AcuteappendicitisWangJunThesecondgeneralsurgicaldepartmentPeople’shospitalofyuxicityAcuteappendicitisWangJun1OutlinesGeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatmentOutlinesGeneralconsiderations2GeneralconsiderationsAbout8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%)GeneralconsiderationsAbout8%3GeneralconsiderationsAcuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.GeneralconsiderationsAcuteap4Historicalperspective

WillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.FitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatmentHistoricalperspectiveWillard5HistoricalperspectiveIn1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurney

describedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.HistoricalperspectiveIn1889,6HistoricalperspectiveInthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.HistoricalperspectiveInthe17急性闌尾炎英文課件8Anatomy＆physiologyThebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.Anatomy＆physiologyThebaseo9急性闌尾炎英文課件10急性闌尾炎英文課件11Pathophysiology

Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.PathophysiologyObstructionof12PathophysiologyObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressurePathophysiologyObstructionof13PathophysiologySubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.PathophysiologySubsequentimpa14PathophysiologyInflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.PathophysiologyInflammationof15Clinicalfindings

Clinicalfindings

Clinicalfindings

Clinicalfin16historyandsymptomAppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.historyandsymptomAppendiciti17

historyandsymptomTheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuria

historyandsymptomTheclassi18migratorypainmigratorypain19PhysicalExaminationLow-gradefeveriscommon(～38℃).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicus

ReboundtendernessVoluntaryguardingPhysicalExaminationLow-grade20PhysicalExaminationDunphy'ssign---coughingcauseincreasedpainRovsing'ssign

---painintherightlowerquadrantduringpalpationoftheleftlowerquadrantPhysicalExaminationDunphy'ss21PhysicalExaminationPsoassign---painonextensionoftherighthip(retrocecalappendix)Obturatorsign---painoninternalrotationofthehip(pelvicappendix)PhysicalExaminationPsoassign22LaboratoryStudiesTheaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsin?ofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.LaboratoryStudiesTheaverage23

ImagingstudiesPlainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.ImagingstudiesPlainabdomina24急性闌尾炎英文課件25A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection(arrow).BL,bladder;UT,uterus.A,CTscanoftheabdomendemo26EssentialsofdiagnosisAbdominalmigratorypainAnorexia,nauseaandvomitingLocalizedabdominaltendernessLow-gradefeverLeukocytosisEssentialsofdiagnosisAbdomin27DifferentialDiagnosesSometimes,thediagnosisofappendicitismaybedifficult.Mesentericlymphadenitis,gastrointestinalulcerperforationMeckel’sdiverticulitis,ectopicpregnancy,pelvicinflammatorydiseaseDifferentialDiagnosesSometime28Specialcategoryofappendicitisininfants，inchildren，inwemenduringpregnancy，inelderlypeopleinpatientsinfectedwithHIVSpecialcategoryofappendicit29ComplicationPerforationPeritonitisAppendicealabscesspylephlebitisComplicationPerforation30TreatmentSurgicaltreatment:Mostpatientswithacuteappendicitisaremanagedbypromptsurgicalremovaloftheappendix.(Appendectomy)Non-surgicaltreatment:EarlyStage,Objectiveconditionsarenotallowed,Seriousorganicdisease.(antibiotics)TreatmentSurgicaltreatment:31急性闌尾炎英文課件32急性闌尾炎英文課件33急性闌尾炎英文課件34TreatmentLaparoscopicappendectomyofferstheadvantageof:diagnosticlaparoscopyshorterrecoverylessconspicuous

incisionsTreatmentLaparoscopicappendec35SubjectivetothinkWhat’stheEssentialsofdiagnosisaboutacuteappendicitis?SubjectivetothinkWhat’sthe36AcuteappendicitisWangJunThesecondgeneralsurgicaldepartmentPeople’shospitalofyuxicityAcuteappendicitisWangJun37OutlinesGeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatmentOutlinesGeneralconsiderations38GeneralconsiderationsAbout8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%)GeneralconsiderationsAbout8%39GeneralconsiderationsAcuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.GeneralconsiderationsAcuteap40Historicalperspective

WillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.FitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatmentHistoricalperspectiveWillard41HistoricalperspectiveIn1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurney

describedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.HistoricalperspectiveIn1889,42HistoricalperspectiveInthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.HistoricalperspectiveInthe143急性闌尾炎英文課件44Anatomy＆physiologyThebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.Anatomy＆physiologyThebaseo45急性闌尾炎英文課件46急性闌尾炎英文課件47Pathophysiology

Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.PathophysiologyObstructionof48PathophysiologyObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressurePathophysiologyObstructionof49PathophysiologySubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.PathophysiologySubsequentimpa50PathophysiologyInflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.PathophysiologyInflammationof51Clinicalfindings

Clinicalfindings

Clinicalfindings

Clinicalfin52historyandsymptomAppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.historyandsymptomAppendiciti53

historyandsymptomTheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuria

historyandsymptomTheclassi54migratorypainmigratorypain55PhysicalExaminationLow-gradefeveriscommon(～38℃).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicus

ReboundtendernessVoluntaryguardingPhysicalExaminationLow-grade56PhysicalExaminationDunphy'ssign---coughingcauseincreasedpainRovsing'ssign

---painintherightlowerquadrantduringpalpationoftheleftlowerquadrantPhysicalExaminationDunphy'ss57PhysicalExaminationPsoassign---painonextensionoftherighthip(retrocecalappendix)Obturatorsign---painoninternalrotationofthehip(pelvicappendix)PhysicalExaminationPsoassign58LaboratoryStudiesTheaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsin?ofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.LaboratoryStudiesTheaverage59

ImagingstudiesPlainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.ImagingstudiesPlainabdomina60急性闌尾炎英文課件61A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection