Acute Abdomen. 14.03.11
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Transcript of Acute Abdomen. 14.03.11
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ACUTE ABDOMEN
Acute Appendicitis &
Its Complication
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Acute Abdomen
Definition:
It encompasses many diverse
entities except traumatic causewhich is urgent is nature and may
or may not require surgical
intervention.
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Acute Appendicitis
Introduction:1. Appendicectomy is the most frequently
performed urgent abdominal operation.
2. It is often the first major procedureperformed by surgeon in training.
3. With all advancement of diagnosticlaboratory investigations the diagnosis ofappendicitis remains essentially clinical,requiring a mixture of observation, Clinicalacumen and surgical science.
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Anatomy:1. Present only is human, certain
anthropoids.
2. It is undeveloped distal segment oflarge caecum.
3. Layers, length lumen, blood supply.
4. Position of appendix5. Histology.
Acute Appendicitis
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Incidence:1. In the developed countries it is estimated
that 10% of the population but now it isdeclining and around 6-8%.
2. Rare is infants, common in early childhood.
3. Peak incidence- early 20s.
Male: Female = before puberty in teen age &young adult 3:2
Acute Appendicitis
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Aetiology:
1. No definite cause.
2. Decrease dietary fibre and increasedconsumption of refined carbohydratesassociated with this condition.
3. Bacterial proliferation.
4. Obstruction to the lumen-
Faecolith
Lymphoid hyperplasia
Acute Appendicitis
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5. Extreme of age
6. Immunosuppresion.7. DM.Risk factors for perforation of the appendix:
1. Extremes of age2. Immunosuppression3. Diabetes mellitus
4. Faecolith obstruction5. Pelvic appendix6. Previous abdominal surgery.
Acute Appendicitis
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Symptoms of appendicitis : Peri- umbilical colic
Pain shifts to the right iliac fossa
Anorexia
Nausea.
Signs: Pyrexia
Localized tenderness in right iliac fossa
Muscle guarding
Rebound tenderness.
Clinical Features
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Signs to elicit in appendicitis:
Pointing sign
Rovsings sign
Psoas sign
Obturator sign.
Clinical features
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Differential diagnosis of acute appendicitis
Children AdultGastroenteritis Regional enteritisMesenteric adenitis Ureteric colic
Meckels diverticulitis Perforated peptic ulcer
Intussusception Torsion of testis
Henoch schonleinpurpura
Pancreatitis
Lobar pneumonia Rectus sheathhaematoma
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Adult female Elderly
Mittelschmerz Diverticulitis
Pelvic inflammatorydisease
Intestinal obstruction
Pyelonephritis Colonic carcinoma
Ectopic pregnancy Torsion appendixepiploicae
Torsion/rupture ofovarian cyst
Mesenteric infarction
Endometriosis Leaking aortic aneurysm
Differential diagnosis of acute appendicitis
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Symptoms Score
Migratory RIF pain 1
Anorexia 1
Nausea and vomiting 1
Signs
Tenderness(RIF) 2
Rebound tenderness 1
Elevated temperature 1
Laboratory
Leucocytosis 2
Shift to left 1
Total 10
The Alvarado (MANTRELS) Score
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ACUTE APPENDICITIS
Investigation:Preoperative investigations in appendicitis:
A. Routine: Full blood count
UrinalysisB. Selective:Pregnancy testUrea and electrolytes
Supine abdominal radiographUltrasound of the abdomen/pelvisContrast- enhanced CT scan of the abdomen.
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Management:
1. Management of acute appendicitis
2. Management of appendix abscess
3. Management of appendix mass
ACUTE APPENDICITIS
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Post operative Complication:1. Wound infection
2. Intra-abdominal abscess.
3. Ileus.4. Respiratory
5. Venous thrombosis
6. Faecal fistula7. Intestinal obstruction
ACUTE APPENDICITIS
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Other Condition of appendix:1. Mucocele of appendix.
2. Carcinoid tumour3. Primary adenocarcinoma.
Acute Appendicitis