Acute AppendicitisAcute Appendicitis

Dr Moayad Ahmad LamberDr Moayad Ahmad Lamber

General surgeonGeneral surgeon

M.O.HM.O.H

3/6/20153/6/2015

AnatomyAnatomy

• It is a blind end muscular tube with mucosal , submucosal ,muscular and serosal layers.

• The lumen layered by colmnuar epithelium.

• Length 7.5- 10 cm

• Position most common retrocecal

• Base constant , confluence of the taenia coli

AnatomyAnatomy

AnatomyAnatomy

• Blood supply is by appendicular artery ,branch of the ilecolic artery , branch of SMA

• End artery

• Four , six or more lymphatic channels traverse the mesoappendics drain in the ilececal lymph nodes

AnatomyAnatomy

AetiologyAetiology

• Low fiber diet ? High sugar diet ?

• Luminal obstruction ( faecolith, sticture, lymphnode enlargment , tumor ,foreign body , pinwarms).

• Bacterial over growth within the lumen (mixed aerobic , anaerobic).

AetiologyAetiology

• Peak incidence in the teens and early 20S

• Rare in infants

• Male to female ratio 3:2 at age of 25 thereafter this declines

• Life time risk for appendectomy is 8.6 % for males and 6.7% for females .

pathologypathology

• Luminal obstruction with continues mucus secretion and inflammatory exudation increase intraluminal pressure , obstructing lymphatic drainage .

• Odema , mucosal ulceration , bacterial translocation to the submucosa.

pathologypathology

• Continues rise in pressure lead to venous obstruction and ischemia of the appendix wall .

• Ischaemic necrosis of the wall produce gangrene and peritonial contamination .

• Greater omentum and small bowel loops adhere to localize the inflammation .

Clinical diagnosisClinical diagnosis

Clinical diagnosisClinical diagnosis

Clinical diagnosisClinical diagnosis

Clinical diagnosisClinical diagnosis

• Special features according to position:

Retrocecal – rigidity is absent on deep pressure.

Pelvic – diarrhoea , tenderness may be absent , tendernesss on PR .

Postileal – pain may not shift , diarrhoea .

Clinical diagnosisClinical diagnosis

• Special features according to age

• Infants- rare , unable to give history , underdeveloped omentum.

• Children – vomiting , loss of appétit .

• Elderly – gangrene and perforation .

• Obese patient – obscure local signs , difficulty in operation.

• Pregnancy : most common surgical emergancy , fetal loss 3-5%, up to 20 %

Differential diagnosis Differential diagnosis

investigationinvestigation

DiagnosisDiagnosis

• CBC: the WBC is of limited value.

• C-Reactive Protien CRP and ESR have been studied with mixed results

DiagnosisDiagnosis

• UA: abnormal UA results are found in 19-40%

• Abnormalities include: pyuria, hematuria, bacteruria

• Presence of >20 wbc per field should increase consideration of Urinary tract pathology

TreatmentTreatment

• Appendectomy :- open

• - laprascopic

• Ivf

• Npo

• analgesia

Thank you