Acute appendicited for students

1. Аppendicitis
PhD

2. Acute appendicitis
• Acute appendicitis is a nonspecific bacterial
inflammatory disease of the appendix of the caecum.
• This is the most common disease of the appendix.
• The number of sick people is - 300-500 from 100 000
population per each year.
• The most common acute appendicitis occurs at the age
of 20 to 40 years, women get sick 2 times more often
than men. Mortality from the disease 0,1-0,3 %,
• Post operating complications are - 5-9 %.

3. Classification
by V.S. Saveliev (1995)
1. Acute appendicites,
2. Suppurative acute appendicitis :
a) Suppurative
b) Suppurative- ulcerous
3 Gangrenous/necrotizing
appendicitis :
a) primary gangrenous
b) secondary gangrenous

4. Surgical anatomy
-The appendix is
attached at the point
of convergence of
the three taeniae coli
of the caecum on its
posteromedial wall
- The mesentery of the
appendix containing
fat & appendicular
artery and vien

5. Type of location of the
appendix
1 – Post ileal (1%)
2 – Retrocaecal (63%)
3 – pelvic (33%);
4 – pre- ileal (1%);
5 – Subcaecal (1%)

6. Variants of the location of the
vermiform appendix (depend on the
gestational age)

7. Predisposing factors :
1- Obstructive agents
2- Infective agents
Obstructive agents
Foreign bodies :
animal (e.g. thread worms
,round worms) ,
vegetables (e.g. seeds )
mineral (faecalith = common
cause)
submucous lymphoid tissue
hyperplasia leads to
obstruction

8. 2. Infective agents
• Primary infection leading to lymphoid
hyperplasia
• Secondary infection caused by pressure of an
obstructed agent leads to epithelial erosion and
bacteria gain access to the wall

9. Сlinical evidence
Examination
patient complaints
anamnesis
symptoms
•Blood analyses
•Urine analyses
•biochemical analyses
•X-Ray examination
of abdomen
•Ultrasound detection
abdominal cavity
Diagnostics

10. Various symptoms of appendicitis
symptoms %
1. nausea
2. vomiting
3. contipation
4. diarrhea
5. Tachycardia
6. Fever op to 38 С
7. Fever over 38 С
8. Local pain
9. Hardness of abdomen
10. Аbdominal pain
50
26
14
8
90
65
32
95
75
100

11. Abscesses around appendix Distant abscesses
Mesentery
abscess
Межкишеч-
ный
абсцесс
retroperitoneal
Duglas cavity
abscess
Sub diaphragma
abscess
Appendicites complication

12. Surgery Treatment

13. Pre-operation interview.
• Surgical field and skin preparation.
• Analgesia before surgery treatment
• Antibacterial treatment

14. Surgical approach
(open and laparoscopic)

15. Open appendectomy

16. Laparoscopic
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17. Postoperative complications
1.Bleeding
2. Suppuration
3.Postoperative peritonitis
4.Interstitial abscess
5.Bowel obstruction

18. Conclusions
• All patients with suspected acute appendicitis should be hospitalized for
dynamic observation.
• In case of a doubtful diagnosis of appendicitis, video laparoscopy should
be used ̆.
• When establishing destructive forms of appendicitis and the presence of
local unlimited or diffuse purulent peritonitis, the abdominal cavity must
be drained.

19. THANK YOU