阑尾炎(英文).ppt

Anatomy
Varied anatomy
Length: 5~10 cm, narrow lumen
haustra of colon
Epidemiology
The most common acute abdoe peritoneal structures
Typically causing pain in the RLQ
Pathophysiology
The change in stimulation form visceral to somatic pain fibers explains the classic migration of pain in the periumbilical area to the RLQ seen with acute appendicitis.
Pathophysiology
Exceptions exist in the classic presentation due to anatomic variability of the appendix
Appendix can be retrocecal causing the pain to localize to the right flank
In pregnancy, the appendix can be shifted and patients can present with RUQ pain
Pathophysiology
In some males, retroileal appendicitis can irritate the ureter and cause testicular pain.
Pelvic appendix may irritate the bladder or rectum causing suprapubic pain, pain with urination, or feeling the need to defecate
Multiple anatomic variations explain the difficulty in diagnosing appendicitis
Manifestations
Primary symptom:
abdominal pain
½ to 2/3 of patients have the classical presentation
Pain beginning in epigastrium or periumbilical area that is vague and hard to localize
Manifestations
As the illness progresses RLQ localization typically occurs
RLQ pain was 81 % sensitive and 53% specific for diagnosis
Migration of pain from initial periumbilical to RLQ was 64% sensitive and 82% specific
Manifestations
Associated symptoms:
indigestion, discomfort, flatus, need to defecate, anorexia, nausea, vomiting
Anorexia is the most common of associated symptoms
Vomiting is more variable, occuring in about ½ of patients
Physical Exam
Findings depend on duration of illness prior to exam.
Early on patients may not have localized tenderness
With progression there is tenderness to deep palpation over McBurney’s point
Physical Exam
Rovsing’s sign:
pain in RLQ with palpation to LLQ
Obturator sign:
passively flex the R hip and knee and internally rotate the hip. If there is increased pain then the sign is positive
Physical ex