Acute Appendicitis ANATOMY AN 310

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Acute Appendicitis ■ Acute Appendicitis is the most common acute abdo men. ■ Appendicectomy is the most common emergency sur gical operation. ■ Appendicitis can occur at any age bu... t is most comm on below 40 years, especially between the ages of 8 and 14. ■ Acute appendicitis should be in the differential diagn osis of all patients presenting to hospital with abdo minal pain. Essentials of anatomy -1 The appendix (vermiform process) is a blind-ending tube a rising from the caecum at the meeting point of the thre e taeniae coli, just distal to the ileo-caecal junction. The cecum and vermiform process, with their arteries. Interior of the cecum and lower end of ascending colon, sh owing colic valve. Essentials of anatomy-2 This is the normal appearance of the appendix against the backgr ound of the cecum (left). The colonoscopic view of the appendi ceal orifice between the fork of two haustral folds in the cecum is seen (right). 1. The base of the appendix thus l ies in the right iliac fossa, clos e to McBurney’s point. This is t wo-thirds of the way along a lin e drawn from the umbilicus to t he anterior superior iliac spine. 2. Its position will determine the c linical presentation of the disea se. Essentials of Pathophysiology ■ Appendicitis is probably initiated by obstruction of the lumen. Transverse section of human vermiform process. X 20. Essentials of Pathophysiology 1 In the early stages, the mucosal inflammation extends through th e submucosa to involve the muscular and serosal (peritoneal) lay ers, eventually causing a localized peritonitis (acute simple appe ndicitis). 2. In a later stage, the necrotic glandular mucosa sloughs into the l umen, which becomes distended with pus (acute suppurative app endicitis). 3. Finally, the end-arteries supplying the appendix become thrombo sed and the infarcted appendix becomes necrotic or gangrenous (acute gangrenous appendicitis). 4. If the faecally contaminated appendiceal contents from a perforat ed appendix are not enveloped by omentum or adherent small bo wel (appendiceal abscess), the spreading peritonitis develops. Case-1 This is the tip of the appendix from a patient with acute appendicitis. The appendix has been sectioned in half. The serosal surface at the left show s a tan-yellow exudate. The cut surface at the right demonstrates yellowis h-tan mucosal exudation with a hyperemic border. ...................................................................................continued........................................................................ [Show More]

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