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Appendicitis - Peritonitis

This document discusses appendicitis and peritonitis. It begins with the anatomy and physiology of the appendix and peritoneum. It then discusses the pathophysiology, clinical signs and symptoms, differential diagnosis, investigations and treatment of appendicitis. For peritonitis, it discusses the anatomy and physiology of the peritoneum and peritoneal cavity. It also discusses the pathophysiology, disorders, diagnosis and surgical treatment of peritonitis.

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104 views37 pages

Appendicitis - Peritonitis

This document discusses appendicitis and peritonitis. It begins with the anatomy and physiology of the appendix and peritoneum. It then discusses the pathophysiology, clinical signs and symptoms, differential diagnosis, investigations and treatment of appendicitis. For peritonitis, it discusses the anatomy and physiology of the peritoneum and peritoneal cavity. It also discusses the pathophysiology, disorders, diagnosis and surgical treatment of peritonitis.

Uploaded by

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

Peritonitis
FK Unswagati
Cirebon
Anatomy
Patophysiology
Diagnostic
Treatment
Appendi
x
anatomy
The appendix is a 58 cm diverticulum arising
from the cecum at the convergence of the teniae
coli. It is typically 23 cm below the ileocecal
valve.

The appendix most commonly lies in the ileocecal


location but may also be retrocecal (16%),
retroileal, or pelvic

The position of the appendix may affect the


clinical presentation of acute appendicitis.
anatomy
The lumen of the appendix communicates with the cecum.
The appendiceal wall has mucosal, submucosal, muscular, and
serosal layers. The mucosa is colonic in appearance with goblet cells.
The submucosa is rich with lymphoid tissue that aggregates as
numerous lymphoid follicles. The muscle wall and serosa are similar
to those of the cecum.
The appendix, like the small intestine and right colon, originates from
the midgut of the embryo and, as such, is supplied by the ileocolic
branch of the superior mesenteric artery and is innervated by T-10,
the same somatic innervation as the skin surrounding the umbilicus.
Thus, in early appendicitis, when only the visceral wall of the
appendix is involved, the pain is initially referred to the region of the
umbilicus.
Parenthetically, it must also be pointed out that when the jejunum,
ileum or right colon are obstructed, the colicky abdominal pain
initially felt by the patient is periumbilical.
anatomy
anatomy
anatomy
Physiology

The function of the appendix in the adult human is


unknown but is likely to be related to the role of
the lymphoid tissue in immunologic processes
PATHOPHYSIOLOGY
A primary event in the initiation of acute appendicitis is luminal
obstruction, which in over 70% of cases is caused by fecalith, foreign
body, tumor of the appendix or cecum, parasites, or fibrous bands.
When such definitive obstruction is present, appendicitis is likely to
progress rapidly and result in gangrene and perforation, known as
acute obstructive appendicitis.
In approximately 25% to 30% of patients with acute appendicitis, no
luminal cause for obstruction is found. Instead, hyperplasia of the
submucosal lymphoid follicles appears to compromise the appendiceal
lumen. Such lymphoid hyperplasia has been related to recent or
concurrent incidences of upper respiratory tract or other viral
infections, particularly in children.
Acute obstructive appendicitis can progress within 12 to 24 h to
gangrene of the wall of the appendix and perforation.
Perforation may become rapidly confined by the omentum and/or small
bowel and develop into an appendiceal abscess.
PATHOPHYSIOLOGY
When the perforation is not localized,general peritonitis
develops.
Acute appendicitis may lead to hematogenous spread
of bacteria and infection of the portal vein
(pylephlebitis) or liver abscesses.
Independent of the etiology, obstruction is believed to
cause an increase in pressure within the lumen. Such
an increase is related to continuous secretion of fluids
and mucus from the mucosa and the stagnation of this
material. At the same time, intestinal bacteria within
the appendix multiply, leading to the recruitment of
white blood cells and the formation of pus and
subsequent higher intraluminal pressure.
Clinical Sign
The most common symptom of appendicitis is
abdominal pain. Typically, symptoms begin as
periumbilical or epigastric pain migrating to the
right lower quadrant (RLQ) of the abdomen.
Patients usually lie down, flex their hips, and draw
their knees up to reduce movements and to avoid
worsening their pain. Later, a worsening
progressive pain along with vomiting, nausea, and
anorexia are described by the patient. Usually, a
fever is not present at this stage.

Physical Examination
The most specific physical findings in appendicitis are
tenderness, rebound tenderness, pain on percussion,
rigidity
Accessory signs
The Rovsing sign (RLQ pain with palpation of the LLQ)
The obturator sign (RLQ pain with internal and external rotation
of the flexed right hip)
The psoas sign (RLQ pain with extension of the right hip or with
flexion of the right hip against resistance)
The Dunphy sign (sharp pain in the RLQ elicited by a voluntary
cough)
The Markle sign, pain elicited in a certain area of the abdomen
when the standing patient drops from standing on toes to the
heels with a jarring landing
Physical Examination
The stages of appendicitis can be divided into
early
suppurative
Gangrenous
Perforated
Phlegmonous
spontaneous resolving
recurrent, and chronic.
Differential
Diagnose
Investigation
Laboratory Finding : blood, urinary
Radiological studies : Plain BNO, Appendicogram,
Ultrasound
Laparoscopy : diagnostic and treatment
Treatment : Surgical
PERITONITIS
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
The peritoneal cavity is the abdominal space
bounded by the diaphragm superiorly, the pelvic
floor inferiorly, the retroperitoneum posteriorly,
and the anterior abdominal wall anteriorly.
It contains all the abdominal viscera except those
that lie in the retroperitoneum, which include the
second, third, and fourth portion of the
duodenum, the distal rectum, the pancreas, the
kidneys and ureters, the adrenal glands, and the
aorta and inferior vena cava.
Physiologi of Peritoneum
The peritoneum and omentum play several roles of physiologic
significance:
Provision of a surface that allows smooth gliding of the small intestine
within the peritoneal cavity. This function is aided by the presence of
free fluid (50mL of transudate) within the peritoneal cavity.
Fluid exchange. Approximately 500mL of fluid or more per hour may be
exchanged between the peritoneal cavity and the circulation across the
peritoneum. This remarkable property is exploited in the performance of
peritoneal dialysis in renal failure. In infants, circulating blood volume
may be replenished by the administration of fluid intraperitoneally.
Response to tissue damage or infection. The mesothelial and mast cells
secrete histamine and other vasodilators in response to injury or
infection.
Omental migration. The omentum migrates to areas of inflammation,
perforation, or ischemia. This wellvascularized tissue attempts to isolate
the pathology and also exerts bacteriophagic function.
Patophysiology of Peritoneum
The peritoneum mounts rapid response to infection, injury,
and leakage into the peritoneal cavity of digestive fluid, bile,
pancreatic juice, urine, or blood. The result is vascular
permeability, fluid exudation, and both neutrophil and
cytokine response.
Reflex pathways cause muscular contraction in the
abdominal wall to limit movement (guarding and rigidity).
Similarly, peristaltic movement of the intestine is arrested
(hypoactive or absent bowel sounds).
Untreated, generalized peritonitis most commonly cause
death secondary to gram-negative septicemia, septic shock,
and disseminated intravascular coagulation. On other
occasions, generalized peritonitis leads to intraabdominal
abscesses, which tend to be multiple.
Peritoneum Disordes
Prymary peritonitis
Secondary Peritonitis
Intraabdominal Abcess
Malignancy
Diagnostic
History
Physical Examination
Laboratory Finding : blood, urinary
Radiological studies : Upright BNO, Ultrasound
Treatment: Surgical
Laparotomy
Terimaka
sih

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