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AcuteAppendicitis2012.8Epidemiology(流行病学）ThemostcommonacuteabdomendiseaseTheincidenceofappendectomyappearstobedecliningduetomoreaccuratepreoperativediagnosis.Despitenewerimagingtechniques,acuteappendicitiscanbeverydifficulttodiagnose.Etiology（病因）1.Theanatomy（解剖）characteristics2.Thetissuefeatures3.Foreignbodyobstruction4.Parasites（寄生虫）causethemucosa（粘膜）damage5.Adhesion,pressurecauseappendixdistortedObstruction→highpressure→lymphobstructed,ischemia→mucosadamage→bacteriainvade（70%～80%）Etiology（病因）Eventuallythepressureexceedscapillary（毛细血管）perfusionpressureandvenousandlymphaticdrainageareobstructed.Withvascularcompromise,epithelial（上皮）mucosabreaksdownandbacterialinvasionbybowelflora（肠道菌群）occurs.Etiology（病因）IncreasedpressurealsoleadstoarterialstasisandtissueinfarctionEndresultisperforation（穿孔）andspillage（溢出）ofinfectedappendicealcontentsintotheperitoneum（腹膜）Pathophisiology（病理生理）SimpleappendicitisSuppurative（化脓的）appendicitisGangrenous（坏疽的）appendicitisPerforated（穿孔的）appendicitisPeritonitis（腹膜炎）Abscess（脓肿）aroundtheappendixMucocele（粘液囊肿）ofappendixPathophysiology（病理生理）Acuteappendicitisisthoughttobeginwithobstructionofthelumen（内腔）Obstructioncanresultfromfoodmatter,adhesions,orlymphoidhyperplasia（增生）Appendixistwisted,andLumenofappendixisnarrow,resultinobstructionMucosalsecretionscontinuetoincreaseintraluminal（管腔内的）pressurePathophysiology（病理生理）Initialluminaldistentiontriggersvisceralafferentpainfibers（疼痛内脏输入纤维）,whichenteratthe10ththoracicvertebrallevel.Thispainisgenerallyvagueandpoorlylocalized.Painistypicallyfeltintheperiumbilical（脐周的）orepigastric（上腹部）area.Pathophysiology（病理生理）Asinflammationcontinues,theserosa（浆膜）andadjacentstructuresbecomeinflamedThistriggerssomatic（躯体的）painfibers,innervating（刺激）theperitonealstructuresTypicallycausingpainintheRightLowerQuadrant(右下象限）Manifestations（临床表现）Primarysymptom:abdominalpain½to2/3ofpatientshavetheclassicalpresentationPainbeginninginepigastriumorperiumbilicalareathatisvagueandhardtolocalizeManifestations（临床表现）AstheillnessprogressesRLQlocalizationtypicallyoccursRLQpainwas81%sensitiveand53%specificfordiagnosisMigrationofpainfrominitialperiumbilicaltoRLQwas64%sensitiveand82%specificManifestations（临床表现）Associatedsymptoms:indigestion,discomfort,flatus（胀气）,needtodefecate（排便）,anorexia（厌食）,nausea,vomitingAnorexia

isthemostcommonofassociatedsymptomsVomitingismorevariable,occurringinabout½ofpatientsPhysicalExam（体格检查）Findingsdependondurationofillnesspriortoexam.EarlyonpatientsmaynothavelocalizedtendernessWithprogressionthereistendernesstodeeppalpation（触诊）overMcBurney’spointPhysicalExam（体格检查）Rovsing’ssign:paininRLQwithpalpationtoLLQObturator（闭孔）sign:passivelyflextheRhipandkneeandinternallyrotatethehip.IfthereisincreasedpainthenthesignispositivePhysicalexam（体格检查）Psoas（腰大肌）sign:placepatientinLlater