appendicitis

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脐与右髂前上棘连线
中外 1/3 交界处为
Mc Burney point （麦氏点）
navel and
right anterior superior
iliac spine
 A BC 盆位 pelvic
 D 盲肠 below cecum
 E lateral cecum
 F behind cecum
 G Anterior ileum
回肠前位
 H posterior ileum
retroileal
回肠后位
 Appendix Anatomy
 appendix shap
appendix shap
short mesangial
系膜→

bent

Appendix A. :
one , end. -- infarc
t -- necrosis
 Appendix V.

ileum – colon V.
superior mesenteric V.
portal V. （回结，肠系膜，门）
liver (abscess)
 Appendix nerve
 the sympathetic N.→
splanchnic 内脏 N. →
thoracic spinal cord sections 10,11

Pain around navel (Visceral pain ) ,

referred pain
Acute appendicitis
 acute abdominal disease
(1/4)
 morbidity 1:1000

 Age: 1 to 90, young （ 10m

old)
 M: F 2, 3: 1
 Acute appendicitis
etiology

 appendiceal lumen obstruction s

oya 黄豆

(cavity small, mouth small, curly )

 gastrointestinal disease

 Bacteria , toxin, wall pressure ↑→ ische

mic
Negative bacilli and anaerobes
40
 the fate of acute
 inflammation subsided : chronic
appendicitis
妞妞 antibiotics

 limitations of inflammation :

abscess, absorbed.
 inflammation-proliferation :
扩散

diffuse peritonitis, suppurative 化脓的

gate v. inflammation, septic shock
 symptoms
1. Bellyache: metastatic 转移 right lower abdominal p
ain .
(first) the upper abdomen or umbilical pain
location, pathology ___ degree
2. gastrointestinal symptoms : vomiting ,
tenesmus sense 里急后重 ( pelvic cavity )
abdominal distention , obstruction
3. systemic reactions : fever , jaundice ( pylephlebiti
s)
门静脉 炎
 signs
1. fixed right lower quadrant pressing p
ain :
McBurney point
2. peritoneal irritation :
rebound pain , abdominal muscle st
rain
bowel sounds – weak, disappear
3. right lower quadrant mass
 signs
4. special signs :

＊ inflatable colon test( Rovsing sign): Positive

＊ psoas test ： left-lateral position ,
腰大肌

hyperextension to back, pain

左侧卧位将右下肢
向后过伸，引起右下腹痛为阳性
 signs
5. Rectal examination :
right in front of the rectum pressing pain

painful mass
6. Lab test: WBC, neutrophil ↑
7. Imaging findings : X-ray
B-US
CT
laparoscope
 pathological
classification
 acute simple appendicitis

 acute suppurative appendicitis

 gangrenous and perforated appendicitis

坏疽，穿孔

 appendiceal abscess
 distinguish diagnosis
 gastric ulcer perforation :
subdiaphragmatic free gas
 gynecological and obstetrical diseases : 妇产
ruptured ectopic pregnancy
ovarian cyst torsion
acute pelvic inflammatory disease
( B-US internal genitalia 内生殖器 )
 Right ureteral stones
 acute mesenteric lymphadenitis:
 treatment
 non-surgical treatment
（ concervative )
 Surgical treatment

indications:
methods: Appendectom
y
 appendectomy
1. anesthesia

2. incision
3. look for
4. appendix mesangial 系膜

5. Treat root
6. Drainage 引流
50
appendix mesangial 系膜
purse-string suture 荷包缝合

suture
bury the appendix
stump
 complications of acute
appendicitis
 abdominal abscess

 internal and external intestinal fistula

 Pylephlebitis

门V炎
 complications after
appendectomy
 wound infection
 peritonitis,
 intra-abdominal abscess
 Bleeding
 intestinal fistula
 adhesive intestinal obstruction
 appendix stump inflammation
残端
 special type of
appendicitis
 acute appendicitis in children
 acute appendicitis during pregnancy:
not in the right lower quadrant
tenderness
diffuse peritonitis
Operation early
 elderly patients with acute appendicitis