Presented by Sara Shokri Moghaddam Anatomy amp Function of appendix The three taeniae coli converge at the junction of the cecum with the appendix The tip of appendix can be found in a ID: 165718
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Slide1
ACUTE APPENDICITIS
Presented by :
Sara
Shokri
MoghaddamSlide2
Anatomy & Function of appendix
The three
taeniae
coli converge at the junction of the
cecum
with the appendix.
The tip of appendix can be found in a
retrocecal,pelvic,subcecal,preileal
or right
pericolic
position.Slide3Slide4
Anatomy & Function of appendix
Appendix is an immunologic organ that participate in the secretion of IGs., specially
IgA
.Slide5
Incidence
≈ 7 % of all people
andergoes
appendectomy during their life
More frequently in 2
nd
through 4
th
decades of life
M > F
The percentage of misdiagnosed cases of appendicitis is higher among women.Slide6
Etiology and Pathogenesis
Obstruction of the lumen is the dominant etiologic factor of appendicitis.
The most common cause of obstruction is
fecaliths
.
Other
causes:hypertrophy
of
limphoid
tissue,inspissated
barium,tumor,vegetable
and fruit seeds and intestinal parasites.Slide7Slide8
Etiology and Pathogenesis
A sequence of events lead to appendicitis:
Proximal obstruction and normal secretion of mucosa
Distention of appendix Stimulation of visceral afferent nerves a vague diffused pain in the
midabdominal
or lower
epigastrium
Slide9
Distention of appendix N/V
occlusion of capillaries
vascular congestion
involvement of the
serosa
involvement of parietal peritoneum
SHIFT in the PAIN to RLQ
Slide10Slide11
Bacteriology
The bacterial population of a normal appendix is similar to that of normal colon
The principal organisms seen in the normal
appendix,in
acute appendicitis, and in perforated appendicitis are Escherichia coli &
Bactroid
fragilis
.Slide12
AB prophylaxis
Effective in prevention of wound infection and
abcesses
.
24-48h in non perforated appendicitis.
7-10D in perforated appendicitis.Slide13
Clinical manifestations
SYMPTOMS:
Abdominal pain
Shifting of pain to the RLQ
Anorexia
N/V
Sequence of symptoms:
anorexia pain N/V(if
accours
)Slide14
Clinical manifestations
SIGNS:
Tendernes
around
Mcburney
point
Rebound tenderness
Rovsing
sign
Guarding
Obturator
sign
Psoas
signSlide15Slide16
Laboratory findings
Mild
leukocytosis
(10000 to 18000)
Several RBC or WBC can be present from
ureteral
or bladder irritationSlide17
Imaging studies
Plain films of the abdomen
Barium enema examination and radioactively labeled leukocyte scans
Compression
sonography
High resolution helical CTSlide18Slide19
Differential Diagnosis
Acute mesenteric adenitis
PID
Ruptured
graffian
follicle
Twisted ovarian cyst
Ruptured EP
Acute
gastroentritis
Meckle’s
diverticulitis
Crohn’s
entritis
Colonic lesions
Other
diseasSlide20
Treatment
Open appendectomy
Laparoscopic appendectomy
Natural orifice
transluminatiom
endoscopic surgery
Antibiotics
Interval appendectomySlide21
Incidental appendectomy
Childrens
about to undergo chemotherapy
Disabled patient
Patients with
crohn’s
disease
The
indivisual
who are about to travel to remote places