Apendicitis

ApendicitisMigdoel Cruz Rodrguez 10-8071DefinicinInflamacin de la apndice causada por una obstruccin del lumen apendicular, produciendo un asa cerrada la cual resulta en inflamacin que puede llevar a necrosis y perforacin.

Surgical Recall:Inflammation of the appendix caused by obstruction of the appendiceal lumen, producing a closed loop with resultant inflammation that can lead to necrosis and perforation.

2AnatomaVisible a la 8va semana de gestacin Protuberancia de la porcin terminal del ciego, desplazada medialmente hacia la vlvula ileocecal.Localizacin variable retrocecal, pelvica, subcecal, preileal o posicin pericolica derecha.Medida: 30 cmLa mayora 6 9 cm

The appendix first becomes visible in the eighth week of embryologic development as a protuberance off the terminal portion of the cecum. During both antenatal and postnatal development, the growth rate of the cecum exceeds that of the appendix, so that the appendix is displaced medially toward the ileocecal valve. The relationship of the base of the appendix to the cecum remains constant, whereas the tip can be found in a retrocecal, pelvic, subcecal, preileal, or right pericolic position (Fig. 30-1). These anatomic considerations have significant clinical importance in the context of acute appendicitis. The three taeniae coli converge at the junction of the cecum with the appendix and can be a useful landmark to identify the appendix. The appendix can vary in length from 30 cm; most appendices are 6 to 9 cm long. Appendiceal absence, duplication, and diverticula have all been described.3Posiciones de la Apndice

Apndice Retrocecal

Radiografa con barium

Taenia coli

Irrigacin

Histologia

InervacinPlexos mesentericos superioresSimpatica (Segmentos espinales torcicos bajos)Parasimpatica (nervio vago)

Vermiform appendixArises from the posteromedial side of cecumUsually retrocecalHas a short mesentery from cecum: mesoappendixSupplied by appendicular artery from ileocolic arteryVascular supply: ileocolic artery and vein, with lymph to ileocolic nodesNerves: sympathetic and parasympathetic nerves from the superior mesenteric plexusParasympathetic fibers from vagus nervesSympathetic fibers from lower thoracic spinal cord segments11

FuncinMal llamado rgano vestigial Tejido linfoide presente 2 semanas de edad Aumenta en la pubertad Disminuye con la edad (>60 no tejido linfoide)Produccin de mocoSecrecin de Inmunoglobulina A

Lymphoid tissue first appears in the appendix approximately 2 weeks after birth. The amount of lymphoid tissue increases throughout puberty, remains steady for the next decade, and then begins a steady decrease with age. After the age of 60 years, virtually no lymphoid tissue remains within the appendix, and complete obliteration of the appendiceal lumen is common. 1413EtiologaObstruccin es el factor dominanteFecalitosHipertrofia linfoideaTumorVegetales o frutasParasitos intestinales

Fecalitos encontrados en 40% de apendicitis aguda65% de apendicitis gangrenosa sin ruptura90% de apendicitis gangrenosa con rupturaObstruction of the lumen is the dominant etiologic factor in acute appendicitis. Fecaliths are the most common cause of appendiceal obstruction. Less common causes are hypertrophy of lymphoid tissue, inspissated barium from previous x-ray studies, tumors, vegetable and fruit seeds, and intestinal parasites. The frequency of obstruction rises with the severity of the inflammatory process. Fecaliths are found in 40% of cases of simple acute appendicitis, in 65% of cases of gangrenous appendicitis without rupture, and in nearly 90% of cases of gangrenous appendicitis with rupture.14FisiopatologaFasesInflamatoria, cogestiva, edematosa o catarralSupurativa o purulentaGangrenosaPerforativa