General Surgery KNMU Actue Appendicitis Lecture

Kharkov National Medical University Department of Surgery No.

Name: Akoto Sesime Adima Akosua Course: th! general medicine "roup: ## Date: $%&##&$%#'  (opic:  (opic: Acute Appendicitis

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De,nition: Acute appendicitis is in-ammation of the appendi. Anatomy /ayers of the 0all of the appendi Serous coat Muscular coat1 outer longitudinal! inner circular Su2mucosa: has lymphoid tissue and lymphoid follicles Mucous coat1 similar to hat of the large intestine3s • • • •

Appendi has mesentery called mesoappendi. Mc4urney3s point corresponds to the 2ase of the appendi. Mc4urney3s point is located on the line dra0n from the anterior superior iliac spine to the um2ilicus. (he one5third of this line that is closest to the anterior iliac spine is Mc4urney3s point. 4lood supply: Appendi is supplied 2y the appendicular artery! 0hich is a 2ranch of the ileocolic artery. (he appendicular artery reaches the tip of the appendi. (he accessory appendicular artery! a 2ranch of the posterior cecal artery supplies of the 2ase of appendi.  (he appendi is drained 2y the appendicular vein 0hich travels 0ith the appendicular artery. Anatomical positions of the appendi 6etorcecal *elvic Su2cecal *eriileal 6ight pericolic • • • • •

6ole of the appendi  (he appendi is also kno0n as the a2dominal tonsil. +t is invovled in maturation of 4 lymphocytes 7its lymphoid follicles8 and is part of the "A/( 9gut associated lymphoid system8

)tiology of acute appendicitis: #. 2struction of the lumen of the appendi 2y a fecolith or hyperplasia of su2mucosa lymphoid follicles. +t is the most common cause of acute appendicitis. ther causes of o2struction: 0orms! fruit seeds! etc

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*athophysiology of acute appendicitis involves: 2struction Continuous mucosal secretion ;orsened edema! high luminal pressure and 2acterial proliferation  (ransmural necrosis and 2acterial penetration • • • •

Classi,cation
 (here is also appendicular colic. Clinical 8 pain 2ut it depends on position of the appendi Dry tongue /ocal tenderness in 6/> /o0 grade fever ?@C "uarding *eritoneal signs anoreia Signs in acute appendicitis: *soas sign5 patient lies on left side! etend the right thigh to stretch the iliopsoas muscle. +f there is pain! this is positive *soas sign 2turator sign 0hile the patient is lying do0n! raise the right leg! 2end the right knee and rotate the knee in0ards to0ards the midline of  the patient3s 2ody. +f pain is felt! this is positive o2turator sign. 6ovsing3s sign5 palpation in the left lo0er =uadrant produces pain in the right lo0er =uadrant. (his is also kno0n as referred re2ound tenderness. (his is due to the displacement of air or intestinal loops from the left side to the right side thus irritating the in-amed appendi. Dunphy3s sign5 coughing increases pain in right lo0er =uadrant 6aBdolsky3s sign5 pain upon light percussion at Mc4urney3s point. Sitovsky3s sign  turning to the left side increases the right lo0er =uadrant pain. •

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4lum2erg3s sign  re2ound tenderness upon pressing and releasing if the eaminer3s hand. +t is a sign of peritonitis

+nvestigations C4C moderate leukocytosis Normal urine analysis +maging investigations: US! C( are the preferred methods of imaging. 5ray does not sho0 any signs of appendicitis.  (reatment of acute appendicitis:  (he trestment of choice in acute appendicitis is surgical. Antegrade or retrograde appendectomy and laparoscopic appendectomy can 2e used. Complications of acute appendicitis Appendicular mass  can 2e treated conservatively Appendicular a2scess *eritonitis Sepsis *yelophle2itis • • • • •

Complications of appendectomy: +nfection of the incision 7su2cutaneous tissues8 +nfection of the formed stump *eritonitis A2dominal a2scess: pelvic! su2phrenic! intra5a2dominal +ntestinal o2struction 4leeding Stool ,stula

DiEerential Diagnosis of acute appendicitis: #. Acute cholecystitis $. *erforated peptic ulcer ?. Meckel3s diverticulitis . Acute pancreatitis '. Mesenteric vascular occlusion F. 6ight ureteric colic G. (0isted right ovarian cyst @. "ynecological disorders: salpingitis! ectopic gestation! ruptured ovarian follicle

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