ACUTE APPENDICITIS By : Niloofar Azizi

Appendicitis *About 8% of people in Western countries *Acute appendicitis is the most common general surgical emergency

Embryology & Anatomy The appendix, ileum, and ascending colon are all derived from the midgut The appendix first appears at the 8th week of gestation

appendiceal artery, a branch of the ileocolic artery lymphatics drain into the anterior ileocolic lymph nodes length of the appendix varies from 2 to 20 cm, and the average is 9 cm in adults base of the appendix is located at the convrgence of the taeniae tip of the appendix may lie in a variety of locations

Pathophysiology Obstruction of the lumen due to inspissated stool (fecalith or appendicolith), lymphoid hyperplasia, vegetable matter or seeds, parasites, or a neoplasm

Obstruction →bacterial overgrowth & continued secretion of mucus →intraluminal distention &increased wall pressure → visceral pain sensation → impairment of lymphatic and venous drainage → mucosal ischemia → localized inflammatory process → gangrene & perforationan → abscess ,peritonitis & septic shock ,multiple intraperitoneal abscesses

Bacteriology

Diagnosis History periumbilical pain → anorexia & nausea → The pain localizes to RLQ → vomiting → leukocytosis → Fever urinary symptoms or microscopic hematuria Adynamic ileus & absent bowel movements Diarrhea Small bowel obstruction

Physical Examination look ill Low-grade fever diminished bowel sounds focal tenderness voluntary guarding Rovsing's sign obturator sign iliopsoas sign

Laboratory Studies White blood cell count is elevated with more than 75% neutrophils Urinalysis

Alvarado scoring

Radiography Plain abdominal radiographs Barium enema Ultrasonography Computed tomography (CT)

Diagnostic Laparoscopy

Differential Diagnoses Intussusception Meckel's diverticulitis acute gastroenteritis mesenteric lymphadenitis Inflammatory bowel disease other regional inflammatory conditions( pyelonephritis , colitis & diverticulitis) Pelvic pathology (pelvic inflammatory disease (PID), tubo-ovarian abscess, ruptured ovarian cyst or ovarian torsion & ectopic pregnancy)

Diagnostic Algorithm

Treatment laparoscopic open appendectomy

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