外科-阑尾炎PPT.ppt

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） etiology Symptoms Migration of pain from the periumbilical area to the right lower quadrant of the abdomen ：70～80％ Ectopic appendix retrocecal →right flank pelvic →suprapubic area subhepatic→right upper quadrant left abdominal→left lower quadrant characteristic of abdominal pain dull pain-- simple paroxysmal colic or distending pain-- suppurative persistent pain– gangrenous progressed abdominal pain - peritonitis Abdominal pain Symptoms Gastrointestinal symptoms Nausea, vomiting and diarrhea Pelvic appendicitis → stimulate the rectum and bladder → tenesmus(里急后重) Diffuse peritonitis → intestinal paralysis Systemic symptoms weakness fever, approximately 38 ℃ , higher temperature →perforation heart rate increased Sign Right lower quadrant tenderness The most c