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Head, Chair of Faculty Surgion, doctor of

Medicine, prof. Vladimir N. Shilenok

Acute appendicitis

/1735/ -

F. Melier /1828/

, /1884 / -

. /1886/ -

History
Amanda Klaudius (1735) the successful
amputation of appendix
F. Melier (1828) described the clinic of
appendicitis with fatal outcome
Kronline, Mohamed (1884) appendectomy
R.Phits (1886) the term acute appendicitis

1980 .

22

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22 22

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22

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II

III

IV

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22

VI

VII

VIII

22

IX

2 - 4

200


80- - 0,1 - 0,2 %

1 .

1994 - 95 - -

0,08 - 0,07 %

1995 - 96- . - 0,08 - 0,05 %

1995 - 96 -

0%

The morbility of appendicitis


1 from 200 every year
Women are ill with appendicitis more often in 2
4 times

Post operative lethality


1980 USSR 0,1 0,2% per one million
operations
1994 95 Belarus 0,08 0,07%
1995 96 Vitebsk region - 0,008 0,05%
1995 96 our clinic 0%

Brunn, Ricker, - -

Lucas Championiere -
()

Aetiopathogenesis
Brunn, Ricker, Rusakov nervo-vascular
theory
Lucas Championiere role of alimentary
factor (meat)
Allergic theory

.. (1986) -

Kretz -

Faisane -

Aschoff -

Actiopa the genesis


A.A.Bobrov (1986) anatomic special
features
Kretz hematogenic infectio
Faisane viral infection
Aschoff the theory of primary affect as
wedge by base in side of serous coat



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Clinical classification of acute


appendicitis
(by N.M.Elanskomu V.I.Kolesovu)
I. Acute appendalgia
II. Acute simple (catarrhal appendicitis)
III. Acute destructive (phlegmonic,
gangrenous, perforated)
IV. Appendicitis with complications.
(infiltration, appendical abscess,
generalized peritonitis pylephlebitis sepsis
and other)

Appearance of cecal appendage (above) and mucosa


(below) in case of simple appendicitis

() ()

Appearance of cecal appendage in case of phlegmonic


appendicitis


.
- ; -

( ) - 100%

, 41-42%

10-20%

( ) 2%

: 37-380 - 45%
380 - 40%

57%

Clinic
Anorexia 100%
Pain
Nausea, vomiting 41 42%
Constipation 10 20%
Diarrhea (children) 2%
Increase of temperature: 370 380C 45%
more than 380C 40%
Tachycardia 57%

77%

72%

67%

Clinic

Symptom of Kochera
Rigidity of abdominal muscles
Blunberg symptom 72%
Rovsing symptom
Sitkovski symptom
Bartome - Michelsona symptom
Mendel symptom

- :

,
;

,
:



.

Advise of professor Voino-Yasenecki:


You must carefully expose the abdome, put whole
hand on abdome, barely touching skin. Then you
must move hand over, whole surface of abdomen
and press by elongated fingers a little. Using this
method you can receive important diagnostic
results: even small distinction in resistance of
different regions of abdomen and degree of their
painfulness/

,


.

.

If you begin to feel abdomen so gentle soon


you can greatly increase palpation and
make it deeper. Rough beginning makes the
examination of abdomen impossible and
ineffectual.

,

,

.

Very often we saw doctors, who thrust


fingers in the abdomin very roughly. They
couldnt know anything and lose the trust of
patients at once.

,

,
,


.

Meanwhile both at inflammation in abdomen


and at absolute its painlessness patients
respond by protective movement on any
rude palpation



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,
.

Sometimes our medical goals force us to


course pain. Ruefully, if we become callous
person and begin to consider that we have a
right to paint and patient are obliged to
suffer pain.

Supplementary investigation in acute


appendicitis

:
- ,
- ,
- . . .,
- , ,
,

- .

Differential diagnostic in right-stated lower


abdominal pain
Intraperitoneal
Nonspecific pains
Mesenteric adenitis
Terminal ileitis
Nonspecific ulcerative
colitis
Yersiniosis, salmonellesis,
typhoid
Crohndisease
Gynaecological
Meckels diverticulum
Perforation of duodenal ulcer
Acute cholecystitis
Sigmoid diverticulitis

Extraperitoneal
Right lower lobe
pneumonia
Right ureteric colic
Urinary tract infection
Right pyelonephritis
Cystitis
Rectus sheath
heamatoma


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Surgical treatment of acute


appendicitis
Classic operation cut by M. Burney
Volcovit-Dyakonov
Laporoscop-appendectomy
Infiltration conservative treatment in the
beginning
Localized peritonitis abscess dissect
extraperitoneally (Pirogov cut)
Extensive peritonitis laparotomy in the
middle of abdomen

;

;


( )

Puncture and lancing of pelvis gathering (abscess of


Duglasov space)

0,3 - 0,5%

0,2 - 3,5%

0,2 - 1,5%
1,0 - 1,2%
0,15 - 1,35%
0,6 - 5,0%

Complications

Appendical infiltration 0,3 - 0,5%


Appendical abscess
Abscess of Duglassov spase
Subdiaphragmatic abscess
Pylephlebitis
Abscess of liver
Intestinal fistula