扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 26. Appendicitis

Appendicitis

Appendicitis

Outlines> General considerations>Historical perspective>Anatomy>Pathophysiology>Clinical findings>DiagnosisMesoappendixAppendiculaarten>TreatmentADI

Outlines ➢ General considerations ➢ Historical perspective ➢ Anatomy ➢ Pathophysiology ➢ Clinical findings ➢ Diagnosis ➢ Treatment

GeneralconsiderationsAbout8% ofpeopleinWestern countrieshave appendicitis at sometime duringtheirlife,withapeak incidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(1o%)

General considerations ● About 8% of people in Western countries have appendicitis at some time during their life, with a peak incidence between 10 and 30 years of age . ● Acute appendicitis is the most common general surgical emergency.(10%)

GeneralconsiderationsAcuteappendicitishasproteanmanifestationsIt maysimulatealmostany otheracuteabdominal illnessand inturnmaybemimickedbyavarietyofconditions.Progression of symptoms and signsis therulein contrasttothefluctuating course ofsome otherdiseases

General considerations ● Acute appendicitis has protean manifestations. ● It may simulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions. ● Progression of symptoms and signs is the rule —in contrast to the fluctuating course of some other diseases

HistoricalperspectiveWillardPackardperformedthefirstsurgeryin1867In1886,ReginaldFitzdescribedthecharacteristic,clinical findingsandpathologyofthedisease,identifiedtheappendixas theprimary causeofrightlowerquadrantinflammation.Fitzcoinedtheterm appendicitisand recommended earlysurgical treatment

Historical perspective ● Willard Packard performed the first surgery in 1867. ● In 1886,Reginald Fitz described the characteristic, clinical findings and pathology of the disease,identified the appendix as the primary cause of right lower quadrant inflammation. ● Fitz coined the term appendicitis and recommended early surgical treatment

HistoricalperspectiveIn 1889,ChesterMcBurneydescribedcharacteristic migratorypainas well aslocalization of the pain along an obliqueline from the anterior superior iliac spine totheumbilicus.In1894,McBurneydescribedarightlowerquadrantmuscle-splittingincisionforremoval oftheappendix

Historical perspective ● In 1889, Chester McBurney described characteristic migratory pain as well as localization of the pain along an oblique line from the anterior superior iliac spine to the umbilicus. ● In 1894, McBurney described a right lower quadrant muscle-splitting incision for removal of the appendix

HistoricalperspectiveInthe 194Os,the mortalityrate from appendicitisimproved with thewidespreaduseofbroad-spectrumantibioticsIn1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears

Historical perspective ● In the 1940s,the mortality rate from appendicitis improved with the widespread use of broad-spectrum antibiotics. ● In 1982, Laparoscopic appendectomy was first reported by the gynecologist Kurt Semm but has only gained widespread acceptance in recent years

Anatomy&physiologyThebase ofthe appendixis located attheconvergence ofthetaeniae(3)of colonThis anatomic relationship facilitates identification andlocation of theappendix atoperation

Anatomy ＆ physiology ● The base of the appendix is located at the convergence of the taeniae(3) of colon. ● This anatomic relationship facilitates identification and location of the appendix at operation

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Haustum(saccutation)ofascendingcoloneocecalFrenulumotorificeileocecal vafve-lleocecalvalveOrificeofITerminalappendixileum(A)BealpapillaloaloriiceBeum2.0.5%64%Opening of1%vermitormCecalappendixtoldsVemitorm(B)(C)appendixcumAnteriorviows