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Appendicitis: Prof E. C. Ohanaka Consultant Surgeon

This document discusses appendicitis, including its anatomy, pathology, clinical forms, diagnosis using the Alvarado score, differential diagnosis, investigations, management of acute and perforated appendicitis, appendix masses, abscesses, types of appendectomies, and complications. Appendicitis is the most common surgical abdominal emergency and appendectomy is the most common emergency abdominal surgery. Knowledge of appendicitis is important for clinical practice and patient examinations.

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102 views17 pages

Appendicitis: Prof E. C. Ohanaka Consultant Surgeon

This document discusses appendicitis, including its anatomy, pathology, clinical forms, diagnosis using the Alvarado score, differential diagnosis, investigations, management of acute and perforated appendicitis, appendix masses, abscesses, types of appendectomies, and complications. Appendicitis is the most common surgical abdominal emergency and appendectomy is the most common emergency abdominal surgery. Knowledge of appendicitis is important for clinical practice and patient examinations.

Uploaded by

Taylor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd

APPENDICITIS

PROF E. C. OHANAKA
CONSULTANT SURGEON
APPENDICITIS
COMMONEST SURGICAL ABDOMINAL
EMERGENCY
APPENDICECTOMY: COMMONEST ABDOMINAL
EMERGENCY SURGERY
RISING INCIDENCE PARTICULARLY IN THE
DEVELOPING WORLD
KNOWLEDGE IS IMPORTANT
ANATOMY OF APPENDIX
• PART OF LARGE INTESTINE
• RETROCAECAL: 75%
• PELVIC: 21%
• OTHERS: RETROILEAL, PREILEAL, SUBILEAL
(4%)
• A LUMINAL STRUCTURE
PATHOLOGY OF APPENDICITIS
• INTRALUMINAL OBSTRUCTION
- LYMPHOID HYPERPLASIA, FAECOLITHS
- PARASITIC WORMS: OXYURIA VERMICULARIS
- TUMOURS OF APPENDIX, CAECUM AND
ASCENDING COLON
- FAMILIAL
- OBSTRUCTION/DISTENSION/VENOUS
CONGESTION/ ISCHEMIC
NECROSIS/PERFORATION/PERITONITIS
CLINICAL FORMS OF APPENDICITIS
• RECURRENT APPENDICITIS

* ACUTE APPENDICITIS

* PERFORATED APPENDICITIS

• APPENDIX MASS

• APPENDIX ABSCESS
CLINICAL: ALVARADO SCORE
MIGRATORY RIF PAIN 1
ANOREXIA 1
NAUSEA/VOMITING 1
TENDERNESS 2
REBOUND TENDERNESS 1
ELEVATED TEMP 1
LEUCOCYTOSIS 2
SHIFT TO THE LEFT 1
TOTAL 10
ALVARADO SCORE (CONTD)
• 0 – 4 : LOW PROBABILITY (OBSERVATION)

• 5 – 8: PROBABLE APPENDICITIS (IMAGING:


USS, CT SCAN)

• 9 – 10: HIGHLY PROBABLE (APPENDICECTOMY)


DIFFERENTIAL DIAGNOSIS
• ANY ACUTE ABDOMINAL EMERGENCY

• FEMALE PELVIC CONDITIONS

• CHILDHOOD CONDITIONS

• MEDICAL CONDITIONS
INVESTIGATIONS
• FULL BLOOD COUNT
• ELECTROLYTES/UREA/CREATININE
• URINALYSIS
• ABDOMINAL USS
• CT SCAN
• DIAGNOSTIC LAPAROSCOPY
• HCG ASSAY
MANAGEMENT OF ACUTE APPENDICITIS

• NIL ORALLY
• IV INFUSION AND BLOOD INVESTIGATIONS
• ? NASOGASTRIC ASPIRATION
• INTRAVENOUS ANTIBIOTICS
• ANALGESIA
• SURGERY: EMERGENCY APPENDICECTOMY
(OPEN OR LAPAROSCOPIC)
PERFORATED APPENDICITIS
• CLINICAL FEATURES
• PREPARATION FOR SURGERY
• INVESTIGATIONS
• SURGERY: EXPLORATORY LAPAROTOMY,
APPENDICECTOMY, PERITONEAL LAVAGE
• POSTOPERATIVE MANAGEMENT
APPENDIX MASS
• DEFINITION
• CLINICAL FEATURES
• DIFFERENTIAL DIAGNOSIS: INTRA-
ABDOMINAL, RETROPERITONEAL
• INVESTIGATIONS/MANAGEMENT
• OCHNER – SHERREN’S REGIMEN
• SURGICAL INTERVENTION
• FOLLOW - UP
APPENDIX ABSCESS
• PATHOGENESIS

• DIAGNOSIS

• TREATMENT

• INTERVAL APPENDICECTOMY
TYPES OF APPENDICECTOMY
• ELECTIVE

• EMERGENCY

• INTERVAL

• INCIDENTAL
COMPLICATIONS OF APPENDICECTOMY

• HAEMORRHAGE: WOUND, INTRAPERITONEAL

• INFECTION: WOUND, INTRA-ABDOMINAL


(PELVIC, SUBPHRENIC), PORTAL PYAEMIA

• ENTEROCUTANEOUS FISTULA

• DAMAGE TO OTHER STRUCTURES


CONCLUSION
• KNOWLEDGE OF APPENDICITIS VERY
IMPORTANT

- EXAMINATONS

- CLINICAL PRACTICE
• THANKS FOR LISTENING

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