阑尾炎

Appendicitis,Huimin Jia M.DDepartment of Pediatric Surgery Shengjing Hospital of China Medical University,Basic and Clinical Research of Anorectal Malformations,Research Field,Introduction,The most common condition leading to emergency abdominal operations in children and adolescents. The first references to a disease similar to appendicitis appeared 500 years ago.,Introduction,In 1886, Fitz demonstrated that perityphlitis began with inflammation of the appendix and coined the term appendicitis. So the paper by Charles McBurney in 1889 about the diagnosis and treatment of appendicitis remains a classic. The clinical findings and operative treatment of appendicitis were clearly established over 100 years ago. When was the first appendectomy? Answer:1735,Incidence,1/1000 children are diagnosed with appendicitis per year In the United States, more than 70,000 children are diagnosed with appendicitis one year.M:F 1-3.5:1,Embryology and Anatomy,Visible:8th week of gestation The exact location of varies widely. Length:0.3-33cm; diameter:5-10mm. Blood supply: appendiceal branch of the ileocolic artery. The base of the appendix arises at the junction of the three taeniac coli, a useful landmark in locating an elusive appendix.,Etiology,Appendicitis results from luminal obstruction followed by infection (mainly inspissated fecal material, edema caused by virus infection) of the appendiceal lumen is the prime cause of appendicitis.But the cause of the obstruction is not always clear. Fecaliths can be found in 20% children with app and are reported in 30-40% of children with perforated app.,Spectrum of disease,The peak incidence occurs between ages 11 and 12.The disorder is uncommon in infants. !Perforation is common.,Initially :Mild gastrointestinal symptom before the onset of pain, such as decreased appetite, indigestion, or subtle changes in bowel habits. Anorexia Early visceral pain is nonspecific in the periumbilical region.Nausea and Vomiting which typically follows the onset of pain within a few hours. Nausea is common, but vomiting is typically not severe. The appearance of these symptoms before the onset of pain casts doubt on the diagnosis.,Symptoms,Symptoms,Classic triadsPain FeverVomiting others,Diagnosis,HistoryPhysical examinationLaboratory studiesRadiologic studies,Diagnosis,History-abdominal pain *initial periumbilical and then right lower quadrant Children with app usually lie in bed with minimal movement,Diagnosis,HistoryPhysical examinationLaboratory studiesRadiologic studies,Diagnosis,Slight limp, hesitation to climb onto the examining table, inability to stretch the right leg Tenderness at the right lower quadrant of the abdomen, and guarding Peritonitis indicate perforation Perforation-temporary relief of symptoms as the pain of the distended viscus is relieved. Older children-an organized abscess The infants -diffuse peritonitis,Diagnosis,HistoryPhysical examinationLaboratory studiesRadiologic studies,Laboratory examination,WBC neutrophil countsCRP ,App score based on weighing eight clinical factors: localized right lower quadrant tenderness leukocytosis pain migration left shift fever nausea/vomiting anorexia peritoneal irritation,Diagnosis,HistoryPhysical examinationLaboratory studiesRadiologic studies,Plain radiography: helpful Fecaliths: 10%-20% of patients and an indication for surgery.Chest radiography: rule out pneumonia may be indicated.Barium enema contrast radiography may show absent or incomplete filling of the appendix. It is best used in the diagnosis of nonspecific abdominal pain.Ultrasonography:effective diagnostic aidCT has become more widely used in the diagnosis of app Useful diagnostic criteria: enlarged appendix ( 6mm); appendiceal wall thicking( 1mm), periappendiceal fat stranding and appendiceal wall enhancement. CT is more sensitive and US is more specific,Differential diagnosis,Differential diagnosis,Intestinal diseases- Mesenteric lymphadenitis Intestinal spasm viral and bacterial enteritis chronic inflammatory disease: ulcerative colitis and chrohns disease Meckels diverticulum intussuception,Differential diagnosis,Acute gastroenteritis viral illness self-limited watery diarrhea, crampy abdominal Pain, fever, nausea and vomitting Constipation Abdominal pain,nausea,and vomittingPain is usually persistent but not progressiveHistory and a plain radiography will suggest the diagnosis,Differential diagnosis,Uterine tubo-ovarian lesion salpingitis pregnancy ovarian cysts torsion tumor,Differential diagnosis,Urinary infection: fever nausea vomitting urinalysis should be obtainedSystemic diseases: purpura, rheumatic fever, jevenile diabetes, etc.Right lower lobe pneumonia,Treatment,Acute nonperforated appendicitis presents a surgical emenrgencyFor perforated appendicitis, ideal antibiotic should be used,Appendectomy,Endoscopic appendectomy,First described:1983Single portThree ports 3D,Treatment,In most children, the perforated appendix can be safely removed In patients whose appendix cannot be removed, drain tube should be placed in the appendiceal abscess, and the appendix was removed 4-8 weeks later,Appendiceal abscess,Primary non-operative treatment with antibiotics,Postoperative complications,W