1. ACUTE APPENDICITIS
By :
Niloofar Azizi

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

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

4. 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

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

6. 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

7. Bacteriology

8. 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

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

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

11. Alvarado scoring

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

14. Diagnostic Laparoscopy

15. 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)

16. Diagnostic Algorithm

18. Treatment
laparoscopic
open appendectomy

20. Thank You