急性阑尾炎英文课件

Acuteappendicitis,WangJunThesecondgeneralsurgicaldepartmentPeopleshospitalofyuxicity,Outlines,GeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatment,Generalconsiderations,About8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%),Generalconsiderations,Acuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistheruleincontrasttothefluctuatingcourseofsomeotherdiseases.,Historicalperspective,WillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.Fitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatment,Historicalperspective,In1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurneydescribedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.,Historicalperspective,Inthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.,Anatomyphysiology,Thebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.,Pathophysiology,Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.,Pathophysiology,ObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressure,Pathophysiology,SubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.,Pathophysiology,Inflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.,Clinicalfindings,Clinicalfindings,historyandsymptom,AppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.,historyandsymptom,TheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuria,migratorypain,PhysicalExamination,Low-gradefeveriscommon(38).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurneyspoint)-locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicusReboundtendernessVoluntaryguarding,PhysicalExamination,Dunphyssign-coughingcauseincreasedpainRovsingssign-painintherightlowerquadrantduringpalpationoftheleftlowerquadrant,PhysicalExamination,Psoassign-painonextensionoftherighthip(retrocecalappendix)Obturatorsign-painoninternalrotationofthehip(pelvicappendix),LaboratoryStudies,Theaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsinofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.,Imagingstudies,Plainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.,A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection(arrow).BL,bladder;UT,uterus.,Essentialsofdiagnosis,AbdominalmigratorypainAnorexia,nauseaandvomitingLocalizedabdominaltendernessLow-gradefeverLeukocytosis,DifferentialDiagnoses,Sometimes,thediagnosisofappendicitismaybedifficult.Mesentericlymphadenitis,gastrointestinalulcerperforationMeckelsdiverticulitis,ectopicpregnancy,pelvicinflammatorydisease,Specialcategoryofappendicitis,ininfants，inchildren，inwemenduringpregnancy，inelderlypeopleinpatientsinfectedwithHIV,Complication,PerforationPeritonitisAppendicealabscesspylephlebitis,Treatment,Surgicaltreatment:Mostpatientswithacuteappendicitisaremanagedbypromptsurgicalremovaloftheappendix.(Appendectomy)Non-surgicaltreatment:EarlyStage,Objecti