急性闌尾炎英文培訓(xùn)課件

OutlinesGeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatment1急性闌尾炎英文1/1/2023OutlinesGeneralconsiderations1GeneralconsiderationsAbout8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%)2急性闌尾炎英文1/1/2023GeneralconsiderationsAbout8%2GeneralconsiderationsAcuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.3急性闌尾炎英文1/1/2023GeneralconsiderationsAcuteap3Historicalperspective

WillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.Fitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatment4急性闌尾炎英文1/1/2023HistoricalperspectiveWillard4HistoricalperspectiveIn1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurney

describedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.5急性闌尾炎英文1/1/2023HistoricalperspectiveIn1889,5HistoricalperspectiveInthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.6急性闌尾炎英文1/1/2023HistoricalperspectiveInthe167急性闌尾炎英文1/1/20237急性闌尾炎英文12/28/20227Anatomy＆physiologyThebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.8急性闌尾炎英文1/1/2023Anatomy＆physiologyThebaseo89急性闌尾炎英文1/1/20239急性闌尾炎英文12/28/2022910急性闌尾炎英文1/1/202310急性闌尾炎英文12/28/202210Pathophysiology

Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.11急性闌尾炎英文1/1/2023PathophysiologyObstructionof11PathophysiologyObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressure12急性闌尾炎英文1/1/2023PathophysiologyObstructionof12PathophysiologySubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.13急性闌尾炎英文1/1/2023PathophysiologySubsequentimpa13PathophysiologyInflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.14急性闌尾炎英文1/1/2023PathophysiologyInflammationof14Clinicalfindings

Clinicalfindings

15急性闌尾炎英文1/1/2023Clinicalfindings

Clinicalfin15historyandsymptomAppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.16急性闌尾炎英文1/1/2023historyandsymptomAppendiciti16

historyandsymptomTheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuria17急性闌尾炎英文1/1/2023

historyandsymptomTheclassi17migratorypain18急性闌尾炎英文1/1/2023migratorypain18急性闌尾炎英文12/28/218PhysicalExaminationLow-gradefeveriscommon(～38℃).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicus

ReboundtendernessVoluntaryguarding19急性闌尾炎英文1/1/2023PhysicalExaminationLow-grade19PhysicalExaminationDunphy'ssign---coughingcauseincreasedpainRovsing'ssign

---painintherightlowerquadrantduringpalpationoftheleftlowerquadrant20急性闌尾炎英文1/1/2023PhysicalExaminationDunphy'ss20PhysicalExaminationPsoassign---painonextensionoftherighthip(retrocecalappendix)Obturatorsign---painoninternalrotationofthehip(pelvicappendix)21急性闌尾炎英文1/1/2023PhysicalExaminationPsoassign21LaboratoryStudiesTheaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsin?ofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.22急性闌尾炎英文1/1/2023LaboratoryStudiesTheaverage22

ImagingstudiesPlainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.23急性闌尾炎英文1/1/2023ImagingstudiesPlainabdomina2324急性闌尾炎英文1/1/202324急性闌尾炎英文12/28/202224A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection(arrow).BL,bladder;UT,uterus.25急性闌尾炎英文1/1/2023A,CTscanoftheabdomendemo25EssentialsofdiagnosisAbdominalmigratorypainAnorexia,nauseaandvomitingLocalizedabdominaltendernessLow-gradefeverLeukocytosis26急性闌尾炎英文1/1/2023EssentialsofdiagnosisAbdomin26DifferentialDiagnosesSometimes,thediagnosisofappendicitismaybedifficult.Mesentericlymphadenitis,gastrointestinalulcerperforationMeckel’sdiverticulitis,ectopicpregnancy,pelvicinflammatorydisease27急性闌尾炎英文1/1/2023DifferentialDiagnosesSometime27Specialcategoryofappendicitisininfants，inchildren，inwemenduringpregnancy，inelderlypeopleinpatientsinfectedwithHIV28急性闌尾炎英文1/1/2023Specialcategoryofappendicit28ComplicationPerforationPeritonitisAppendicealabscesspylephlebitis29急性闌尾炎英文1/1/2023ComplicationPerforation29急性闌尾炎29TreatmentSurgicaltreatment:Mostpatientswithacuteappendicitisaremanagedbypromptsurgicalremovaloftheappendix.(Appendectomy)Non-surgicaltreatment:EarlyStage,Objectiveconditionsarenotallowed,Seriousorganicdisease.(antibiotics)30急性闌尾炎英文1/1/2023TreatmentSurgicaltreatment:3031急性闌尾炎英文1/1/202331急性闌尾炎英文12/28/20223132急性闌尾炎英文1/1/202332急性闌尾炎英文12/28/20223233急性闌尾炎英文1/1/202333急性闌尾炎英文12/28/202233TreatmentLaparoscopicappendectomyofferstheadvantageof:diagnosticlaparoscopyshorterrecoverylessconspicuous

incisions34急性闌尾炎英文1/1/2023TreatmentLaparoscopicappendec34SubjectivetothinkWhat’stheEssentialsofdiagnosisaboutacuteappendicitis?35急性闌尾炎英文1/1/2023SubjectivetothinkWhat’sthe35OutlinesGeneralconsiderationsHistoricalperspectiveAnatomyPathophysiologyClinicalfindingsDiagnosisTreatment36急性闌尾炎英文1/1/2023OutlinesGeneralconsiderations36GeneralconsiderationsAbout8%ofpeopleinWesterncountrieshaveappendicitisatsometimeduringtheirlife,withapeakincidencebetween10and30yearsofage.Acuteappendicitisisthemostcommongeneralsurgicalemergency.(10%)37急性闌尾炎英文1/1/2023GeneralconsiderationsAbout8%37GeneralconsiderationsAcuteappendicitishasproteanmanifestations.Itmaysimulatealmostanyotheracuteabdominalillnessandinturnmaybemimickedbyavarietyofconditions.Progressionofsymptomsandsignsistherule—incontrasttothefluctuatingcourseofsomeotherdiseases.38急性闌尾炎英文1/1/2023GeneralconsiderationsAcuteap38Historicalperspective

WillardPackardperformedthefirstsurgeryin1867.In1886,ReginaldFitzdescribedthecharacteristic,clinicalfindingsandpathologyofthedisease,identifiedtheappendixastheprimarycauseofrightlowerquadrantinflammation.Fitzcoinedthetermappendicitisandrecommendedearlysurgicaltreatment39急性闌尾炎英文1/1/2023HistoricalperspectiveWillard39HistoricalperspectiveIn1889,ChesterMcBurneydescribedcharacteristicmigratorypainaswellaslocalizationofthepainalonganobliquelinefromtheanteriorsuperioriliacspinetotheumbilicus.In1894,McBurney

describedarightlowerquadrantmuscle-splittingincisionforremovaloftheappendix.40急性闌尾炎英文1/1/2023HistoricalperspectiveIn1889,40HistoricalperspectiveInthe1940s,themortalityratefromappendicitisimprovedwiththewidespreaduseofbroad-spectrumantibiotics.In1982,LaparoscopicappendectomywasfirstreportedbythegynecologistKurtSemmbuthasonlygainedwidespreadacceptanceinrecentyears.41急性闌尾炎英文1/1/2023HistoricalperspectiveInthe14142急性闌尾炎英文1/1/20237急性闌尾炎英文12/28/202242Anatomy＆physiologyThebaseoftheappendixislocatedattheconvergenceofthetaeniae(3)ofcolon.Thisanatomicrelationshipfacilitatesidentificationandlocationoftheappendixatoperation.43急性闌尾炎英文1/1/2023Anatomy＆physiologyThebaseo4344急性闌尾炎英文1/1/20239急性闌尾炎英文12/28/20224445急性闌尾炎英文1/1/202310急性闌尾炎英文12/28/202245Pathophysiology

Obstructionofthelumenisbelievedtobethemajorcauseofacuteappendicitis.Thismaybeduetolymphoidhyperplasia,inspissatedstool,fecalith,vegetablematterorseeds,parasites,oraneoplasm.46急性闌尾炎英文1/1/2023PathophysiologyObstructionof46PathophysiologyObstructionoftheappendiceallumenBacterialovergrowthContinuedsecretionofmucusIntraluminaldistentionandincreasedwallpressure47急性闌尾炎英文1/1/2023PathophysiologyObstructionof47PathophysiologySubsequentimpairmentoflymphaticandvenousdrainagemucosalischemiaThesefindingsincombinationpromotealocalizedinflammatoryprocessthatmayprogresstogangreneandperforation.48急性闌尾炎英文1/1/2023PathophysiologySubsequentimpa48PathophysiologyInflammationoftheadjacentperitoneumgivesrisetolocalizedpainintherightlowerquadrant.Perforationtypicallyoccursafteratleast48hoursfromtheonsetofsymptomsandisaccompaniedbyanabscesscavitywalled-offbythesmallintestineandomentum.49急性闌尾炎英文1/1/2023PathophysiologyInflammationof49Clinicalfindings

Clinicalfindings

50急性闌尾炎英文1/1/2023Clinicalfindings

Clinicalfin50historyandsymptomAppendicitisneedstobeconsideredinthedifferentialdiagnosisofnearlyeverypatientwithacuteabdominalpainThetypicalpresentationbeginswithvagueperi-umbilicalpainfollowedbyanorexia,nauseaandvomiting.Thenlocalizestotherightlowerquadrant.51急性闌尾炎英文1/1/2023historyandsymptomAppendiciti51

historyandsymptomTheclassicpatternofmigratorypainisthemostreliablesymptomofacuteappendicitisFeverensues,followedbythedevelopmentofleukocytosisOccasionalpatientshaveurinarysymptomsormicroscopichematuria52急性闌尾炎英文1/1/2023

historyandsymptomTheclassi52migratorypain53急性闌尾炎英文1/1/2023migratorypain18急性闌尾炎英文12/28/253PhysicalExaminationLow-gradefeveriscommon(～38℃).DiminishedbowelsoundsFocaltenderness(commonlyatMcBurney‘spoint)------locatedonethirdofthedistancealongalinedrawnfromtheanteriorsuperioriliacspinetotheumbilicus

ReboundtendernessVoluntaryguarding54急性闌尾炎英文1/1/2023PhysicalExaminationLow-grade54PhysicalExaminationDunphy'ssign---coughingcauseincreasedpainRovsing'ssign

---painintherightlowerquadrantduringpalpationoftheleftlowerquadrant55急性闌尾炎英文1/1/2023PhysicalExaminationDunphy'ss55PhysicalExaminationPsoassign---painonextensionoftherighthip(retrocecalappendix)Obturatorsign---painoninternalrotationofthehip(pelvicappendix)56急性闌尾炎英文1/1/2023PhysicalExaminationPsoassign56LaboratoryStudiesTheaverageleukocytecountis15*109/L,and90%ofpatienthavecountover10*109/LMorethan75%neutrophilsin?ofpatients.Acompletelynormalleukocytecountanddifferentialisfoundinabout10%ofpatients.57急性闌尾炎英文1/1/2023LaboratoryStudiesTheaverage57

ImagingstudiesPlainabdominalfilms:maybeusefulforthedetectionofureteralcalculi,smallbowelobstruction,orperforatedulcer,butsuchconditionsarerarelyconfusedwithappendicitis.UltrasonographyandCTscan:behelpfulinpatientswithatypicalsymptoms,suchaschildrenandelderlyperson.58急性闌尾炎英文1/1/2023ImagingstudiesPlainabdomina5859急性闌尾炎英文1/1/202324急性闌尾炎英文12/28/202259A,CTscanoftheabdomendemonstratesanedematous,thickenedappendix(arrow)withobstructingappendicolith(arrowhead).B,CTscanofabdomendemonstratesaperforatedappendixwithacomplexabscessandpelvicfluidcollection(arrow).BL,bladder;UT,uterus.60急性闌尾炎英文1/1/2023A,CTscanoftheabdomendemo60EssentialsofdiagnosisAbdominalmig