Apendicite Aguda. RF. Rafael Fernandes. Updated 4 December Transcript. Blumberg; Rovsing; Lapinsky; Lenander; Sinal do psoas; Sinal do obturador. 10 ago. John Parkinson – fisiopatologia (apendicolito). Semm (Alemanha) APENDICITE AGUDA: TÉCNICA CIRÚRGICA. Cherles McBurney. 29 ago. Apendicite Aguda Causa mais comum de abdome agudo não traumático 8% ocidente* 10 e 30 anos. Homem Quadro clínico típico.
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Acute appendicitis, Vermiform appendix, Computed tomography Descritores: Acute appendicitis is the most important cause of abdominal pain requiring surgical intervention in the Western world. The early diagnosis of this disease is of paramount relevance for minimizing its morbidity. Diagnostic difficulty is higher in children, the elderly, and women in childbearing age. The main imaging methods for evaluation of acute appendicitis are ultrasound and computed tomography.
The present study is aimed at describing the disease physiopathology, commenting main computed tomography technical aspects, demonstrating and illustrating tomographic findings, and describing main differential diagnoses. Acute appendicitis is the most important cause of abdominal pain requiring surgical intervention in the Western world 1,2. The disease may occur at any age range, with higher incidence in fisiopatollogia second decade of life 1.
The main imaging methods for acute appendicitis evaluation are ultrasonography US and computed tomography CT.
Patients presenting with typical clinical and laboratory signs may be directly referred for surgery and can dispense with imaging methods 1. However, imaging methods become essential when patients present with atypical symptoms, in retrocecal appendicitis, in obese patients, an in case of complications of the disease.
The choice between US and CT is extremely variable, depending on some ds such as preference and experience of the institution, age, sex and biotype of the patient. Advantages of US include short acquisition time, non-invasiveness, low-cost besides not requiring preparation of the patients or contrast agent administration; however, is extremely operator-dependent 3.
Considering the lack of ionizing radiation, and the fact of representing a good method for evaluation of acute gynecological conditions, US is recommended aprndicite the initial imaging test in women of childbearing age, pregnant women and children. CT represents an excellent diagnostic alternative for all the other cases, especially obese patients and in the complications of the disease appendix perforation.
The present study is aimed at describing cisiopatologia disease physiopathology; commenting main CT technical aspects; demonstrating and illustrating tomographic findings; and describing main differential diagnoses. The wpendicite appendix is a long diverticulum, measuring 10 cm in length, arising from the medial flsiopatologia wall of the cecum, about 3 cm below the ileocecal valve.
The base is at a constant location, whereas the position of the tip of the appendix varies and xe occupy several regions inside de abdominal cavity Figure 2including the pelvic region 1the left iliac fossa, or even inside the inguinal canal. Clinical presentation is highly influenced by this wide variation in the topography of the appendix 1. Obstruction of the appendiceal lumen due to the presence of fecalith the most frequent onelymphoid hyperplasia, foreign body or tumor 1.
Appendicolith, a calcified fecalith, is less frequent but is associated with perforation and abscess formation 1,2. The obstruction of the lumen there is secretion accumulation leading to an increase in the intraluminal pressure, and determining stimulation of afferent visceral fibers between T8 and T10, with periumbilical epigastric pain as a consequence 1.
Anorexia, nausea and emesis may be present in this phase. The gradual increase in the intraluminal pressure exceeds the pressure of capillary perfusion, determining appendiceal walls ischemia, with loss of the epithelial integrity fusiopatologia bacterial mural invasion 1,2.
Then, the pain migrates into the appendiceal region, generally in the right iliac fossa, and may be associated with signs of peritoneal irritation positive sudden decompression.
Fever is low or absent; the presence of high fever suggests perforation 1. In the absence of surgical intervention, appendicitis naturally progresses to perforation, with extension of the infection toward periappendiceal tissues.
Local or distant abscess formation may occur. The appendicolith may migrate towards other sites of the abdominal cavity, determining collections formation 1,2.
Other possible complications are infection dissemination to the abdominal wall, ureteral obstruction, venous thrombosis portal system and hepatic abscesses 1,2. Indiscriminate use of antibiotics may change the disease progress, difficulting an early diagnosis and increasing the morbidity. A delayed surgical intervention increases the risk for complications 1,2.
Notwithstanding the advantages of helical CT over the conventional CT sequential, transverse sectionswith shorter acquisition time and possibility of images reconstruction with thinner slices, in our experience they present similar final results.
Transverse multidetector CT followed by coronal reconstruction may improve the characterization of the appendix, but its sensitivity is the same only with the utilization of transverse sections 4. Fisopatologia images acquisition must cover the apendicitd abdomen, from the xiphoid appendix to the pubic symphysis, since the appendix localization is highly variable and distant complications may coexist.
Besides, the possibility of other differential diagnosis should be considered 3,5,6. In conventional CT equipment, the collimation slice thickness may range between 5 mm and 10 mm, possibly requiring thicker slices. We consider the evaluation of the whole abdomen with 10 mm collimation followed by thin slices 5 mm on the right iliac fossa or on the suspicious region as sufficient.
Many times, these thin slices are performed on the topography of the painful area indicated by the patients, facilitating the inflammatory process identification.
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In institutions where helical equipment is available, 5 mm-thick-slices are performed at 8 mm-intervals, followed by 5 mm-reconstruction, according to Lane et al. Intravenous contrast agent is not routinely utilized 7,8although it may be quite useful, especially in case of complications perforated appendicitisin young and thin patients with paucity of peritoneal fatin non-specific findings, and in the differential diagnosis of a malignant process 1.
The ifsiopatologia of rectal-contrast reduces the fisioptaologia of false-positive results, since intestinal loops filled with fluid may be confused with distended appendices 2. The aepndicite of oral contrast is unnecessary in the majority of cases; it is helpful only in patients with non-specific abdominal pain, or when ileal opacification is necessary to solve any doubt in the case the rectal contrast is not elucidative 6. Finally, the apendicote protocol in the evaluation of acute appendicitis is the one suggested by Lane et al.
Usually, the appendix contents is liquid Figure 4. Higher values suggest the possibility of mucoceles or neoplasm. In patients with paucity of peritoneal fat, rectal contrast may facilitate its identification 5,9.
In the inflammatory process, mural thickening is present, and if intravenous contrast agent is utilized 1we will observe the contrast uptake on the inflammed appendix walls Figure 5. However, this finding gains high significance in the presence of other findings. After appendix perforation, the appendicolith may migrate to other sites in the abdominal cavity 1resulting in formation of distant abscess, including during the post-operatory period Figure 8.
In some cases, the appendix may be totally destructed by infection, so its identification is unfeasible 2. Pneumoperitoneum pneumoperitoneum is less frequent, and, if present, is small 1. Complications occur as a result from delayed diagnosis and appendix perforation 1,2disseminating the infectious process into the peritoneal cavity.
Main complications are the fisiolatologia Also, hepatic abscesses may be observed. Main differential diagnoses are 2,4,6: Appendicitis at agjda millennium. Helical CT in the evaluation of the acute abdomen.
fisiopatologia de apendicite aguda pdf
Evaluation of suspected appendicitis in children and young adults: Evaluation of suspected appendicitis in children using limited helical CT and colonic contrast material. Unenhanced helical CT for suspected acute appendicitis.
Tomografia computadorizada sem contraste intravenoso no abdome agudo: Radiol Bras ;39 2: Right lower quadrant pain and suspected appendicitis: Received May 12, Accepted after revision September 26,