英語查房預(yù)習(xí)資料課件

1、 Acute Appendicitis2012.8Epidemiology(流行病學(xué)）The most common acute abdomen disease The incidence of appendectomy appears to be declining due to more accurate preoperative diagnosis.Despite newer imaging techniques, acute appendicitis can be very difficult to diagnose. Etiology（病因）1. The anatomy（解剖） ch

2、aracteristics2. The tissue features3. Foreign body obstruction4. Parasites（寄生蟲） cause the mucosa（粘膜） damage5. Adhesion, pressure cause appendix distortedObstruction high pressure lymph obstructed, ischemia mucosa damage bacteria invade（70%80%）Etiology（病因）Eventually the pressure exceeds capillary（毛細血

3、管） perfusion pressure and venous and lymphatic drainage are obstructed.With vascular compromise, epithelial （上皮）mucosa breaks down and bacterial invasion by bowel flora（腸道菌群） occurs.Etiology （病因）Increased pressure also leads to arterial stasis and tissue infarctionEnd result is perforation（穿孔） and s

4、pillage（溢出） of infected appendiceal contents into the peritoneum（腹膜）Pathophisiology （病理生理）Simple appendicitisSuppurative（化膿的） appendicitis Gangrenous（壞疽的） appendicitisPerforated（穿孔的） appendicitisPeritonitis（腹膜炎）Abscess（膿腫） around the appendixMucocele（粘液囊腫） of appendixPathophysiology （病理生理）Acute appe

5、ndicitis is thought to begin with obstruction of the lumen（內(nèi)腔）Obstruction can result from food matter, adhesions, or lymphoid hyperplasia（增生）Appendix is twisted, and Lumen of appendix is narrow, result in obstructionMucosal secretions continue to increase intraluminal（管腔內(nèi)的） pressureManifestations （臨

6、床表現(xiàn)）Primary symptom: abdominal pain to 2/3 of patients have the classical presentationPain beginning in epigastrium or periumbilical area that is vague and hard to localize Manifestations （臨床表現(xiàn)）As the illness progresses RLQ localization typically occursRLQ pain was 81 % sensitive and 53% specific fo

7、r diagnosisMigration of pain from initial periumbilical to RLQ was 64% sensitive and 82% specificManifestations （臨床表現(xiàn)）Associated symptoms: indigestion, discomfort, flatus（脹氣）, need to defecate（排便）, anorexia（厭食）, nausea, vomitingAnorexia is the most common of associated symptomsVomiting is more varia

8、ble, occurring in about of patientsPhysical Exam （體格檢查）Additional components that may be helpful in diagnosis: rebound tenderness（反跳痛）, voluntary guarding, muscular rigidity（硬度）, tenderness on rectalFever: another late finding.At the onset of pain fever is usually not found. Temperatures 39 C are un

9、common in first 24 h, but common after rupture（破裂）DiagnosisAcute appendicitis should be suspected in anyone with epigastric, periumbilical, right flank（側(cè)面）, or right sided abd pain who has not had an appendectomyWomen of child bearing age need a pelvic exam and a pregnancy test.Additional studies: C

10、BC, UA, imaging studiesDiagnosisThe WBC is of limited value. Sensitivity of an elevated WBC is 70-90%, but specificity is very low.But, +predictive value of high WBC is 92% and predictive value is 50%C-reactive protein have been studied with mixed resultsDiagnosisImaging studies: include X-rays, CTX rays of abd are abnormal in 24-95%Abnormal findings include: Fecalith(糞石）, appendiceal gas, localized paralytic ileus（麻痹性腸梗阻）, blurred（模糊） right psoas（腰大肌）, and free airDiscussion1.What are the main appendicitis si