医学急性阑尾炎英文培训课件

急性阑尾炎英文课件急性阑尾炎英文课件1OutlinesGeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatmentOutlinesGeneralconsiderations2GeneralconsiderationsAbout8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%)GeneralconsiderationsAbout8%3GeneralconsiderationsAcuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.GeneralconsiderationsAcuteap4Historicalperspective

WillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.FitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatmentHistoricalperspectiveWillard5HistoricalperspectiveIn1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurney

describedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.HistoricalperspectiveIn1889,6HistoricalperspectiveInthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.HistoricalperspectiveInthe17医学急性阑尾炎英文培训课件8Anatomy＆physiologyThebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.Anatomy＆physiologyThebaseo9医学急性阑尾炎英文培训课件10医学急性阑尾炎英文培训课件11Pathophysiology

Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.PathophysiologyObstructionof12PathophysiologyObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressurePathophysiologyObstructionof13PathophysiologySubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.PathophysiologySubsequentimpa14PathophysiologyInflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.PathophysiologyInflammationof15Clinicalfindings

Clinicalfindings

Clinicalfindings

Clinicalfin16historyandsymptomAppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.historyandsymptomAppendiciti17

historyandsymptomTheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuria

historyandsymptomTheclassi18migratorypainmigratorypain19PhysicalExaminationLow-gradefeveriscommon(～38℃).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicus

ReboundtendernessVoluntaryguardingPhysicalExaminationLow-grade20PhysicalExaminationDunphy'ssign---coughingcauseincreasedpainRovsing'ssign

---painintherightlowerquadrantduringpalpationoftheleftlowerquadrantPhysicalExaminationDunphy'ss21PhysicalExaminationPsoassign---painonextensionoftherighthip(retrocecalappendix)Obturatorsign---painoninternalrotationofthehip(pelvicappendix)PhysicalExaminationPsoassign22LaboratoryStudiesTheaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsin¾ofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.LaboratoryStudiesTheaverage23

ImagingstudiesPlainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.ImagingstudiesPlainabdomina24医学急性阑尾炎英文培训课件25A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection(arrow).BL,bladder;UT,uterus.A,CTscanoftheabdomendemo26EssentialsofdiagnosisAbdominalmigratorypainAnorexia,nauseaandvomitingLocalizedabdominaltendernessLow-gradefeverLeukocytosisEssentialsofdiagnosisAbdomin27DifferentialDiagnosesSometimes,thediagnosisofappendicitismaybedifficult.Mesentericlymphadenitis,gastrointestinalulcerperforationMeckel’sdiverticulitis,ectopicpregnancy,pelvicinflammatorydiseaseDifferentialDiagnosesSometime28Specialcategoryofappendicitisininfants，inchildren，inwemenduringpregnancy，inelderlypeopleinpatientsinfectedwithHIVSpecialcategoryofappendicit29ComplicationPerforationPeritonitisAppendiceala