2%, post

illeal

- 0.5%, pre

illeal

- 1% .

Arterial supply:-

Appendicular

artery branch of

ileocolic

artery

Venous ;-

.

Appendicular

vein

Functions;-.

Maintaining gut flora, important in maintaining B cell mediated immune responses, movement and removal of waste matter in the digestive system .

Appendicitis

It

is the inflammation of the Appendix

.

Acute

or chronic .

Begins in inner layer of Appendix then spreads to other parts .

It

is one of the common cause of abdominal pain.

Aetiology ;-

No unifying cause .

Decreased

dietary fibre and increased consumption of carbohydrates.

Blockage of the

Appendicular

luman

by

faecolith

, tumour of

caecum

, intestinal parasites.

Pathology

Luminal obstruction (

faecolith

) leads to bacterial overgrowth results in inflammation and swelling (Mucosal ulceration ) .

Appendix become inflamed and filled with pus which results in increased pressure and localised ischemia.

If not treated it can rupture .

perforation leads to local abscess formation and peritonitis , shock and may leads to death.

Clinical features

Abdominal

pain

- pain begins around the umbilicus ,as the inflammation progresses .the pain localised in the right

illiac

fossa

as the peritoneum becomes inflamed , it results in rebound tenderness . Pain aggravation from movement

.

Maximum tenderness/pain in the Mc.

Burney,s

point.

Site of pain may vary depending up on the position of Appendix.

Anorexia, nausea,

vomiting

Fever

initially low grade fever that may worsen as the illness progresses.

Signs

Localised

tendernes

in right

il

liac

fossa

muscle guarding

rebound tenderness.

Maximum

tenderness in the

Mc.burneys

point

Hyperesthesia in

sherran's

triangle

Rovsing’s

sign positive

Psoas

sign positive in

retrocaecal

Appendix,

obturator

sign positive in pelvic Appendix.

Diagnosis and treatment

Diagnosis

Blood

;- increased WBC, ESR

USG

Contrast CT

Surgery:-

Appendicectomy

:- laparoscopic / conventional

Complications

of appendicitis:-

Perforation

Appendicular

abscess

Risk

factors for perforation:-

Extremes

of age,

immunosuppression

, Diabetes,

faecolith

obstruction, pelvic Appendix, previous abdominal surgery.

Appendicular mass (phlegmonosmass

)

It is an inflamed Appendix with an adherent

omentum

and small bowel.

ie

, greater

omentumand

loops of small intestine are adherent to the inflamed Appendix

.

Between 2-6% of patients with acute appendicitis presents with

Appendicular

mass

.

It can usually felt after 24-48hrs of onset of pain &becomes well defined by 4

th

or 5

th

day and there after it resolves or forms an abscess.

Treatment

;- conservative treatment , medicinal treatment,

Monitoring the general state of the patient and vital signs regularly. The presence of worsening of symptoms or signs is an indication for surgical treatment.

Appendicular abscess

Rare, it is the collection of pus resulting from the inflammation of appendix

.

It is a life threatening complication of acute appendicitis

.

Abscess is formed around the Appendix.

Treatment

:- Drainage of pus under radiological guidance

Chronic appendicitis

Long term condition characterised by

recurrent

attack of acute appendicitis. Symptoms that come and go

.

Symptoms may be mild

.

Most common symptom is abdominal pain (right lower quadrant ).

sharp,dull

pain sometimes continues for more than 48hrs or weeks

.

other

symptoms are fever, swelling, tenderness, fatigue,

malaise.

Cause is like that of acute appendicitis inflammation and obstruction of Appendix by

faecolith

, parasites, tumours, foreign bodies etc

..

Chronic appendicitis

Diagnosis

is difficult and it includes history, physical

examination,CT

, MRI etc.. and rule out the other conditions by blood test, urine analysis, abdominal USG, X-ray etc..

The most common treatment is

appendicectomy

Most common complications are acute appendicitis, rupture, abscess, peritonitis, sepsis.

Appendicitis therapeutics

Iris

tenax

Aconite

Belladonna

Colocynth

Echinace

Colchicum

Nux

vomica

Plumbum

met