【正文】 hematuria。 the stage of the process ,that is simple or ruptureed。 welllocalized abscesses may be managed with percutaneous drainage。 the pulse rate is normal or slightly elevated. Changes of greater magnitude usually mean that a plication has occurred or that another diagnosis should be considered 2022/10/23 44 Patients with appendicitis usually prefer to lie supine, with the thighs, particularly the right, drawn up, because any motion increases pain. If asked to move, they do so slowly and gingerly 2022/10/23 45 The classic right lower quadrant signs are present when the inflamed appendix lies in the anterior position. Tenderness is often maximal at or near the point described by Mcburney 2022/10/23 46 Located exactly between an inch and a half and two inches from the anterior spinous process of the ileum on a straight line drawn from that process to the umbilicus 2022/10/23 47 Direct rebound tenderness is usually present, and referred or indirect rebound tenderness is frequently present, and the tenderness is felt maximally in the right lower quadrant, indicating peritoneal irritation. 2022/10/23 48 Rovsing signpain in the right lower quadrant when palpatory pressure is exerted in the left lower quadrantalso indicates the site of peritoneal irritation 2022/10/23 49 In patients with obvious appendicitis, the Rovsing’ sign is superfluous, but in some early cases, it may be the first positive sign. It is elicited either by needle prick or, better, by gently picking up the skin between the forefinger and thumb. 2022/10/23 50 Muscular resistance to palpation of the abdominal wall roughly parallels the severity of the inflammatory process. Early in the disease, resistance, if present, consists mainly of voluntary guarding. As peritoneal irritation progresses, muscle spasm increases and bees largely involuntary—true reflex rigidity as opposed to voluntary guarding 2022/10/23 51 Variations in the position of the inflamed appendix produce variations from the usual in physical findings. With a retrocecal appendix, the anterior abdominal findings are less striking, and tenderness may be most marked in the flank. 2022/10/23 52 When the inflamed appendix hangs into pelvis abdominal findings may be entirely absent, and the diagnosis may be missed unless the rectum is examined. As the examining finger exerts pressure on the peritoneum of the culdesac Douglas, pain is felt in the suprapubic area as well as locally 2022/10/23 53 Signs of localized muscle irritation may also be present . Psoas sign indicates an irritative focus in proximity to that muscle . the test is performed by having patients lie on their left side。2022/10/23 1 Acute Appendicitis an acute inflammation of appendix 2022/10/23 2 Historical Background 2022/10/23 3 ?There is evidence in the literature that alchemists and physicians in the 1500s recognized the existence of a clinical entity associated with severe inflammation of the cecal region, known as “perityphlitis” 2022/10/23 4 Although the first successful appendectomy was reported in 1736, it was not until 1886 that Reginald Fitz helped established the role of surgical removal of the inflamed appendix as curative therapy for this disease, which was once thought to be fatal 2022/10/23 5 ?In 1889, Charles Mcburney presented his classic report on the importance of early operative intervention for acute appendicitis. Five years later, he devised the muscle splitting incision which today bears his name 2022/10/23 6 INCIDENCE 2022/10/23 7 ?Remains one of the most mon acute surgical diseases ?Roughly parallels that of lymphoid development, with the peak incidence in early adulthood ?100/100,000(1975) to 52/100,000(1991) 2022/10/23 8 ?Approximately 7% of individuals in western countries develop appendicitis at sometime during their lives,and about 200,000 appendectomies for acute appendicitis are performed annually in the USA. ?The rate of normal appendectomy averages 16%(68% female) 2022/10/23 9 ANATOMY AND FUNCTION 2022/10/23 10 ?The appendix, like a earthworm, is a structure connected to the cecum, its average length is 510 cm and it is cm in diameter. ?An immunologic an which actively participates in the secretion of IgA 2022/10/23 11 ?After the age 60,virtually no lymphoid tissue remains within the appendix ?An integral ponent of the gutassociated lymphoid tissue,it`s function is not essential 2022/10/23 12 Appendix is at the base of cecum,the meeting of three colic bands. Anterior band Ileocecal valve Cecum Appendix Ileum 2022/10/23 13 umbilicus Right anterior superior iliac spine Its projection on body surface is Mcburney’s point,which is a point onethird of the distance between the right anterior superior iliac spine and the umbilicus. 2022/10/23 14 The appendix is located in right iliac fossa(right lower quadrant) . Neighboring ans are: ovary (female) right ureter cecum ascending colon the end of the ileum 2022/10/23 15 Anatomic Position Preileal Pelvic Retrocecal Subcecal Lateral cecal Retroileal 1 2 4 5 3 6 2022/10/23 16 The appendix runs into a serosal sheet of the peritoneum called the mesoappendix