急性阑尾炎英文.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,急性阑尾炎英文,Outlines,General considerations,Historical perspective,Anatomy,Pathophysiology,Clinical findings,Diagnosis,Treatment,General considerations,About 8%of people in Western countries have appendicitis at some time during their life,with a peak incidence between 10 and 30 years of age,.,Acute appendicitis is,the most common,general surgical emergency.(10%),General considerations,Acute appendicitis has protean manifestations.,It may simulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions.,Progression of symptoms and signs is the rule,in contrast to the fluctuating course of some other diseases.,Historical perspective,Willard Packard,performed the first surgery in 1867.,In 1886,Reginald,Fitz,described the characteristic,clinical findings and pathology of the disease,identified the appendix as the primary cause of right lower quadrant inflammation.,Fitz,coined the term,appendicitis,and recommended early surgical treatment,Historical perspective,In 1889,Chester,McBurney,described characteristic,migratory pain,as well as localization of the pain along an oblique line from the anterior superior iliac spine to the umbilicus.,In 1894,McBurney,described a right lower quadrant,muscle-splitting incision,for removal of the appendix.,Historical perspective,In the 1940s,the mortality rate from appendicitis improved with the widespread use of broad-spectrum antibiotics.,In 1982,Laparoscopic appendectomy,was first reported by the gynecologist,Kurt Semm,but has only gained widespread acceptance in recent years.,Anatomy,physiology,The base of the appendix is located at the convergence of the taeniae(3)of colon.,This anatomic relationship facilitates identification and location of the appendix at operation.,Pathophysiology,Obstruction of the lumen is believed to be the major cause of acute appendicitis.,This may be due to lymphoid hyperplasia,inspissated stool,fecalith,vegetable matter or seeds,parasites,or a neoplasm.,Pathophysiology,Obstruction of the appendiceal lumen,Bacterial overgrowth,Continued secretion of mucus,Intraluminal distention and increased wall pressure,Pathophysiology,Subsequent impairment of lymphatic and venous drainage,mucosal ischemia,These findings in combination promote a localized inflammatory process that may progress to gangrene and perforation.,Pathophysiology,Inflammation of the adjacent peritoneum gives rise to localized pain in the right lower quadrant.,Perforation typically occurs after at least 48 hours from the onset of symptoms and is accompanied by an abscess cavity walled-off by the small intestine and omentum.,Clinical findings,Clinical findings,history and symptom,Appendicitis needs to be considered in the differential diagnosis of nearly every patient with acute abdominal pain,The typical presentation begins with vague,peri-umbilical pain,followed by,anorexia,nausea and vomiting,.Then localizes to the right lower quadrant.,history and symptom,The classic pattern of,migratory pain,is the most reliable symptom of acute appendicitis,Fever,ensues,followed by the development of,leukocytosis,Occasional patients have urinary symptoms or,microscopic hematuria,migratory pain,Physical Examination,Low-grade fever is common(,38).,Diminished bowel sounds,Focal tenderness(commonly at McBurney,s point)-,located one third of the distance along a line drawn from the anterior superior iliac spine to the umbilicus,Rebound tenderness,Voluntary guarding,Physical Examination,Dunphys sign,-coughing cause increased pain,Rovsings sign,-pain in the right lower,quadrant during palpation,of the left lower quadrant,Physical Examination,Psoas sign,-pain on extension of the right hip(retrocecal appendix),Obturator sign,-pain on internal rotation of the hip (pelvic appendix),Laboratory Studies,The average leukocyte count is 15*10,9,/L,and 90%of patient have count over 10*10,9,/L,More than 75%neutrophils in of patients.,A completely normal leukocyte count and differential is found in about 10%of patients.,Imaging studies,Plain abdominal films:,may be useful for the detection of ureteral calculi,small bowel obstruction,or perforated ulcer,but such conditions are rarely confused with appendicitis.,Ultrasonography and CT scan:,be helpful in patients with atypical symptoms,such as children and elderly person.,A,CT scan of the abdomen demonstrates an edematous,thickened appendix,(arrow),with obstructing appendicolith,(arrowhead),.,B,CT scan of abdomen demonstrates a perforated appendix with a complex abscess and pelvic fluid collection,(arrow),.BL,bladder;UT,uterus.,Essentials of diagnosis,Abdominal migratory pain,Anorexia,nausea and vomiting,Localized abdominal tenderness,Low-grade fever,Leukocytosis,Differential Diagnoses,Sometimes,the diagnosis of appendicitis may be difficult.,Mesenteric lymphadenitis,gastrointestinal ulcer perforation,Meckels diverticulitis,ectopic pregnancy,pelvic inflammatory disease,Special category of appendicitis,in infants,，,in children,，,in wemen during pregnancy,，,in elderly people,in patients infected with HIV,Complication,Perforation,Peritonitis,Appendiceal abscess,pylephlebitis,Treatment,Surgical treatment:,Most patients with acute appendicitis are managed by prompt surgical removal of the appendix.(,Appendectomy,),Non-surgical treatment:,Early Stage,Objective conditions are not allowed,Serious organic disease.(antibiotics),Treatment,Laparoscopic appendectomy,offers the advantage of:,diagnostic laparoscopy,shorter recovery,less conspicuous,incisions,Subjective to think,What,s the Essentials of diagnosis about acute appendicitis?,