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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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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. • most common cause of acute abdomen in young adult.
Surgical anatomy • Size: 8 – 10 cm. • Positions: • Retrocaecal • Paracaecal • Subcaecal • Pelvic • Pre ileal and post ileal
Surgical anatomy Blood supply branch of ileocolic artery Lymphatic drainage
Acute appendicitis • Definition • Acute inflammation of apendix is called acute appedecitis
Etiology • Age • Racial factor • Familial susceptability • Dietary factor • Socio economic status • Obstruction • Bacterial inflamation
Pathology • Non obstructive • Obstructive • Mucosal ulceration and lymphoid hyperplasia------ narrow lumen ------ closed loop---- increased intraluminal pressure---- venus obstruction and
Pathology contin----- ischemia---- bacterial invasion---- acute appendicitis necrosis ----- gangrene ----- perforation ------ peritoneal conaimintion. Alternatively, greater omentum + small gut ----- walling off peritoneal contamination phlegmonous mass.
Clinical features • Symptoms • Pain: Sever, colicky, paraumblical or RIF. • Nausea/vomiting • Fever • Anorexia • Constipation • Diarrhea • Haematuria
Signs • Pyrexia • Pointing sign • Cough tenderness • ON EXAMINATION • Tenderness Muscle gaurding • Rebond tenderness Rovsing sign • Psoas sign Obturator sign • Tenderness in right rectal wall.
Investigations • Routine • FBC raised TLC • Urine R/E • Viral profile • Special condition • Pregnancy test • Urea & electrolytes • X-ray abd • USG Abd / Pelvis • CT Scan
D/D • CHILDREN • Enterocolitis • Meckels diverticulum • Mesenteric lymphadenitis • HSP • Lobar pneumonia
D/D contin---- • ADULTS • Enterocolitis • Rt ureteric colic • Torsion of undescended testis • Pancreatitis
D/D contin---- • ADULTS FEMALE • Mid cycle pain • PID • Pylonephrotis • Ectopic pregnancy • Ruptured ovarian cyst
D/D contin---- • ELDERLY • Diverticulitis • Intestinal obstruction • Colonic tumor
Treatment • Surgical Rx: Appendicectomy • Pre op Rx • I/V fluids • Abx • Pain killers
Appendicectomy • Open Laproscopic • Anaesthesia • GA
Incisions for open appendicectomy • Grid iron • Rutherford morison • Lanz • Lower midline • Para median
Laproscopic appendicectomy • Triport method • Laproscopic tissue holding forcep • Disecting forcep • Camera