2/2/2020 OneNote

Apendicita acuta
10 September 2019 16:42

• Cea mai comuna urgenta chir abdo Dx

• 10-20 ani, M:F= 1,4:1, adolescenti, adulti tineri • Scor Alvarado
○ <3: prob mica
Etiologie ○ 4-6: prob creste
• Principala cauza= inf microbiana ○ >7: prob f mare
• De la niv foliculi limf --> toti peretii --> depasire perete (forme complicate) Simptome Semne Paraclinice durer
• Patogeni din lumen: vărsăturile apărarea musculară in fo
decompresiune febra leucocitoza creș
○ E coli
○ Strep viridans
○ Bacteroides
○ Pseudomonas
• Teorii: 3

Enterogena • Coproliti/corpi straini obstructioneaza lumen

• Cavitate inchisa Dieulafoy
• Prolif microbiana
• Lez mecanice
DDx
Hematogena • Alt focar
Vasculara • Ischemie Urologice Chirurgicale Gin
• Tromboza a apendiculara/ cuduri apendice • Colica renala, • Ocluzie, •
ureterala invaginati
dreapta e
Man clinice • Pielonefrita • Div •
• Forma acuta tipica • Infectii Meckel,
diverticuli
Durere abdo • Plina sanatate/ fond usor disconfort digestiv ta
• Brusc/ insidios • Colecistita
• Epigastru/ periombilical ---> RIF
• Continua • Ulcer
• Dupa cateva h: miscari/mers exacerbeaza peptic
• Pozitie antalgica perf
• Coapsa dreapta flexie si usoara abductie
• Semnul tusei: efortul/ tusea accentueaza durerea
Anorexie • Precoce, nespecific Complicatii
• N/V ulterior
Peritonita generalizata •
Tulb tranzit • Constipatie: frecventa
•
• Diaree: ap pelvine/ forme toxice/ copii
•
•
Semne generale Peritonita acuta primara •
• Temperatura <38 Peritonita acuta secundara •
• Temp >38 + frison ---> perf apendiculara generalizata in 2 timpi •
• Tahicardia prop cu gravitate inf/temp •

Examen obiectiv Peritonita acuta secundara •

generalizata in 3 timpi
Inspectie • Diminuare misc resp hemiabdo drept Bloc apendicular (plastron •
• Blocaj in inspir apendicular) •
• Avansat: distensie abdo
•
Palpare • Manevra Rovsing
•
• Triunghi Iacobovici
•
• Medial: marg externa muschi drept
• Inferior: linie orizontala ASIS
• Lateral: ombilic si ASIS drept
• Punct McBurney
• Manevre localizare
•
Semn Durere rotatie interna coapsa Apendice pelvine
obturator
Abscese •
Semn iliopsoas Durere ridicare activa membru inf drept in Apendice
extensie retrocecal
•
• Triada Diuelafoy= extindere proces inflam- iritatie peritoneala
1. Durere
2. Hiperestezie cutanata •
3. Aparare musc in RIF
Aparare musculara • Semn peritonita acuta
• Semn Lantz: diminuare/ disparitie reflexe cutanate in RIF/ hemiabdoment drept
• Semn Bloomberg: exacerbare durere la decompresiune brusca dupa palpare (rebound)
Tuseu • Durere
rectal/vaginal • Fata laterala dreapta rect
• Fund sac vaginal drept

Exam paraclinic
• Leucocitoza >10.000, N>75% = caracteristic
• Leuc >20.000 = semn perforatie

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2/2/2020 OneNote
• Sediment urinar normal

Expl imagistice
• Eco abdo: spec 81%
○ Ddx gineco
• CT: spec 95%
○ Ddx lichid/ flegomon/ absces
• Marire diametru AP > 7 mm
• Ingrosare perete apendicular
• Dx lap= dx neclar

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