XX医院阑尾炎教学.pptVIP

1. Gastric or duodenal ulcer Perforation? History of peptic ulcer. ? Sudden onset and not a shifting pain. ? Pain: rarely in the right lower abdomen. ? Signs: peritonitis marked in upper abdomen. ? X-ray is helpful: free air under diaphragm. Differential Diagnosis 2. Right ureteral stone ? Sudden severe colic pain. ? Signs is not obvious. ? A number of RBC in urine. ? B type ultrasound or X-ray is helpful:  stone in urinary tract. 3. Gynecologic disorders A: Ruptured ectopic pregnancy ? Menolipsis,irregular vaginal bleeding history.  ? Acute hemorrhage symptoms  intra-abdominal bleeding signs  ? Culdocentesis: non-clotting blood. ? HCG: (+) B: Ovarian follicles or luteal cyst rupture? Clinical manifestation is similar to ectopic pregnancy but not very severe. ? Occurs after the ovulation and the middle of a menstrual period. C: Acute Salpingitis or pelvic inflammation ? Occur at the end of a menstrual period.  ? Pain: bilateral in the lower abdomen.  ? Leukorrhea: suppurative. D: Ovarian cyst torsion  ? Obvious and severe pain. ? Palpable mass on abdominal or pelvic examination. ? Ultrasound is helpful for the diagnosis. 4. Acute mesenteric adenitis ? Often in children. ? Upper respiratory tract infection history. ? Pain tenderness: not sharply localized ? Usually no muscle rigidity. 5. Acute gastroenteritis ? Profuse diarrhea, nausea vomiting.? Abdominal signs absent: No fixed tenderness or peritoneal irritation. Treatment 1. Surgical treatment If appendicitis is diagnosed or strongly suspected, the best treatment is surgical removal called appendectomy because treatment delay increases mortality. Open appendectomy Laparoscopic appendectomy 2. non-surgical treatment Only simple and early stage of appendicitis. With severe organic disease contraindication to surgery. Its measures include effective antibiotics and rehydration therapy. Techniques of open app