APPENDICITIS presentación para exposición.pptx

Apendicitis

1. APPENDICITIS DR. MELQUISEDEC SARMIENTO ANTONIO 

2. INFLAMMATION OF THE CECAL OR VERMIFORM APPENDIX DEFINITION

3. ETIOLOGY/CAUSES 60% OF CASES ARE DUE TO LYMPHOID HYPERPLASIA 30-40% IS DUE TO A FECALITE OR APPENDICOLITE 4% FOREIGN BODIES 1% CANCER 1) IT IS DUE TO OBSTRUCTION OF THE APPENDICULAR LIGHT

4. WHICH CAUSES AN ACCUMULATION OF MUCOUS SECRETION, DISTENSION OF THE APPENDIX, COMPROMISE OF VENOUS AND LYMPHATIC DRAINAGE AND BACTEIRAN OVERGROWTH

5. SEMIOLOGY OF PAIN PAIN PERIUMBILICAL OR EPIGASTRIC

6. PHASES … PHASES CHARACTERISTICS EARLY STAGE APENDICITIS (CATARRAL) mucosal edema (NORMAL) PHLEGMONOUS mucosal ulceration SUPURATIVE Transmural spread of bacteria causes acute suppurative appendicitis GANGRENOUS Intramural venous and arterial thromboses ensue, resulting in gangrenous appendicitis.

7. PHYSICAL EXAMINATION MCBURNEY BLUMBERG Pain in the outer third of a straight line, between the right anterior iliac spine and the belly button. Temporary rebound tenderness in the abdominal wall I NEED VOLENTEERS PLEASE.

8. REMEMBER… THE SIGNS THAT HAVE THE MOST PREDICTIVE VALUE IN APPENDICITIS ARE: PAIN IN THE RIGHT ILIAC FOSSA SIGNS OF PERITONEAL IRRITATION MIGRATION OF PAIN FROM THE MESOGASTRIUM TO THE RIGHT ILIAC FOSSA APPENDICULAR SIGNS

9. DX IT IS CLINICAL IN 80% OF CASES. LABORATORIES: white blood cell (WBC) count greater than 10,500 cells/µl ( Neutrophilia ) C-Reactive Protein : is an acute-phase reactant synthesized by the liver in response to infection or inflammation and rapidly increases within the first 12 hours.

10. IMAGING STUDIES In doubtful cases (especially in children, the elderly and pregnant women), these imaging techniques are used. CT SCAN: SENSITIVITY ECOGRAPHY: CHILDREN/ YOUNG WOMEN.

11. TRAETMENT 1ST OF ALL: APPENDICECTOMY BUT….. FIRST OF ALL PROPHYLACTIC ANTIBIOTICS AND REPLACEMENT OF LIQUIDS ANTIBIOTIC: CEFTRIAXONE OR CEPHALOTHIN + METRONIDAZOLE FOR ALLERGICS TO CEPHALOSPORINS WE CAN USE CLINDAMICIN + AMINOGLYCOSIDS

12. CONTRAINDICATIONS FOR LAPAROSCOPIC SURGERY: CARDIAC INSUFFICIENCY MULTIPLE ABDOMINAL SURGERIES PULMONARY HYPERTENSION

13. CLINICAL CASE … A 35-year-old obese woman , with abdominal pain of 8 hours clinical course . Pain starts in the epigastrium and then sits in the right iliac fossa . She has tenderness in the right iliac fosa with Blumberg (+). Laboratory testings reveals neutrophilic leukocytosis . In regard to the suspected pathology , select the response that is NOT true: Laparoscopic appendicectomy is the procedure of choice since this is an acute abdomen in a woman of fertile age . Laparoscopic apendicectomy is not suitable because she is an obese patient . Lparoscopic surgery is clearly superior to open surgery in patients where there are doubts over diagnosis.