阑尾炎英文专题知识

阑尾炎英文专题知识阑尾炎英文专题知识第1页阑尾炎英文专题知识第2页Anatomy阑尾炎英文专题知识第3页VariedanatomyLength:5~10cm,narrowlumenhaustraofcolon阑尾炎英文专题知识第4页EpidemiologyThemostcommonacuteabdomendiseaseTheincidenceofappendectomyappearstobedecliningduetomoreaccuratepreoperativediagnosis.Despitenewerimagingtechniques,acuteappendicitiscanbeverydifficulttodiagnose.阑尾炎英文专题知识第5页PathophisiologySimpleappendicitisSuppurativeappendicitisGangrenousappendicitisPerforatedappendicitisPeritonitisAbscessaroundtheappendixMucoceleofappendix阑尾炎英文专题知识第6页PathophysiologyAcuteappendicitisisthoughttobeginwithobstructionofthelumenObstructioncanresultfromfoodmatter,adhesions,orlymphoidhyperplasiaAppendixistwisted,andLumenofappendixisnarrow,resultinobstructionMucosalsecretionscontinuetoincreaseintraluminalpressure阑尾炎英文专题知识第7页Etiology1.Theanatomycharacteristics2.Thetissuefeatures3.fecality,foreignbodyobstruction4.Parasitescausethemucosadamage5.adhesion,pressurecauseappendixdistortedObstruction→highpressure→limphobstructed,ischemia→mucosadamage→bacteriainvade（70%～80%）阑尾炎英文专题知识第8页ArteryTheappendixarteryhasnobranches,iseasilytobeobstacled阑尾炎英文专题知识第9页EtiologyEventuallythepressureexceedscapillaryperfusionpressureandvenousandlymphaticdrainageareobstructed.Withvascularcompromise,epithelialmucosabreaksdownandbacterialinvasionbybowelfloraoccurs.microbes：Ecoli,streptococcus,Pseudomonas,anaerobe阑尾炎英文专题知识第10页EtiologyIncreasedpressurealsoleadstoarterialstasisandtissueinfarctionEndresultisperforationandspillageofinfectedappendicealcontentsintotheperitoneum阑尾炎英文专题知识第11页PathophysiologyInitialluminaldistentiontriggersvisceralafferentpainfibers,whichenteratthe10ththoracicvertebrallevel.Thispainisgenerallyvagueandpoorlylocalized.Painistypicallyfeltintheperiumbilicalorepigastricarea.阑尾炎英文专题知识第12页PathophysiologyAsinflammationcontinues,theserosaandadjacentstructuresbecomeinflamedThistriggerssomaticpainfibers,innervatingtheperitonealstructuresTypicallycausingpainintheRLQ阑尾炎英文专题知识第13页PathophysiologyThechangeinstimulationformvisceraltosomaticpainfibersexplainstheclassicmigrationofpainintheperiumbilicalareatotheRLQseenwithacuteappendicitis.阑尾炎英文专题知识第14页PathophysiologyExceptionsexistintheclassicpresentationduetoanatomicvariabilityoftheappendixAppendixcanberetrocecalcausingthepaintolocalizetotherightflankInpregnancy,theappendixcanbeshiftedandpatientscanpresentwithRUQpain阑尾炎英文专题知识第15页PathophysiologyInsomemales,retroilealappendicitiscanirritatetheureterandcausetesticularpain.Pelvicappendixmayirritatethebladderorrectumcausingsuprapubicpain,painwithurination,orfeelingtheneedtodefecateMultipleanatomicvariationsexplainthedifficultyindiagnosingappendicitis阑尾炎英文专题知识第16页ManifestationsPrimarysymptom:abdominalpain½to2/3ofpatientshavetheclassicalpresentationPainbeginninginepigastriumorperiumbilicalareathatisvagueandhardtolocalize阑尾炎英文专题知识第17页ManifestationsAstheillnessprogressesRLQlocalizationtypicallyoccursRLQpainwas81%sensitiveand53%specificfordiagnosisMigrationofpainfrominitialperiumbilicaltoRLQwas64%sensitiveand82%specific阑尾炎英文专题知识第18页ManifestationsAssociatedsymptoms:indigestion,discomfort,flatus,needtodefecate,anorexia,nausea,vomitingAnorexiaisthemostcommonofassociatedsymptomsVomitingismorevariable,occuringinabout½ofpatients阑尾炎英文专题知识第19页PhysicalExamFindingsdependondurationofillnesspriortoexam.EarlyonpatientsmaynothavelocalizedtendernessWithprogressionthereistendernesstodeeppalpationoverMcBurney’spoint阑尾炎英文专题知识第20页PhysicalExamRovsing’ssign:paininRLQwithpalpationtoLLQObturatorsign:passivelyflextheRhipandkneeandinternallyrotatethehip.Ifthereisincreasedpainthenthesignispositive阑尾炎英文专题知识第21页PhysicalexamPsoassign:placepatientinLlateraldecubitusandextendRlegatthehip.Ifthereispain,thesignispositive.Rectalexam:paincanbemostpronouncedifthepatienthaspelvicappendix阑尾炎英文专题知识第22页PhysicalExamAdditionalcomponentsthatmaybehelpfulindiagnosis:reboundtenderness,voluntaryguarding,muscularrigidity,tendernessonrectalFever:anotherlatefinding.Attheonsetofpainfeverisusuallynotfound.Temperatures>39Careuncommoninfirst24h,butcommonafterrupture阑尾炎英文专题知识第23页DiagnosisAcuteappendicitisshouldbesuspectedinanyonewithepigastric,periumbilical,rightflank,orrightsidedabdpainwhohasnothadanappendectomyWomenofchildbearingageneedapelvicexamandapregnancytest.Additionalstudies:CBC,UA,imagingstudies阑尾炎英文专题知识第24页DiagnosisTheWBCisoflimitedvalue.SensitivityofanelevatedWBCis70-90%,butspecificityisverylow.But,+predictivevalueofhighWBCis92%and–predictivevalueis50%CRPandESRhavebeenstudiedwithmixedresults阑尾炎英文专题知识第25页DiagnosisImagingstudies:includeX-rays,US,CTXraysofabdareabnormalin24-95%Abnormalfindingsinclude:fecalith,appendicealgas,localizedparalyticileus,blurredrightpsoas,andfreeairAbdominalxrayshavelimiteduse:forthefindingsareseeninmultipleotherprocesses阑尾炎英文专题知识第26页DiagnosisLimitationsofUS:retrocecalappendixmaynotbevisualized,perforationsmaybemissedduetoreturntonormaldiameter阑尾炎英文专题知识第27页DiagnosisCT:bestchoicebasedonavailabilityandalternativediagnoses.Inonestudy,CThadgreatersensitivity,accuracy,-predictivevalue阑尾炎英文专题知识第28页SpecialPopulationsVeryyoung,veryold,pregnant,andHIVpatientspresentatypicallyandoftenhavedelayeddiagnosisHighindexofsuspicionisneededinthethesegroupstogetanaccuratediagnosis阑尾炎英文专题知识第29页TreatmentAppendectomyisthestandardofcarePatientsshouldbegivenIVF,andpreoperativeantibioticsAntibioticsaremosteffectivewhengivenpreoperativelyandtheydecreasepost-opinfectionsandabscessformation阑尾炎英文专题知识第30页TreatmentTherearemultipleacceptableantibioticstouseaslongthereisanaerobicflora,enterococciandgram(-)intestinalfloracoverageOnesamplemonotherapyregimenisZosyn3.375gorUnasyn3gAlso,shortactingnarcoticsshouldbeusedforpain