外科-阑尾炎.pptVIP

LOGO APPENDICITIS Anatomy of appendix Variable position McBurney’s point： one-third of the distance from the anterior superior iliac spine to the umbilicus The taenia of the cecum lead to the base of the appendix Anatomy of appendix appendiceal artery an end artery arising from ileocolic artery gangrene necrosis appendiceal V→ ileocolic V→ superior mesenteric V→ portal V pylephlebitis and liver abscess visceral afferent pain fibers producing vague, dull, diffuse pain in the mid abdomen or lower epigastrium When the inflammation spread to the peritoneum around the appendix, the somatic nerve can produce precise pain in the right lower quadrant. Acute appendicitis Most common surgical emergency Can happened at any age, Peak incidence in the 10- to 20-years-old age group The prognosis is usually very good. BUT，sometimes, the diagnosis may be very difficult, and improper treatment can cause a number of serious complications. Pathogenesis Obstruction of the lumen Fecalith lymphoid hyperplasia food residues, roundworm distorted, folding, strapping, mass oppression inflammation, tumors and polyps bacterial invasion （ Gram-negative bacteria and anaerobes） Pathology acute simple appendicitis Mild, early. Mild swelling, congestion, a small amount of leakage. neutrophil infiltration. less serious. acute suppurative or phlegmonous appendicitis Swelling Obviously, high degree of congestion, purulent exudation. small abscess. heavier. acute gangrenous and perforated appendicitis Wall necrosis. Perforation in the root or end, acute diffuse peritonitis. periappendicural absecess Omentum adhesion and wrap Prognosis localized Septic, gangrene or perforated appendicitis,wrapped by omentum,periappendicural abscess forms.Healing slowly. alleviated Some simple appendicitis after timely medical treatment. the majority chronic appendicitis, easy to relapse. Acute appendicitis spreading heavy,rapid development, failed to surgical resection,can not be wr