急性闌尾炎英文培訓課件

OutlinesGeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatment1急性闌尾炎英文7/30/2023OutlinesGeneralconsiderations1GeneralconsiderationsAbout8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%)2急性闌尾炎英文7/30/2023GeneralconsiderationsAbout8%2GeneralconsiderationsAcuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.3急性闌尾炎英文7/30/2023GeneralconsiderationsAcuteap3Historicalperspective

WillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.Fitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatment4急性闌尾炎英文7/30/2023HistoricalperspectiveWillard4HistoricalperspectiveIn1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurney

describedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.5急性闌尾炎英文7/30/2023HistoricalperspectiveIn1889,5HistoricalperspectiveInthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.6急性闌尾炎英文7/30/2023HistoricalperspectiveInthe167急性闌尾炎英文7/30/20237急性闌尾炎英文7/28/20237Anatomy＆physiologyThebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.8急性闌尾炎英文7/30/2023Anatomy＆physiologyThebaseo89急性闌尾炎英文7/30/20239急性闌尾炎英文7/28/2023910急性闌尾炎英文7/30/202310急性闌尾炎英文7/28/202310Pathophysiology

Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.11急性闌尾炎英文7/30/2023PathophysiologyObstructionof11PathophysiologyObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressure12急性闌尾炎英文7/30/2023PathophysiologyObstructionof12PathophysiologySubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.13急性闌尾炎英文7/30/2023PathophysiologySubsequentimpa13PathophysiologyInflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.14急性闌尾炎英文7/30/2023PathophysiologyInflammationof14Clinicalfindings

Clinicalfindings

15急性闌尾炎英文7/30/2023Clinicalfindings

Clinicalfin15historyandsymptomAppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.16急性闌尾炎英文7/30/2023historyandsymptomAppendiciti16

historyandsymptomTheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuria17急性闌尾炎英文7/30/2023

historyandsymptomTheclassi17migratorypain18急性闌尾炎英文7/30/2023migratorypain18急性闌尾炎英文7/28/2018PhysicalExaminationLow-gradefeveriscommon(～38℃).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicus

ReboundtendernessVoluntaryguarding19急性闌尾炎英文7/30/2023PhysicalExaminationLow-grade19PhysicalExaminationDunphy'ssign---coughingcauseincreasedpainRovsing'ssign

---painintherightlowerquadrantduringpalpationoftheleftlowerquadrant20急性闌尾炎英文7/30/2023PhysicalExaminationDunphy'ss20PhysicalExaminationPsoassign---painonextensionoftherighthip(retrocecalappendix)Obturatorsign---painoninternalrotationofthehip(pelvicappendix)21急性闌尾炎英文7/30/2023PhysicalExaminationPsoassign21LaboratoryStudiesTheaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsin?ofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.22急性闌尾炎英文7/30/2023LaboratoryStudiesTheaverage22

ImagingstudiesPlainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.23急性闌尾炎英文7/30/2023ImagingstudiesPlainabdomina2324急性闌尾炎英文7/30/202324急性闌尾炎英文7/28/202324A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection(arrow).BL,bladder;UT,uterus.25急性闌尾炎英文7/30/2023A,CTscanoftheabdomendemo25EssentialsofdiagnosisAbdominalmigratorypainAnorexia,nauseaandvomitingLocalizedabdominaltendernessLow-gradefeverLeukocytosis26急性闌尾炎英文7/30/2023EssentialsofdiagnosisAbdomin26DifferentialDiagnosesSometimes,thediagnosisofappendicitismaybedifficult.Mesentericlymphadenitis,gastrointestinalulcerperforationMeckel’sdiverticulitis,ectopicpregnancy,pelvicinflammatorydisease27急性闌尾炎英文7/30/2023DifferentialDiagnosesSometime27Specialcategoryofappendicitisininfants，inchildren，inwemenduringpregnancy，inelderlypeopleinpatientsinfectedwithHIV28急性闌尾炎英文7/30/2023Specialcategoryofappendicit28ComplicationPerforationPeritonitisAppendicealabscesspylephlebitis29急性闌尾炎英文7/30/2023ComplicationPerforation29急性闌尾炎29TreatmentSurgica