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ACUTE APPENDICITIS

By :

Niloofar Azizi

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Appendicitis*About 8% of people in Western countries *Acute appendicitis is the most common general surgical emergency

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Embryology & Anatomy• The appendix, ileum, and

ascending colon are all derived from the midgut

• The appendix first appears at the 8th week of gestation

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• appendiceal artery, a branch of the ileocolic artery

• lymphatics drain into the anterior ileocolic lymph nodes

• length of the appendix varies from 2 to 20 cm, and the average is 9 cm in adults

• base of the appendix is located at the convrgence of the taeniae

• tip of the appendix may lie in a variety of locations

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Pathophysiology• Obstruction of the lumen • due to inspissated stool (fecalith

or appendicolith), lymphoid hyperplasia, vegetable matter or seeds, parasites, or a neoplasm

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• Obstruction →bacterial overgrowth & continued secretion of mucus →intraluminal distention &increased wall pressure → visceral pain sensation → impairment of lymphatic and venous drainage → mucosal ischemia → localized inflammatory process → gangrene & perforationan → abscess ,peritonitis & septic shock ,multiple intraperitoneal abscesses

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Bacteriology

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Diagnosis• History periumbilical pain → anorexia & nausea

→ The pain localizes to RLQ → vomiting → leukocytosis → Fever

urinary symptoms or microscopic hematuria

Adynamic ileus & absent bowel movements

Diarrhea Small bowel obstruction

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• Physical Examination look ill Low-grade fever diminished bowel sounds focal tenderness voluntary guarding Rovsing's sign obturator sign iliopsoas sign

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• Laboratory Studies White blood cell count is elevated with

more than 75% neutrophils Urinalysis

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Alvarado scoring

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• Radiography Plain abdominal radiographs Barium enema Ultrasonography Computed tomography (CT)

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• Diagnostic Laparoscopy

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Differential Diagnoses Intussusception Meckel's diverticulitis acute gastroenteritis mesenteric lymphadenitis Inflammatory bowel disease other regional inflammatory

conditions( pyelonephritis , colitis & diverticulitis)

Pelvic pathology (pelvic inflammatory disease (PID), tubo-ovarian abscess, ruptured ovarian cyst or ovarian torsion & ectopic pregnancy)

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Diagnostic Algorithm

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Treatment• laparoscopic • open

appendectomy

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Thank You