急性阑尾炎英文培训课件

OutlinesnGeneral considerationsnHistorical perspectivenAnatomynPathophysiology nClinical findings nDiagnosisnTreatment1急性阑尾炎英文6/19/2024OutlinesGeneral considerations1General considerationsnAbout 8%of people in Western countries have appendicitis at some time during their life,with a peak incidence between 10 and 30 years of age.nAcute appendicitis is the most common general surgical emergency.(10%)2急性阑尾炎英文6/19/2024General considerationsAbout 8%2General considerationsnAcute appendicitis has protean manifestations.nIt may simulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions.nProgression of symptoms and signs is the rule in contrast to the fluctuating course of some other diseases.3急性阑尾炎英文6/19/2024General considerationsAcute ap3Historical perspective nWillard Packard performed the first surgery in 1867.nIn 1886,Reginald Fitz described the characteristic,clinical findings and pathology of the disease,identified the appendix as the primary cause of right lower quadrant inflammation.nFitz coined the term appendicitis and recommended early surgical treatment4急性阑尾炎英文6/19/2024Historical perspective Willard4Historical perspectivenIn 1889,Chester McBurney described characteristic migratory pain as well as localization of the pain along an oblique line from the anterior superior iliac spine to the umbilicus.nIn 1894,McBurney described a right lower quadrant muscle-splitting incision for removal of the appendix.5急性阑尾炎英文6/19/2024Historical perspectiveIn 1889,5Historical perspectivenIn the 1940s,the mortality rate from appendicitis improved with the widespread use of broad-spectrum antibiotics.nIn 1982,Laparoscopic appendectomy was first reported by the gynecologist Kurt Semm but has only gained widespread acceptance in recent years.6急性阑尾炎英文6/19/2024Historical perspectiveIn the 167急性阑尾炎英文6/19/20247急性阑尾炎英文7/28/20237Anatomy physiologynThe base of the appendix is located at the convergence of the taeniae(3)of colon.nThis anatomic relationship facilitates identification and location of the appendix at operation.8急性阑尾炎英文6/19/2024Anatomy physiologyThe base o89急性阑尾炎英文6/19/20249急性阑尾炎英文7/28/2023910急性阑尾炎英文6/19/202410急性阑尾炎英文7/28/202310Pathophysiology nObstruction of the lumen is believed to be the major cause of acute appendicitis.nThis may be due to lymphoid hyperplasia,inspissated stool,fecalith,vegetable matter or seeds,parasites,or a neoplasm.11急性阑尾炎英文6/19/2024Pathophysiology Obstruction of11PathophysiologynObstruction of the appendiceal lumen nBacterial overgrowth nContinued secretion of mucus nIntraluminal distention and increased wall pressure 12急性阑尾炎英文6/19/2024PathophysiologyObstruction of 12PathophysiologynSubsequent impairment of lymphatic and venous drainage nmucosal ischemia nThese findings in combination promote a localized inflammatory process that may progress to gangrene and perforation.13急性阑尾炎英文6/19/2024PathophysiologySubsequent impa13PathophysiologynInflammation of the adjacent peritoneum gives rise to localized pain in the right lower quadrant.nPerforation typically occurs after at least 48 hours from the onset of symptoms and is accompanied by an abscess cavity walled-off by the small intestine and omentum.14急性阑尾炎英文6/19/2024PathophysiologyInflammation of14nClinical findingsClinical findings15急性阑尾炎英文6/19/2024Clinical findingsClinical fin15history and symptomnAppendicitis needs to be considered in the differential diagnosis of nearly every patient with acute abdominal pain nThe typical presentation begins with vague peri-umbilical pain followed by anorexia,nausea and vomiting.Then localizes to the right lower quadrant.16急性阑尾炎英文6/19/2024history and symptomAppendiciti16history and symptomnThe classic pattern of migratory pain is the most reliable symptom of acute appendicitis nFever ensues,followed by the development of leukocytosis nOccasional patients have urinary symptoms or microscopic hematuria17急性阑尾炎英文6/19/2024history and symptomThe classi17migratory pain18急性阑尾炎英文6/19/2024migratory pain18急性阑尾炎英文7/28/2018Physical ExaminationnLow-grade fever is common(38).nDiminished bowel sounds nFocal tenderness(commonly at McBurneys point)-located one third of the distance along a line drawn from the anterior superior iliac spine to the umbilicus nRebound tendernessnVoluntary guarding19急性阑尾炎英文6/19/2024Physical ExaminationLow-grade 19Physical ExaminationnDunphys sign -coughing cause increased pain nRovsings sign -pain in the right lower quadrant during palpation of the left lower quadrant 20急性阑尾炎英文6/19/2024Physical ExaminationDunphys s20Physical ExaminationnPsoas sign -pain on extension of the right hip(retrocecal appendix)nObturator sign -pain on internal rotation of the hip (pelvic appendix)21急性阑尾炎英文6/19/2024Physical ExaminationPsoas sign21Laboratory StudiesnThe average leukocyte count is 15*109/L,and 90%of patient have count over 10*109/LnMore than 75%neutrophils in of patients.nA completely normal leukocyte count and differential is found in about 10%of patients.22急性阑尾炎英文6/19/2024Laboratory StudiesThe average 22 Imaging studiesnPlain abdominal films:may be useful for the detection of ureteral calculi,small bowel obstruction,or perforated ulcer,but such conditions are rarely confused with appendicitis.nUltrasonography and CT scan:be helpful in patients with atypical symptoms,such as children and elderly person.23急性阑尾炎英文6/19/2024 Imaging studiesPlain abdomina2324急性阑尾炎英文6/19/202424急性阑尾炎英文7/28/202324nA,CT scan of the abdomen demonstrates an edematous,thickened appendix(arrow)with obstructing appendicolith(arrowhead).nB,CT scan of abdomen demonstrates a perforated appendix with a complex abscess and pelvic fluid collection(arrow).BL,bladder;UT,uterus.25急性阑尾炎英文6/19/2024A,CT scan of the abdomen demo25Essentials of diagnosisnAbdominal migratory pain nAnorexia,nausea and vomitingnLocalized abdominal tendernessnLow-grade fevernLeukocytosis 26急性阑尾炎英文6/19/2024Essentials of diagnosisAbdomin26Differential DiagnosesnSometimes,the diagnosis of appendicitis may be difficult.nMesenteric lymphadenitis,ngastrointestinal ulcer perforationnMeckels diverticulitis,nectopic pregnancy,npelvic inflammatory disease27急性阑尾炎英文6/19/2024Differential DiagnosesSometime27Special category of appendicitisnin infants，nin children，nin wemen during pregnancy，nin elderly people nin patients infected with HIV28急性阑尾炎英文6/19/2024Special category of appendicit28ComplicationnPerforationnPeritonitisnAppendiceal abscessnpylephlebitis29急性阑尾炎英文6/19/2024ComplicationPerforation29急性阑尾炎29TreatmentnSurgical treatment:Most patients with acute appendicitis are managed by prompt surgical removal of the appendix.(Appendectomy)nNon-surgical treatment:Early Stage,Objective conditions are not allowed,Serious organic disease.(antibiotics)30急性阑尾炎英文6/19/2024TreatmentSurgical treatment:3031急性阑尾炎英文6/19/202431急性阑尾炎英文7/28/20233132急性阑尾炎英文6/19/202432急性阑尾炎英文7/28/20233233急性阑尾炎英文6/19/202433急性阑尾炎英文7/28/202333TreatmentnLaparoscopic appendectomy offers the advantage of:diagnostic laparoscopy shorter recovery less conspicuous incisions34急性阑尾炎英文6/19/2024TreatmentLaparoscopic appendec34Subjective to thinknWhats the Essentials of diagnosis about acute appendicitis?35急性阑尾炎英文6/19/2024Subjective to thinkWhats the 35