1. Presented by : Sara Shokri Moghaddam

2. Anatomy & Function of appendix The three taeniae coli converge at the junction of the cecum with the appendix. The tip of appendix can be found in a retrocecal,pelvic,subcecal,preileal or right pericolic position.

4. Anatomy & Function of appendix Appendix is an immunologic organ that participate in the secretion of IGs., specially IgA.

5. Incidence ≈ 7 % of all people andergoes appendectomy during their life More frequently in 2 nd through 4 th decades of life M > F The percentage of misdiagnosed cases of appendicitis is higher among women.

6. Etiology and Pathogenesis Obstruction of the lumen is the dominant etiologic factor of appendicitis. The most common cause of obstruction is fecaliths. Other causes:hypertrophy of limphoid tissue,inspissated barium,tumor,vegetable and fruit seeds and intestinal parasites.

8. Etiology and Pathogenesis A sequence of events lead to appendicitis: Proximal obstruction and normal secretion of mucosa Distention of appendix Stimulation of visceral afferent nerves a vague diffused pain in the midabdominal or lower epigastrium

9. Distention of appendix N/V occlusion of capillaries vascular congestion involvement of the serosa involvement of parietal peritoneum SHIFT in the PAIN to RLQ

11. Bacteriology The bacterial population of a normal appendix is similar to that of normal colon The principal organisms seen in the normal appendix,in acute appendicitis, and in perforated appendicitis are Escherichia coli & Bactroid fragilis.

12. AB prophylaxis Effective in prevention of wound infection and abcesses. 24-48h in non perforated appendicitis. 7-10D in perforated appendicitis.

13. Clinical manifestations SYMPTOMS: Abdominal pain Shifting of pain to the RLQ Anorexia N/V Sequence of symptoms: anorexia pain N/V(if accours)

14. Clinical manifestations SIGNS: Tendernes around Mcburney point Rebound tenderness Rovsing sign Guarding Obturator sign Psoas sign

16. Laboratory findings Mild leukocytosis (10000 to 18000) Several RBC or WBC can be present from ureteral or bladder irritation

17. Imaging studies Plain films of the abdomen Barium enema examination and radioactively labeled leukocyte scans Compression sonography High resolution helical CT

19. Differential Diagnosis Acute mesenteric adenitis PID Ruptured graffian follicle Twisted ovarian cyst Ruptured EP Acute gastroentritis Meckle’s diverticulitis Crohn’s entritis Colonic lesions Other diseas

20. Treatment Open appendectomy Laparoscopic appendectomy Natural orifice transluminatiom endoscopic surgery Antibiotics Interval appendectomy

21. Incidental appendectomy Childrens about to undergo chemotherapy Disabled patient Patients with crohn’s disease The indivisual who are about to travel to remote places