外科学课件整理-appendicitis(2015双语).pptVIP

* Diagnosis Periumbilical?or?epigastric?pain?that?migrates?to?right?lower?quadrant Tenderness?in?the?right?lower?abdomen,?usually?about?a?third?of?the?distance?from?the?navel?to? the?top?of?the?hip?bone Lab findings Bus CT ? * Differential diagnosis from other diseases-1 鉴别诊断? 胃十二指肠溃疡穿孔? 急性胆囊炎? 妇科疾病  ● 宫外孕破裂出血 ● 右卵巢囊肿蒂扭转  ● 黄体破裂 ● 卵巢滤泡破裂 ● 右侧附件炎 * Differential diagnosis from other diseases-2 鉴别诊断? 右输尿管结石? 急性肠系膜淋巴结炎? 某些内科疾病：右侧肺炎、胸膜炎、Meckel 憩室等? 其它：急性胃肠炎及回盲部肿瘤等 * Perforated Meckel’s diverticulum This man of 28 presented with a typical history and clinical findings of acute appendicitis. However, at operation he was found to have a normal appendix but a perforated Meckel’s diverticulum (arrowed). The diverticulum was resected and the appendix also removed to prevent future confusion and the patient made a good recovery. On histological examination, the Meckel’s was found to contain gastric mucosa. * Complications -Perforation Perforation may result in localized or generalized peritonitis. Results in more severe pain, higher fever. Results in worse prognosis (more long-term complications and higher mortality). Usually occur 12hrs after the onset, usually among children and elderly people. * Complications -Peritonitis Tenderness, rigidity, abdominal distention, adynamic ileus, fever and toxicity. The severity of manifestations varies depending on if it is localized or generalized peritonitis. * Complications - Appendiceal abscess A right lower quadrant mass + typical course of appendicitis An ultrasound or CT scan is necessary for differentiation. Opinion differs about the treatment. Early operation under antibiotic cover is now performed more frequently. * Complications -Pylephlebitis A suppurative thrombophlebitis of the portal venous system. Catastrophic condition; chill, high fever, jaundice, hepatic abscess. CT scan: thrombosis and gas on the portal vein. Requires vigorous antibiotics and prompt su