1、OutlinesGeneral considerationsHistorical perspectiveAnatomyPathophysiology Clinical findings DiagnosisTreatment1急性闌尾炎英文10/12/2022General considerationsAbout 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.Acute

2、appendicitis is the most common general surgical emergency.(10%)2急性闌尾炎英文10/12/2022General considerationsAcute appendicitis has protean manifestations.It may simulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions. Progression of symptoms and signs is

3、the rule in contrast to the fluctuating course of some other diseases.3急性闌尾炎英文10/12/2022Historical perspective Willard Packard performed the first surgery in 1867.In 1886,Reginald Fitz described the characteristic,clinical findings and pathology of the disease,identified the appendix as the primary

4、cause of right lower quadrant inflammation. Fitz coined the term appendicitis and recommended early surgical treatment4急性闌尾炎英文10/12/2022Historical perspectiveIn 1889, Chester McBurney described characteristic migratory pain as well as localization of the pain along an oblique line from the anterior

5、superior iliac spine to the umbilicus. In 1894, McBurney described a right lower quadrant muscle-splitting incision for removal of the appendix.5急性闌尾炎英文10/12/2022Historical perspectiveIn the 1940s,the mortality rate from appendicitis improved with the widespread use of broad-spectrum antibiotics. In

6、 1982, Laparoscopic appendectomy was first reported by the gynecologist Kurt Semm but has only gained widespread acceptance in recent years.6急性闌尾炎英文10/12/20227急性闌尾炎英文10/12/2022Anatomy physiologyThe base of the appendix is located at the convergence of the taeniae(3) of colon. This anatomic relations

7、hip facilitates identification and location of the appendix at operation. 8急性闌尾炎英文10/12/20229急性闌尾炎英文10/12/202210急性闌尾炎英文10/12/2022Pathophysiology Obstruction of the lumen is believed to be the major cause of acute appendicitis. This may be due to lymphoid hyperplasia, inspissated stool, fecalith, veg

8、etable matter or seeds, parasites, or a neoplasm.11急性闌尾炎英文10/12/2022PathophysiologyObstruction of the appendiceal lumen Bacterial overgrowth Continued secretion of mucus Intraluminal distention and increased wall pressure 12急性闌尾炎英文10/12/2022PathophysiologySubsequent impairment of lymphatic and venou

9、s drainage mucosal ischemia These findings in combination promote a localized inflammatory process that may progress to gangrene and perforation.13急性闌尾炎英文10/12/2022PathophysiologyInflammation of the adjacent peritoneum gives rise to localized pain in the right lower quadrant.Perforation typically oc

10、curs 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急性闌尾炎英文10/12/2022Clinical findingsClinical findings15急性闌尾炎英文10/12/2022history and symptomAppendicitis needs to be considered in the differential diagnosis o

11、f nearly every patient with acute abdominal pain The typical presentation begins with vague peri-umbilical pain followed by anorexia,nausea and vomiting. Then localizes to the right lower quadrant. 16急性闌尾炎英文10/12/2022history and symptomThe classic pattern of migratory pain is the most reliable sympt

12、om of acute appendicitis Fever ensues, followed by the development of leukocytosis Occasional patients have urinary symptoms or microscopic hematuria17急性闌尾炎英文10/12/2022migratory pain18急性闌尾炎英文10/12/2022Physical ExaminationLow-grade fever is common(38).Diminished bowel sounds Focal tenderness (commonl

13、y at McBurneys point ) -located one third of the distance along a line drawn from the anterior superior iliac spine to the umbilicus Rebound tendernessVoluntary guarding19急性闌尾炎英文10/12/2022Physical ExaminationDunphys sign -coughing cause increased pain Rovsings sign -pain in the right lower quadrant

14、during palpation of the left lower quadrant 20急性闌尾炎英文10/12/2022Physical ExaminationPsoas sign -pain on extension of the right hip (retrocecal appendix) Obturator sign -pain on internal rotation of the hip (pelvic appendix) 21急性闌尾炎英文10/12/2022Laboratory StudiesThe average leukocyte count is 15*109/L,

15、and 90% of patient have count over 10*109/LMore than 75% neutrophils in of patients.A completely normal leukocyte count and differential is found in about 10% of patients. 22急性闌尾炎英文10/12/2022 Imaging studiesPlain abdominal films:may be useful for the detection of ureteral calculi, small bowel obstru

16、ction, or perforated ulcer, but such conditions are rarely confused with appendicitis.Ultrasonography and CT scan: be helpful in patients with atypical symptoms ,such as children and elderly person.23急性闌尾炎英文10/12/202224急性闌尾炎英文10/12/2022A, CT scan of the abdomen demonstrates an edematous, thickened a

17、ppendix (arrow) with obstructing appendicolith (arrowhead). B, CT scan of abdomen demonstrates a perforated appendix with a complex abscess and pelvic fluid collection (arrow). BL, bladder; UT, uterus.25急性闌尾炎英文10/12/2022Essentials of diagnosisAbdominal migratory pain Anorexia,nausea and vomitingLoca

18、lized abdominal tendernessLow-grade feverLeukocytosis 26急性闌尾炎英文10/12/2022Differential DiagnosesSometimes,the diagnosis of appendicitis may be difficult.Mesenteric lymphadenitis,gastrointestinal ulcer perforationMeckels diverticulitis, ectopic pregnancy,pelvic inflammatory disease27急性闌尾炎英文10/12/2022Special category of appendicitisin infants，in children，in wemen during pregnancy，in elderly people in patients infected with HIV28急性闌尾炎英文10/12/2022ComplicationPerforationPeritonitis