Acute Appendicitis急性阑尾炎英文教学幻灯课件

there may be an episode of vomiting,examination at this point will show cough tenderness localized to the right lower quadrant there will be well-localized tenderness to one-finger palpation and possibly very slight muscular rigidity.rebound tenderness is classically referred to the same area.

If the evidence for acute appendicitis is insufficient and no other diagnosis can be made ， the patient should be kept under observation, admitted to hospital necessary and reexamined periodically.Eventually ,the symptoms settle or the diagnosis becomes clear．
2.What Cause Appendicitis ?

The cause of appendicitis is usually unknow.But in approximately 70% of acutely inflamed appendices,obstruction of the proximal lumen by fibrous bands fecaliths,tumors ,parasites or foreign bodies can be demonstrated,in others it may occur after a viral infection in the digestive tract.So obstruction and viral infection are two main factors of acute appendicitis.

Special points in the history and examination:acute appendicitis typically runs a short course，between a few hours and about 3 days．if symptoms have been present for longer,appendicitis is unlikely unless an‘appendix mass’has developed ． Urinary symptoms suggest urinary tract infection but may also occur with pelvic appendicitis．

Anatomy of the appendix



Peritoneum Anterior taenia coli leading to appendix True retrocaecal position of appendix plastered to posterior wall of caecum close to right ureter and psoas Meso-appendix Ileo-colic branch of superior mesenteric artery Position of appendix can be anywhere on this circumference Appendicular artery passing behind ileum Pelvic position of appendix close to fallopian tube,rectum or ureter

Diagnosis of acute appendicitis poses little difficulty if the patient exhibits the classical symptoms and signs summarised in the following box, the problem in appendicitis occurs when the symptoms and signs are not typical．the patient may present at a very early stage，or the signs may have some other pathological cause．

Low fever that begins after other symptoms,it may be present along with nausea and vomiting and constipation
Nausea: an inclination to vomit Vomiting:eject(matter)from the stomach through the mouth Constipation:difficult in emptying the bowels Diarrhea:a condition of excessively frequent and loose bowels
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Acute Appendicitis

1.what is appendicitis?


2.what cause appendicitis?
3.what are the symptoms of appendicitis? 4.how is the appendicitis diagnosed ?

Abdominal pain:the pain is persistent and continuous but not severe.It usually begins in the center of the abdominal,around the area of navel, and within several hours the pain shifts to the right lower quadrant, called migration of pain becoming localized and causing discomfort on moving,walking,or coughing.

4.How is the appendicitis diagnosed ?

Acute appendicitis is a clinical diagnosis,relying almost entirely on the history and physical examination．investigations are only useful in excluding other differential diagnoses.If possible，the diagnosis should be made and the appendix removed before it becomes gangrenous and perforates ． on the other hand，unnecessary appendicectomies must be kept to a minimum．
The appendix has been described as lying in several ‘classical sites，but apart from the the true retrocaecal appendix，the organ probably floats in a broad arc about its base..Only inflammation will fix it in a particular place．in about 30％ of appendicectomies ， the appendix lies over the brim of the pelvis (‘pelvic appendix’)．This is adjacent to the bladder and rectum in males and to the uterus, Fallopian tubes and bladder in females ． In some cases ， the appendix lies retroperitoneally behind the caecum and is often plastered to it by fibrous bands ． Thus ， an inflamed retrocaecal appendix may irritate the right ureter and psoas muscle，and may even lie high enough to simulate gall bladder pain．

5.how is the appendicitis treatment?
1.What is appendicitis?


Appendicitis is an inflammation of appendix a small pouch attached to the cecum the beginning of the colon.On the lower right side of the abdomen. The appendix is not necessary for life.But it can become diseased.If untreated an inflamed appendix can burst ,causing infection and even death.Appendicitis can affect people at any age.It is most common in people ages 10 to 30.

The appendix is a blind—ending-tube arising from the caecum at the meeting point of the three taeniae coli,just distal to the ileocecal junction．The base of the appendix thus lies in the right iliac fossa,close to McBurney’s point．This is two-thirds of the way along a line drawn from the umbilicus to the anterior superior iliac Spine. In most cases，the appendix is mobile within the peritoneal cavity ， suspended by its mesentery(mesoappendix) with the appendiceal artery in its free edge. This is effectively an end—artery，with anastomotic connections only proximally．
3.What Are the Symptoms of Appendicitis?

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.The classic symptoms of appendicitis include