英语查房预习资料课件

AcuteAppendicitis2012.8Epidemiology(流行病学）ThemostcommonacuteabdomendiseaseTheincidenceofappendectomyappearstobedecliningduetomoreaccuratepreoperativediagnosis.Despitenewerimagingtechniques,acuteappendicitiscanbeverydifficulttodiagnose.Etiology（病因）Eventuallythepressureexceedscapillary（毛细血管）perfusionpressureandvenousandlymphaticdrainageareobstructed.Withvascularcompromise,epithelial（上皮）mucosabreaksdownandbacterialinvasionbybowelflora（肠道菌群）occurs.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）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:placepatientinLlateraldecubitus（卧位）andextendRlegatthehip.Ifthereispain,thesignispositive.Rectal（直肠）exam:paincanbemostpronouncedifthepatienthaspelvicappendixDiagnosisAcuteappendicitisshouldbesuspectedinanyonewithepigastric,periumbilical,rightflank（侧面）,orrightsidedabdpainwhohasnothadanappendectomyWomenofchildbearingageneedapelvicexamandapregnancytest.Additionalstudies:CBC,UA,imagingstudiesDiagnosisTheWBCisoflimitedvalue.SensitivityofanelevatedWBCis70-90%,butspecificityisverylow.But,+predictivevalueofhighWBCis92%and–predictivevalueis50%C-reactiveproteinhavebeenstudiedwithmixedresultsDiagnosisImagingstudies:includeX-rays,CTXraysofabdareabnormalin24-95%Abnormalfindingsinclude:Fecalith(粪石）,appendicealgas,localizedparalyticileus（麻痹性肠梗阻）,blurred（模糊）rightpsoas（腰大肌）,andfreeairDiagnosisCT:Bestchoicebasedonavailabilityandalternativediagnoses.Inonestudy,CThadgreatersensitivity,accuracy,-predictivevalueTreatmentAppendectomyisthestandardofcarePatientsshouldbegivenIVF（静脉输液）,andpreoperativeantibioticsAntibioticsaremosteffectivewhengivenpreoperativelyandtheydecreasepost-opinfectionsandabscessformationTreatmentschoiceNo