University:
Stanford University
Course:
MED 101 | Human Anatomy
Academic year:

2023
Views:

262

Pages:

3
Author:

larbi43100

‭Acute appendicitis‬ ‭The appendix is an extension of the cecum of very variable length (2 to 20‬ ‭centimeters). It is located at the junction of the three taenia of the colon,‬ ‭approximately 2 centimeters below the ileocaecal junction. It can be in‬ ‭retrocaecal position (66% of cases), mesocoeliac (1% in front of the end of the‬ ‭ileum, 0.5% behind), pelvic (30%) or paracolic (2%). Its classic parietal‬ ‭projection (but in fact very variable) is at the Mac Burney point (junction of the‬ ‭lateral third and the middle third of a line uniting the umbilicus to the right‬ ‭anterosuperior iliac spine).‬ ‭Acute appendicitis is the most common abdominal emergency: approximately‬ ‭10% of Westerners will one day have acute appendicitis, and more than‬ ‭250,000 appendectomies are performed annually in the United States. It‬ ‭reflects an acute appendiceal infection, sometimes recurrent, most often‬ ‭endogenously.‬ ‭Age at diagnosis‬‭-Acute appendicitis can be seen at‬‭any age, but there is‬ ‭a peak frequency from 10 to 30 years old. Perforation, on the other hand,‬ ‭is more common at the extreme ages of life.‬ ‭Sex ratio‬‭-It is generally‬‭1/1, except between puberty and the age of 25 when‬ ‭there is a slight male predominance (3 men for 2 women)‬ ‭the incidence of acute appendicitis is lower in socioeconomically‬ ‭disadvantaged groups.‬ ‭Special case of pregnant women‬‭-Acute appendicitis‬‭occurs in one in‬ ‭500 to 2,000 pregnancies, mainly during the second trimester.‬ ‭The pathophysiology of acute appendicitis is still controversial today. Its classic‬ ‭mechanism is summarized in the figure below. However, it seems that the initial‬ ‭event is not always obstruction of the appendix (involved in only 50 to 80% of‬ ‭cases), but mucosal ulcerations (of viral etiology or caused by‬‭Yersinia‬ ‭?).‬ ‭The different lesions observable at the level of the appendix during acute‬ ‭appendicitis are shown schematically in the table below:‬ ‭ ind‬ K ‭lesion‬ ‭el‬ ‭Description‬ ‭Appearance of‬ ‭of the lesion‬ ‭the appendix‬ ‭appendicitis‬ ‭achievement‬ ‭hyperhealed appendix‬ ‭catarrhal‬ ‭localized‬ ‭mié‬ ‭mucous membrane‬ ‭appendicitis‬ ‭affected by‬ ‭ulcerative‬‭and‬ ‭the entire‬‭wall‬ ‭red appendix and‬ ‭edematous‬ ‭suppurative‬ ‭Pain dominates the picture: initially periumbilical or epigastric pain, usually‬ ‭moderate, followed by nausea or vomiting (50% of cases), then displacement of‬ ‭the pain, which increases in intensity, in the right iliac fossa (this chronology of‬ ‭events is however very variable). The temperature is slightly elevated, but above‬ ‭38.3 degrees Celsius, a complication should be feared (perforation, more‬ ‭common in children and the elderly). Anorexia is the rule (a patient who is‬ ‭hungry does not have acute appendicitis).‬ ‭During the physical examination, three essential points are found:‬ ‭ ain provoked on palpation of the right iliac fossa; existence of a‬ p ‭-‬ ‭parietal defense (sometimes absent if retrocaecal or pelvic‬ ‭appendicitis);‬ -‭ ‬ ‭pain caused by rectal examination.‬ ‭-‬ ‭Special shapes‬‭-They depend on the location of the‬‭appendix:‬ ‭-‬ ‭ elvic appendicitis: the pain is hypogastric and is accompanied‬ p ‭by urinary disorders (pollakiuria, dysuria);‬