acute appendicitis by : niloofar azizi 1. appendicitis *about 8% of people in western countries...
Post on 26-Dec-2015
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Appendicitis*About 8% of people in Western countries *Acute appendicitis is the most common general surgical emergency
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Embryology & Anatomy• The appendix, ileum, and
ascending colon are all derived from the midgut
• The appendix first appears at the 8th week of gestation
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• appendiceal artery, a branch of the ileocolic artery
• lymphatics drain into the anterior ileocolic lymph nodes
• length of the appendix varies from 2 to 20 cm, and the average is 9 cm in adults
• base of the appendix is located at the convrgence of the taeniae
• tip of the appendix may lie in a variety of locations
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Pathophysiology• Obstruction of the lumen • due to inspissated stool (fecalith
or appendicolith), lymphoid hyperplasia, vegetable matter or seeds, parasites, or a neoplasm
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• Obstruction →bacterial overgrowth & continued secretion of mucus →intraluminal distention &increased wall pressure → visceral pain sensation → impairment of lymphatic and venous drainage → mucosal ischemia → localized inflammatory process → gangrene & perforationan → abscess ,peritonitis & septic shock ,multiple intraperitoneal abscesses
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Diagnosis• History periumbilical pain → anorexia & nausea
→ The pain localizes to RLQ → vomiting → leukocytosis → Fever
urinary symptoms or microscopic hematuria
Adynamic ileus & absent bowel movements
Diarrhea Small bowel obstruction
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• Physical Examination look ill Low-grade fever diminished bowel sounds focal tenderness voluntary guarding Rovsing's sign obturator sign iliopsoas sign
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• Laboratory Studies White blood cell count is elevated with
more than 75% neutrophils Urinalysis
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Differential Diagnoses Intussusception Meckel's diverticulitis acute gastroenteritis mesenteric lymphadenitis Inflammatory bowel disease other regional inflammatory
conditions( pyelonephritis , colitis & diverticulitis)
Pelvic pathology (pelvic inflammatory disease (PID), tubo-ovarian abscess, ruptured ovarian cyst or ovarian torsion & ectopic pregnancy)
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