acute appendicitis
Download
Skip this Video
Download Presentation
Acute Appendicitis

Loading in 2 Seconds...

play fullscreen
1 / 50

Acute Appendicitis - PowerPoint PPT Presentation


  • 215 Views
  • Uploaded on

Acute Appendicitis. Dr. Mirzaei. One of the most common surgical emergencies Highest incidence in the second and third decades. Anatomy. Location: three taeniae coli converge at the base (fix) Length: <1cm to >30cm (average 6-9)

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Acute Appendicitis' - maite-haney


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2

One of the most common surgical emergencies

  • Highest incidence in the second and third decades
anatomy
Anatomy
  • Location: three taeniae coli converge at the base (fix)
  • Length: <1cm to >30cm (average 6-9)
  • Tip: retrocecal, pelvic, subcecal, preileal, right pericolic
function
Function?
  • Secretion of immunoglobulin A
  • Appendectomy and U.C protection?
  • As a reservoir to recolonize the colon with healthy bacteria
pathogenesis
Pathogenesis
  • Obstruction

- Fecalith

- Hypertrophy of lymphoid

- Inspissated barium

- Tumors

- Vegetable and fruit

- Intestinal parasites

pathogenesis1
Pathogenesis
  • Normal luminal capacity 0.1 ml
  • Proximal obstruction => closed-loop obstrucation
  • Normal secretion of mucosa => distention
  • 0.5 ml secretion => intraluminal pressure 60cm H2O
pathogenesis2
Pathogenesis
  • Secretion + rapid multiplication of bacteria => venous pressure increased => occlusion of capillaries
  • Arteriolar inflow continue => vascular congestion
pathogenesis3
Pathogenesis
  • Impairment of blood supply => mucosal integrity compromised => bacterial invasion
  • Infarction in antimesentric border => perforation
appendiceal rupture
Appendiceal Rupture
  • Overall Rate: 25.8%
  • Children < 5 years: 45%
  • Patients > 65: 51%
appendiceal rupture1
Appendiceal Rupture
  • Walling-off process -> Phlegmon: Adherence of bowel loops to the inflamed appendix or a periappendiceal abscess.
  • Mass in exam:2-6%
  • Duration: At least 5-7 days
symptoms
symptoms
  • Distention => visceral nerve endings stimulation => vague, dull, diffuse pain in the mid abdomen or lower epigastrium
  • Distention => reflex nausea &vomiting
  • Inflammation of serosa & parietal peritoneum => shift in pain to the right lower quadrant
symptoms1
Symptoms
  • Abdominal pain

- Moderately severe

- steady, sometimes intermittent

cramp

- 1-12 h (4-6h) pain => R.L.Q

symptoms2
Symptoms
  • Pain variation

- Begins in the R.L.Q

- Shift to the L.L.Q (tip in the L.L.Q)

- Retrocecal => flank or back pain

- Pelvic => suprapubic

- Retroileal => testicular pain (irritation of the spermatic artery & ureter)

symptoms3
Symptoms
  • Intenstinalmalrotation

-Visceral: normal location

- Somatic: where the cecum has been arrested

symptoms4
Symptoms
  • Anorexia (nearly always)

- loss of anorexia: diagnosis should be questioned

symptoms5
Symptoms
  • Vomiting

- 75% of patients

- neither prominent nor prolonged

- only once or twice

sequence of symptoms
Sequence of Symptoms
  • 95% anorexia – pain - vomiting
  • Vomiting – pain: diagnosis should be questioned
signs
Signs
  • Temperature : rarely > 1ºC
  • PR: normal or slightly elevated
  • More change: complication?
signs1
Signs
  • Lie supine
  • Right thigh drawn up
  • Any motion increases pain
  • Move slowly with caution
signs2
Signs
  • McBurney point tenderness
signs3
Signs
  • Local tenderness
  • rebound tenderness
  • Voluntary guarding
  • True reflex (involuntary) rigidity (irritation progress)
signs4
Signs
  • Flank tenderness
  • Local tenderness in rectal exam (pelvic)
  • psoas sign
  • Obturator sign
  • Rovsings sign
lab test
Lab test
  • W.B.C 10,000 – 18,000
  • Moderate P.M.N predominance
  • W.B.C > 18,000 => possibility of complication
  • CRP
  • U/A: several W.B.C or R.B.C (ureteral or bladder irritation)
  • Bacteriuria generally not seen
imaging
Imaging
  • Plain film (rarely helpful)

- abnormal bowel gas pattern

- fecalith (highly suggestive)

  • C.X.R (R/O right lower lobe pneumonia)
imaging1
Imaging
  • Sonography (inexpensive, rapid, no contrast medium, even in pregnancy
  • Noncompressible appendix > 6mm
  • Appendicolith
  • Thickening of appendiceal wall & periappendiceal fluid
  • Remainder of abdominal cavity
imaging sono
Imaging - Sono
  • Exclude Gyn pathology
  • Effective in children & pregnancy
imaging sono1
Imaging - sono
  • Limitations

- user dependent

- false – positive: dilated fallopian tube,

inspissated stool can mimic

appendicolith, obesity,

- false – negative: appendicitis in tip,

retrocecal, markedly enlarged,

perforation

imaging c t
Imaging – C.T
  • Dilated appendix>5mm + wall thickening
  • thickened mesoappendix
  • Phlegmon
  • Periappendiceal fat stranding
  • Free fluid
  • Other inflammatory processes
imaging c t1
Imaging – C.T
  • Expensive, exposes to radiation, cannot be used during pregnancy, allergy to contrast, intolerance of oral contast
laparoscopy
Laparoscopy
  • Most useful in females (30 – 40% normal appendix)
  • Differentiating acute Gyn pathology
m isdiagnosis
Misdiagnosis
  • highest rate: child-bearing women,veryyoung,very old
  • Accuracy of preoperative diagnosis should be: 85%
  • Accuracy>90%: Missed some patients
  • Depends on: anatomic location of the appendix, simple or ruptured, age, sex
alvarado scale1
Alvarado scale
  • 7-10 high likelihood
  • 4-6 consider further imaging
  • 1-3 low likelihood
acute mesenteric adenitis
Acute Mesenteric Adenitis
  • Most in Children
  • Upper respiratory tract infection is present or has recently subsided.
  • Pain is diffuse
  • Tenderness is not sharply localized
  • Guarding sometimes present
acute mesenteric adenitis1
Acute Mesenteric Adenitis
  • True rigidity is rare
  • Generalized lymphadenopathy (may)
  • Relative lymphocytosis suggestive
  • Self limited
  • May need immediate exploration
gynecologic disorders
Gynecologic Disorders
  • Pelvic Inflammatory Disease
  • Usually bilateral
  • Nausea & Vomiting: 50%
  • Tenderness Usually lower
  • Motion of cervix is painful
  • Diplococci on smear of purulent vaginal discharge
  • Higher during early phase of cycle
gynecologic disorders1
Gynecologic Disorders
  • Ruptured Graafian Follicle
  • Spillage of follicular fluid
  • Pain and tenderness diffuse
  • Leukocytosis & fever: minimal
  • Midcycle: Mittelschmerz
gynecologic disorders2
Gynecologic Disorders
  • Twisted Ovarian Cyst
  • Sudden pain
  • CT & Sono (transvaginal)
  • Need emergent operation
  • Leakage of ovarian cyst: Treated nonoperatively
gynecologic disorders3
Gynecologic Disorders
  • Ectopic pregnancy
  • Abnormal menses
  • Missing one or two periods or only slight vaginal bleeding
  • Elevated level of human chorionic gonadotropin(B-HCG)
  • Hct level falls
  • Vaginal exam:cervical motion tenderness
  • culdocentesis
acute gastroenteritis
Acute Gastroenteritis
  • Diarrhea, nausea, vomiting
  • Abdominal Cramps
  • Soft Abdomen between cramps
  • No localizing sign
  • Vomiting - Pain
slide47

Cecum or sigmoid Diverticulitis

  • Meckel’s Diverticulitis
  • Perforating Carcinoma of the cecum
  • Epiploicappendagitis
  • Pleuritis of the right lower chest
  • Acute Cholecystitis
  • Acute Pancreatitis
  • Hematoma of the abdominal wall
  • Epididymitis, Testicular torsion, U. T. I, Ureteral Stone
ad