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Acute appendicitis

Acute appendicitis. Appendix Surgical anatomy Definition Etiology Pathology Clinical features Investigations Differential diagnosis treatment. Appendix. Vestigial organ Surgical importance: Propensity for inflammation – this results in clinical syndrome known as acute appendicitis.

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Acute appendicitis

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  1. Acute appendicitis

  2. Appendix • Surgical anatomy • Definition • Etiology • Pathology • Clinical features • Investigations • Differential diagnosis • treatment

  3. Appendix • Vestigial organ • Surgical importance: Propensity for inflammation – this results in clinical syndrome known as acute appendicitis. • most common cause of acute abdomen in young adult.

  4. Surgical anatomy • Size: 8 – 10 cm. • Positions: • Retrocaecal • Paracaecal • Subcaecal • Pelvic • Pre ileal and post ileal

  5. Surgical anatomy Blood supply branch of ileocolic artery Lymphatic drainage

  6. Acute appendicitis • Definition • Acute inflammation of apendix is called acute appedecitis

  7. Etiology • Age • Racial factor • Familial susceptability • Dietary factor • Socio economic status • Obstruction • Bacterial inflamation

  8. Pathology • Non obstructive • Obstructive • Mucosal ulceration and lymphoid hyperplasia------ narrow lumen ------ closed loop---- increased intraluminal pressure---- venus obstruction and

  9. Pathology contin----- ischemia---- bacterial invasion---- acute appendicitis necrosis ----- gangrene ----- perforation ------ peritoneal conaimintion. Alternatively, greater omentum + small gut ----- walling off peritoneal contamination phlegmonous mass.

  10. Clinical features • Symptoms • Pain: Sever, colicky, paraumblical or RIF. • Nausea/vomiting • Fever • Anorexia • Constipation • Diarrhea • Haematuria

  11. Signs • Pyrexia • Pointing sign • Cough tenderness • ON EXAMINATION • Tenderness Muscle gaurding • Rebond tenderness Rovsing sign • Psoas sign Obturator sign • Tenderness in right rectal wall.

  12. Investigations • Routine • FBC raised TLC • Urine R/E • Viral profile • Special condition • Pregnancy test • Urea & electrolytes • X-ray abd • USG Abd / Pelvis • CT Scan

  13. Alvarado scoring system

  14. D/D • CHILDREN • Enterocolitis • Meckels diverticulum • Mesenteric lymphadenitis • HSP • Lobar pneumonia

  15. D/D contin---- • ADULTS • Enterocolitis • Rt ureteric colic • Torsion of undescended testis • Pancreatitis

  16. D/D contin---- • ADULTS FEMALE • Mid cycle pain • PID • Pylonephrotis • Ectopic pregnancy • Ruptured ovarian cyst

  17. D/D contin---- • ELDERLY • Diverticulitis • Intestinal obstruction • Colonic tumor

  18. Treatment • Surgical Rx: Appendicectomy • Pre op Rx • I/V fluids • Abx • Pain killers

  19. Appendicectomy • Open Laproscopic • Anaesthesia • GA

  20. Incisions for open appendicectomy • Grid iron • Rutherford morison • Lanz • Lower midline • Para median

  21. Laproscopic appendicectomy • Triport method • Laproscopic tissue holding forcep • Disecting forcep • Camera

  22. THANK YOU

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