Acute Appendicitis

Dr Moayad Ahmad Lamber

General surgeon
M.O.H
3/6/2015

Anatomy
It is a blind end muscular tube with
mucosal , submucosal ,muscular and
serosal layers.
The lumen layered by colmnuar
epithelium.
Length 7.5- 10 cm
Position most common retrocecal
Base constant , confluence of the taenia
coli

Anatomy

Anatomy
Blood supply is by appendicular artery
,branch of the ilecolic artery , branch of
SMA
End artery
Four , six or more lymphatic channels
traverse the mesoappendics drain in the
ilececal lymph nodes

Anatomy

Aetiology
Low fiber diet ? High sugar diet ?
Luminal obstruction ( faecolith, sticture,
lymphnode enlargment , tumor ,foreign
body , pinwarms).
Bacterial over growth within the lumen
(mixed aerobic , anaerobic).

Aetiology
Peak incidence in the teens and early 20S
Rare in infants
Male to female ratio 3:2 at age of 25
thereafter this declines
Life time risk for appendectomy is 8.6 %
for males and 6.7% for females .

pathology
Luminal obstruction with continues mucus
secretion and inflammatory exudation
increase intraluminal pressure ,
obstructing lymphatic drainage .
Odema , mucosal ulceration , bacterial
translocation to the submucosa.

pathology
Continues rise in pressure lead to venous
obstruction and ischemia of the appendix
wall .
Ischaemic necrosis of the wall produce
gangrene and peritonial contamination .
Greater omentum and small bowel loops
adhere to localize the inflammation .

Clinical diagnosis

Clinical diagnosis

Clinical diagnosis

Clinical diagnosis
Special features according to position:
Retrocecal rigidity is absent on deep
pressure.
Pelvic diarrhoea , tenderness may be
absent , tendernesss on PR .
Postileal pain may not shift , diarrhoea .

Clinical diagnosis
Special features according to age
Infants- rare , unable to give history ,
underdeveloped omentum.
Children vomiting , loss of apptit .
Elderly gangrene and perforation .
Obese patient obscure local signs ,
difficulty in operation.
Pregnancy : most common surgical
emergancy , fetal loss 3-5%, up to 20 %

Differential diagnosis

investigation

Diagnosis
CBC: the WBC is of limited value.
C-Reactive Protien CRP and ESR have
been studied with mixed results

Diagnosis
UA: abnormal UA results are found in 1940%
Abnormalities include: pyuria, hematuria,
bacteruria
Presence of >20 wbc per field should
increase consideration of Urinary tract
pathology

Treatment

Appendectomy :- open
- laprascopic
Ivf
Npo
analgesia

Thank you