七年制医学课件 普外 15ActueAppendicites.pptVIP

Acute Appendicitis an acute inflammation of appendix Remains one of the most common acute surgical diseases Roughly parallels that of lymphoid development, with the peak incidence in early adulthood 100/100,000(1975) to 52/100,000(1991) Approximately 7% of individuals in western countries develop appendicitis at sometime during their lives,and about 200,000 appendectomies for acute appendicitis are performed annually in the USA. The rate of normal appendectomy averages 16%(68% female) The appendix, like a earthworm, is a structure connected to the cecum, its average length is 5-10 cm and it is 0.5-0.7 cm in diameter. An immunologic organ which actively participates in the secretion of IgA Obstruction of the lumen: the dominant causal factor Fecaliths hypertrophy of lympoid tissue inspissated barium from previous x-ray studies vegetable and fruit seeds intestinal worms, particularly ascarids Bacteriology A variety of anaerobes, aerobes, or facultative bacteria have been cultured from peritoneal fluid, abscess contents, and appendiceal tissue in patients with gangrenous of perforated appendicitis. An average of 10 different organisms were recovered per specimen.  Clinical manifestation SymptomsAbdominal painAnorexiaVomiting Variations in the anatomic location of the appendix account for many of the variations in the principal locus of the somatic phase of the pain. For example, a long appendix with the inflamed tip in the left lower quadrant causes pain in that area Clinical manifestation Signs Physical findings are determined by the anatomic position of the inflamed appendix as well as by whether the organ has already ruptured when the patient is first examined A positive Obturator sign of hypogastric pain on stretching the obturator internus indicates irritation at that locus. The test is performed by passive internal rotation of the flexed right thigh with the patient supine Urinalysis can be useful to rule out the urinary tract as