急性阑尾炎英文课件

AcuteappendicitisWangJunThesecondgeneralsurgicaldepartmentPeople'shospitalofyuxicityOutlines?Generalconsiderations?Historicalperspective?Anatomy?Pathophysiology?Clinicalfindings?Diagnosis?TreatmentGeneralconsiderations?About8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.?Acuteappendicitisisthemostcommon

generalsurgicalemergency.(10%)Generalconsiderations?Acuteappendicitishasproteanmanifestations.?Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.?Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.Historicalperspective

?WillardPackardperformedthefirstsurgeryin1867.?In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.?FitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatmentHistoricalperspective?In1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.?In1894,McBurney

describedarightlowerquadrantmuscle-splittingincision

forremovaloftheappendix.Historicalperspective?Inthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.?In1982,Laparoscopicappendectomy

wasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.

Anatomy＆physiology?Thebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.?Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.Pathophysiology

?Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.?Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.Pathophysiology?Obstructionoftheappendiceallumen?Bacterialovergrowth?Continuedsecretionofmucus?IntraluminaldistentionandincreasedwallpressurePathophysiology?Subsequentimpairmentoflymphaticandvenousdrainage?mucosalischemia?Thesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.Pathophysiology?Inflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.?Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.?Clinicalfindings

Clinicalfindings

historyandsymptom?Appendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpain?Thetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.

historyandsymptom?Theclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitis?Feverensues,followedbythedevelopmentofleukocytosis?OccasionalpatientshaveurinarysymptomsormicroscopichematuriamigratorypainPhysicalExamination?Low-gradefeveriscommon(～38℃).?Diminishedbowelsounds?Focaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicus

?Reboundtenderness?VoluntaryguardingPhysicalExamination?Dunphy'ssign---coughingcauseincreasedpain?Rovsing'ssign

---painintherightlowerquadrantduringpalpationoftheleftlowerquadrantPhysicalExamination?Psoassign---painonextensionoftherighthip(retrocecalappendix)?Obturatorsign---painoninternalrotationofthehip(pelvicappendix)LaboratoryStudies?Theaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/L?Morethan75%neutrophilsin?ofpatients.?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?Abdominalmigratorypain?Anorexia,nauseaandvomiting?Localizedabdominaltenderness?Low-gradefever?Leukocytosis

DifferentialDiagnoses?Sometimes,thediagnosisofappendicitismaybedifficult.?Mesentericlymphadenitis,?gastrointestinalulcerperforation?Meckel'sdiverticulitis,

?ectopicpregnancy,?pelvicinflammatorydisease

Specialcategoryofappendicitis?ininfants，

?inchildren，

?inwemenduringpregnancy，

?inelderlypeople?i