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ACUTE APPENDICITIS

ACUTE APPENDICITIS. Presented by : Sara Shokri Moghaddam. 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.

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ACUTE APPENDICITIS

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  1. ACUTE APPENDICITIS Presented by : Sara ShokriMoghaddam

  2. 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.

  3. Anatomy & Function of appendix • Appendix is an immunologic organ that participate in the secretion of IGs., specially IgA.

  4. Incidence • ≈ 7 % of all people andergoes appendectomy during their life • More frequently in 2nd through 4th decades of life • M > F • The percentage of misdiagnosed cases of appendicitis is higher among women.

  5. 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 limphoidtissue,inspissatedbarium,tumor,vegetable and fruit seeds and intestinal parasites.

  6. 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

  7. Distention of appendix N/V occlusion of capillaries vascular congestion involvement of the serosa involvement of parietal peritoneum SHIFT in the PAIN to RLQ

  8. 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 & Bactroidfragilis.

  9. AB prophylaxis • Effective in prevention of wound infection and abcesses. • 24-48h in non perforated appendicitis. • 7-10D in perforated appendicitis.

  10. Clinical manifestations SYMPTOMS: • Abdominal pain • Shifting of pain to the RLQ • Anorexia • N/V • Sequence of symptoms: anorexia pain N/V(if accours)

  11. Clinical manifestations SIGNS: • Tendernes around Mcburney point • Rebound tenderness • Rovsing sign • Guarding • Obturator sign • Psoas sign

  12. Laboratory findings • Mild leukocytosis (10000 to 18000) • Several RBC or WBC can be present from ureteral or bladder irritation

  13. Imaging studies • Plain films of the abdomen • Barium enema examination and radioactively labeled leukocyte scans • Compression sonography • High resolution helical CT

  14. Differential Diagnosis • Acute mesenteric adenitis • PID • Ruptured graffian follicle • Twisted ovarian cyst • Ruptured EP • Acute gastroentritis • Meckle’s diverticulitis • Crohn’sentritis • Colonic lesions • Other diseas

  15. Treatment • Open appendectomy • Laparoscopic appendectomy • Natural orifice transluminatiom endoscopic surgery • Antibiotics • Interval appendectomy

  16. Incidental appendectomy • Childrens about to undergo chemotherapy • Disabled patient • Patients with crohn’s disease • The indivisual who are about to travel to remote places

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