Appendicitis

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12/16/2012 1 In the name of ALLAH, the most merciful & the most beneficent

DEPT. OF SURGERY APPENDICITIS:

12/16/2012 2 DEPT. OF SURGERY APPENDICITIS SHAFAQ SALIM ROLL NO. 20 BDS-III

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12/16/2012 3

PURPOSE OF DISCUSSION??? :

12/16/2012 4 PURPOSE OF DISCUSSION ???

APPENDIX:

12/16/2012 5 APPENDIX

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12/16/2012 6 What is Appendix? The appendix is a small, tube-like structure attached to the first part of the large intestine, the colon.

Anatomical Site:

12/16/2012 7 Anatomical Site

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12/16/2012 8 Present in the RIF Length- avg. length is 7.5-10 cm The longest appendix ever removed was that of a Pakistani man on June 11, 2003, at Pakistan Institute of Medical Sciences, Islamabad, measuring 235 mm (9.2 in) in length.

Position of Appendix:

12/16/2012 9 Position of Appendix

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12/16/2012 10

:

12/16/2012 11 Functions

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12/16/2012 12 Medical literature shows that the appendix has no significant function . The appendix is rich in lymphoid cells , suggesting that it might play a role in the immune system. Whether the appendix has a function or not, it can be removed without any ill effects or side effects.

Vascular Supply:

12/16/2012 13 Vascular Supply

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12/16/2012 14

APPENDICITIS:

12/16/2012 15 APPENDICITIS

What is Appendicitis?:

12/16/2012 16 What is Appendicitis? It refers to the condition characterized by inflammation of the appendix

Incidence:

12/16/2012 17 Incidence

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12/16/2012 18 Rare in infants Common in childhood & early adult life Peak incidence _ teens & early 20s Incidence is equal in males & females Occurs throughout the world equally

Causes:

12/16/2012 19 Causes

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12/16/2012 20 Obstruction a. fecolith ??? b. lymphoid hypertrophy ??? c. intestinal worms d. foreign bodies i.e. vegetable seeds Appendicular Mucosal Secretions Race

Pathology:

12/16/2012 21 Pathology

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12/16/2012 22 Obstruction Intraluminal pressure Edema & mucosal ulceration if condition persist Venous obstruction & Ischaemia Bact. Invasion Gangrenous appendicitis with bact. contamination & perforation of appendix

Clinical Features:

12/16/2012 23 Clinical Features

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12/16/2012 24

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12/16/2012 25 Signs Psoas sign-- pain on extension of right thigh Obturator sign-- pain on internal rotation of right thigh Rovsing's sign-- pain in right lower quadrant with palpation of left lower quadrant Dunphy's sign-- increased pain with coughing Cutaneous Hyperesthesia (Ligat’s Sign)

Diagnosis:

12/16/2012 26 Diagnosis

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12/16/2012 27 Clinical history & examination Blood C.P X-ray_ shows hardened, calcified, pea sized piece of stool Ultrasonography_ shows enlarged appendix or abscess

APPENDECTOMY:

12/16/2012 28 APPENDECTOMY

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12/16/2012 29 “ REMOVAL OF APPENDIX ” Two procedures a. open procedure b. laparoscopic procedure McBurney’s Point This point lies at the junction of the lat 1/3 with the med 2/3 of a line joining the umbilicus & ant. Sup. Spine

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12/16/2012 30 Significance of McBurney’s site of greatest tenderness in appendicitis & also the centre of the grid iron incision Sherrn’s Triangle a line drawn from umbilicus to ant. Sup spine, pubic symphisis & then umbilicus

Open Procedure:

12/16/2012 31 Open Procedure

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12/16/2012 32

Laparoscopic Procedure:

12/16/2012 33 Laparoscopic Procedure

Postoperative Details:

12/16/2012 34 Postoperative Details Administration of intravenous antibiotics Administration of antiemetics and analgesics The patient is encouraged to resume his normal physical activity Usually the first meal is a clear liquid diet If patients tolerate this meal, the next meal usually is a regular diet

Prognosis:

12/16/2012 35 Prognosis Excellent

Complications:

12/16/2012 36 Complications

D/D:

12/16/2012 37 D/D

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12/16/2012 38

Points to Remember:

12/16/2012 39 Points to Remember Definition Anatomical site & Position Causes Clinical Features McBurney’s point & its significance Types of incisions_ their advantages & disadvantages Complications Differential Diagnosis

References:

12/16/2012 40 References Bailey & Love 24 th edition Netter’s Atlas of Human Anatomy 3 rd edition National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/appendicitis/index.htm Indian Medical Journal--Surgical Incisions_ their anatomical basis Wikipedia http://en.wikipedia.org/wiki/Vermiform_appendix http://www.aafp.org/afp/991101ap/2027.html http://www.emedicine.com/med/topic3430.htm www .medicinenet.com/appendicitis/article.htm www.lifespan.org http://www.carenewengland.org/healthGate/images/EE00002_ma.jpg

Q/A:

12/16/2012 41 Q/A

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12/16/2012 42 THANKYOU

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