急性阑尾炎英文课件

AcuteappendicitisWangJunThesecondgeneralsurgicaldepartmentPeople’shospitalofyuxicityOutlinesGeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatmentGeneralconsiderationsAbout8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%)GeneralconsiderationsAcuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.HistoricalperspectiveWillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.FitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatmentHistoricalperspectiveIn1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurneydescribedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.HistoricalperspectiveInthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.Anatomy＆physiologyThebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.PathophysiologyObstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.PathophysiologyObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressurePathophysiologySubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.PathophysiologyInflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.ClinicalfindingsClinicalfindingshistoryandsymptomAppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.historyandsymptomTheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuriamigratorypainPhysicalExaminationLow-gradefeveriscommon(～38℃).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicusReboundtendernessVoluntaryguardingPhysicalExaminationDunphy'ssign---coughingcauseincreasedpainRovsing'ssign---painintherightlowerquadrantduringpalpationoftheleftlowerquadrantPhysicalExaminationPsoassign---painonextensionoftherighthip(retrocecalappendix)Obturatorsign---painoninternalrotationofthehip(pelvicappendix)LaboratoryStudiesTheaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsin¾ofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.ImagingstudiesPlainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection(arrow).BL,bladder;UT,uterus.EssentialsofdiagnosisAbdominalmigratorypainAnorexia,nauseaandvomitingLocalizedabdominaltendernessLow-gradefeverLeukocytosisDifferentialDiagnosesSometimes,thediagnosisofappendicitismaybedifficult.Mesentericlymphadenitis,gastrointestinalulcerperforationMeckel’sdiverticulitis,ectopicpregnancy,pelvicinflammatorydiseaseSpecialcategoryofappendicitisininfants，inchildren，inwemenduringpregnancy，inelderlypeopleinpatientsinfectedwithHIVComplicationPerforationPeritonitisAppendicealabscesspylephlebitisTreatmentSurgicaltreatment:Mostpatientswithacuteappendicitisaremanagedbypromptsurgicalremovaloftheappendix.(Appendectomy)Non-surgicaltreatment:EarlyStage,Objectiveconditionsarenotallowed,Seriousorganicdisease.(antibiotics)TreatmentLaparoscopicappendectomyofferstheadvantageof:diagnosticlaparoscopyshorterrecoverylessconspicuousincisionsSubjectivetothinkWhat’stheEssentialsofdi