Pathophysiology of Acute Appendicitis
急性闌尾炎
Acute appendicitis
PATHOPHYSIOLOGY
Fecalith,
lymphoid follicles
Bacterial growth,
Venous obstruction
Arterial
compromised
History
Physical examination
McBurney’s point tenderness
Rovsing’s sign
RLQ pain resulting from palpation
in the left lower quadrant
Lab & Radiologic exam
Lab
CBC
U/A
Electrolytes, BUN, creatinine
Pregnancy test
Radiologic exam
X-ray: rarely helpful
Ultrasound: operator dependent
CT scan
: most common, sensitivity 94%, specificity 95%
MRI: for pregnant patient
Alvarado Score for Acute Appendicitis
(MANTRELS)
Abdominal pain that
M
igrates to the right iliac fossa
(2pts)
A
norexia (loss of appetite) or ketones in the urine
N
ausea or vomiting
T
enderness in the right iliac fossa
R
ebound tenderness
Fever of 37.3 °C or more (
E
levated temperature)
L
eukocytosis, (>10000 WBC/mL)
(2pts)
Neutrophilia, or
S
hift of neutrophils to the left
Treatment
Antibiotics therapy
Broad-spectrum gram-negative and anaerobic coverage
Appendectomy
Open appendectomy
Conventional procedure
Laparoscopic appendectomy
Reduce pain, hospital stay
Quicker return to work
Lower risk of wound infection
Benefit in obese and woman
Necrosis, perforation, and arterial compromise in acute appendicitis lead to lumen obstruction, increased luminal pressure, bacterial growth, and venous obstruction. Symptoms typically include periumbilical or epigastric pain due to visceral pain caused by lumen obstruction.
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Presentation Transcript
PATHOPHYSIOLOGY Necrosis, Perforation Arterial compromised Lumen obstruction Luminal pressure Bacterial growth, Venous obstruction Fecalith, lymphoid follicles
History Periumbilical or epigastric pain Lumen obstruction Visceral pain Anorexia (90%), nausea & vomiting (70%), diarrhea (10%) Right lower quadrant pain Transmural inflammation Parietal pain Peritoneal irritation, pain on movement, fever, tachycardia Diffused tenderness Ruptured appendicitis with peritonitis
Physical examination McBurney s point tenderness Rovsing s sign RLQ pain resulting from palpation in the left lower quadrant
Lab & Radiologic exam Lab CBC U/A Electrolytes, BUN, creatinine Pregnancy test Radiologic exam X-ray: rarely helpful Ultrasound: operator dependent CT scan: most common, sensitivity 94%, specificity 95% MRI: for pregnant patient
Alvarado Score for Acute Appendicitis (MANTRELS) Abdominal pain that Migrates to the right iliac fossa (2pts) Anorexia (loss of appetite) or ketones in the urine Nausea or vomiting Total score <5 5 or 6 7 or 8 9 or 10 Tenderness in the right iliac fossa Unlikely Possible Likely Highly likely Rebound tenderness Fever of 37.3 C or more (Elevated temperature) Leukocytosis, (>10000 WBC/mL) (2pts) Neutrophilia, or Shift of neutrophils to the left
Treatment Antibiotics therapy Broad-spectrum gram-negative and anaerobic coverage Appendectomy Open appendectomy Conventional procedure Laparoscopic appendectomy Reduce pain, hospital stay Quicker return to work Lower risk of wound infection Benefit in obese and woman
