1. ACUTE APPENDICITIS (Incidence, Etiology and pathology) Flashcards
INCIDENCE of ACUTE APPENDICITIS
Commonest cause of acute abdomen.
Variation in the position of the tip of the appendix
- Retrocaecal 74%
- pelvic 21%
- Paracaecal
- Subcaecal
- Preilial
- postilial
- Subserous
- Subhepatic
Pathogenesis of Subserous appendix in Variation in the position of the tip of the appendix
when it lies beneath the serosa of the caecum
Pathogenesis of Subhepatic appendix inVariation in the position of the tip of the appendix
failure of descent of the caecum
Etiology of ACUTE APPENDICITIS
(A) Non-obstructive (1/3)
B) Obstructive (2/3
Pathogenesis of Non-obstructive Etiology of ACUTE APPENDICITIS
Constipation.
Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS
Obstruction may be in :
* Lumen :
- Wall:
- Outside the wall: .
Lumen Obstruction in Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS
- F.B ( fruit seeds)
- parasites ( oxyuris or ascaris worms)
- faecal concretions.
Wall Obstruction in Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS
- Stricture
- Tumour.
- Crohn’s
- Lymphoid tissue hyperplasia
Outside the wall Obstruction in Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS
- Adhesions
- kinks
- mass
PATHOLOGY of ACUTE APPENDICITIS
- Organisms
- Route of spread
- Pathological stages
- Fate
Organisms in PATHOLOGY of ACUTE APPENDICITIS
- E. coli
- streptococcal faecalis
- streptococcal viridans
Route of spread in PATHOLOGY of ACUTE APPENDICITIS
Direct from the lumen ( Rarely blood ).
Pathological stages in PATHOLOGY of ACUTE APPENDICITIS
(1) Acute catarrhal :
(2) Acute suppurative.
(3) Acute gangrenous
Pathogenesis of Acute catarrhal in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS
Inflammation is confined to the mucosa.
Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS
- Leading to perforation
- ln non obstructive type
- ln obstructive type
- Perforation is more common with obstructive appendicitis
perforation ln non obstructive type in Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS
Perforation occurs at the tip
the reason why perforation ln non obstructive type occurs at the tip , in Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS
due to thrombosis of the appendicular artery.
perforation ln obstructive type in Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS
Perforation occurs at the site of obstruction.
Fate in PATHOLOGY of ACUTE APPENDICITIS
A. Non-obstructive Type :
B. Obstructive Type :
Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
- Inflammatory process
- The appendicular mass:
- Sequel
Inflammatory process in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
- The course of the inflammatory process is slow
- The omentum surrounds the inflamed appendix
- an “Appendicular Mass” forms on the 3rd day after the beginning of the attack of acute appendicitis
The appendicular mass in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
- Alternative name
* Components
Alternative name for The appendicular mass in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
peri-appendicular phlegmon
Components of The appendicular mass in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
a) Appendix in center.
b) Surrounded by loop of gut.
c) And all are wrapped by omentum ( policeman of the abdomen) forming closed box preventing this
inflamed focus from affecting other structures.
Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
a) Complete resolution under medical treatment.
b) Perforation (at the tip) may however occur inside the mass causing “ Appendicular Abscess”.
The Appendicular Abscess in Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
a) Its location
B) Fate:
Location of The Appendicular Abscess in Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
is governed by the location of the appendix thus it may be retrocaecal, pelvic, subcaecal, preilial and postilial
Fate of The Appendicular Abscess in Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
A big abscess may point in the abdominal wall or may burst in the rectum or vagina or in the peritoneal cavity )> peritonitis
Obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
The inflammatory process
Sequel
The inflammatory process in Obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
The course of the inflammatory process is rapid causing perforation (at the site of obstruction) before the defensive mechanism has occurred.
Sequel in Obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS
Perforation causes generalized peritonitis (Within the 1st 48 hours).
