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Diseases of the Appendix

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Presentation on theme: "Diseases of the Appendix"— Presentation transcript:

1 Diseases of the Appendix
בס"ד Diseases of the Appendix יונתן אברהם דמה

2 Appendicitis Disease of the young Incidence
Rare in very young children and elderly Overall mortality 0.25% Higher mortality in age extremes

3 Plan Introduction Diagnosis Treatment preop, op and post op
Special consideration Complication Neoplasm

4 Introduction Embryology Normal anatomy Pathophysiology Bacteriology

5 Embryology

6 Embryology

7 Anatomy

8 Anatomy

9 Pathophysiology

10 Diagnosis Clinical History Physical examination Laboratory Imaging
Plain abdominal film US CT

11 History 1889: Chester McBurney Only 55% have classical features.
History hours Abdominal pain: (diffuse and periumbilical, localizing to the RLQ) Anorexia (almost always). Vomiting (75%). Low grade fever. If >38 suspect perforation Only 55% have classical features.

12 Physical exam

13 Peritoneal inflamation sign
Dunphy's sign Rovsing's sign Guarding Rebound sign Obturator sign Psoas sign

14 Dunphy

15 Rovsing

16 Guarding

17 Rebound

18 Obturator

19 Psoas

20 Diffuse Peritonitis כשהמצב מתקדם

21 Laboratory settings WBC Urinalysis

22 אבחנה של דלקת בתוספתן היא קודם כל קלינית

23 Scoring

24 אבל עם אנחנו לא בטוחים....

25 Diagnosis - US Noninvasive Available Operator dependant
Sensitivity 80% Specificity 90% Positive Findings Noncompressible tubular structure >7 mm Fluid appendicolith

26 CT Requires contrast - oral and IV Radiation Sensitivity 90-95%
Specificity 90% Findings Nonfilling tubular structure (target) >7 mm Pericecal inflammation and Fluid appendicolith

27 Target

28 >7 מ"מ

29 Fecalith

30 DD Go by organ systems or by category Consider symptoms, Age and Sex
Concomitant conditions

31 Differential diagnosis

32 Diagnostic laparoscopy
If you are not sure…

33 Treatment Medical Periappendicular abscess Surgical

34 Surgical Treatment Appendectomy : Laparoscopic versus open Sex Habitus
Diagnostic uncertain NOTES, SILS, Lap assisted

35 Lap versus open appendectomy

36 After the surgery

37 Complication In op: Lap converted to open Bowel resection Post op:
Wound infection Deep space infection/abcess Small bowel obstruction Infertility Enterocutaneous Fistula

38 Special issues Normal appearing appendix Meckels diverticulum
Interval appendectomy Chronic or recurrent appendicitis Children Pregnancy Crohns dis FMF

39 Neoplasms Rare Mucocele benign, malignant, pseudomyxoma
Treatment (Rt colectomy vs appendectomy) Survival rate 55% vs 20% Adenocarcinoma Carcinoid Treatment: size, location Survival

40 Laparoscopic Appendectomy

41 תודה

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