Acute Appendicitis

The most common acute surgical condition of the abdomen

Anatomy, Pathophysiology, Clinical Diagnosis and Principles of Treatments

Anatomy

Vermiform

Right lower quadrant

Rises from cecum

6 to 10 cmMesoappendix

Appendicular A. & V.

Many lymph follicles

Anatomy (various position)

Pelvic

Retrocecal

Retroileal

Left lower quadrant

Right lower quadrant

Etiology and Pathogenesis

Obstruction of the lumen

Hypertrophy of lymphoid follicles

Fecaliths

Foreign bodies

Inflammatory strictions

OthersFever, tachycardia, and leukocytosis

Vein

Continuing secretion &Bacteria multiplication

Intraluminal pressure increases

Impairment of blood supply & endotoxins

PainDistention

Artery

Engorgement

Mucosa damaging

Bacterial invasion

Serosa involved

Ellipsoidal infarcts

Characteristic shift in pain to RLQ

Perforation Abscess

Generalized peritonitis

Nausea & vomiting

• History• Physical findings• Laboratory examinations

Clinical Diagnosis

Symptoms

•Abdominal pain

Typical shifting abdominal pain•Anorexia

•VomitingGeneralized

Clinical Diagnosis

Lower epigastrium

Umbilical area

Right lower quadrant

very constant

after the onset of painThe sequence of symptoms

Abdominal pain→Anorexia & Vomiting (if happens)

•Obstipation, Diarrhea

VariationsLeft lower quadrant Long appendix

Flank or back pain Retrocecal appendix

Suprapubic pain Pelvic appendix

Testicular pain Retroileal appendix

Malrotation puzzling pain patterns

Clinical Diagnosis

Signs

• Vital signs T, P normal or slightly elevated

• Somatic Position lie supine, thighs drawn up

• Classic RLQ signs–Tenderness at or around McBurney’s point

–Rovsing’s sign–Psoas sign–Obturator sign–Rectal examination

–Rebound tenderness –Cutaneous hyperesthesia–Muscular resistance

• Variations

Clinical Diagnosis

• Laboratory Findings

– Leukocytosis– Urinalysis– Radiographic studies

• Plain films of the abdomen

• Ultrasonography

• CT

– Laparoscopy

Essentials of Diagnosis

• Shifting abdominal pain

• Gastrointestinal symptoms

• Localized abdominal tenderness

• Leukocytosis

• Systemic symptoms

Differential Diagnosis

• Adult– Acute gastroenteritis– Cholecystitis– Pyelitis– Salpingitis– Tubo-ovarian abscess– Ruptured ovarian cyst

• Young children– Mesenteric adenitis– Intussusception

Principles of Treatments

• Appendectomy

• Antibiotics

• Laparoscopic Appendectomy

• Nonoperative therapy

Acute Appendicitis

• Anatomy

• Pathophysiology

• Clinical Diagnosis

• Principles of Treatments

Thank you