appendicitis and tumors of appendix mbbs
TRANSCRIPT
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Acute Appendicitis• Appendix normal true
diverticulum of cecum• Acute appendicitis most
common in adolescents and young adults
• Lifetime risk 7%• Males >females
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Pathogenesis• Initiated by progressive increase in
intraluminal pressure compromise venous outflow
• 50% to 80% of cases associated with luminal obstruction by small stone-like mass of stool (fecalith) or less commonly gallstone, tumor, or mass of worms (oxyuriasis vermicularis)
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• Stasis of luminal contents bacterial proliferation, triggers ischemia and inflammatory responses, resulting in tissue edema and neutrophilic infiltration of lumen, muscular wall, and periappendiceal soft tissues
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Morphology• Early cases subserosal vessels are
congested, perivascular neutrophilic infiltrate within all layers of the wall
• Serosa dull, granular with erythematous surface
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• Diagnosis requires neutrophilic infiltration of the muscularis propria
• Severe cases prominent neutrophilic exudate with serosal fibrinopurulent reaction
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• Focal abscesses may form within the wall (acute suppurative appendicitis)
• Compromise of appendiceal vessels leads to large areas of hemorrhagic ulceration and gangrenous necrosis extending to serosa creating acute gangrenous appendicitis followed by rupture and suppurative peritonitis
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Clinical Features• Early acute appendicitis
produces periumbilical pain that ultimately localizes to right lower quadrant, followed by:– nausea–Vomiting– low-grade fever–mildly elevated peripheral
white cell count
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• Physical finding McBurney sign• Deep tenderness located two thirds
of distance from umbilicus to right anterior superior iliac spine (McBurney point)
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• Retrocecal appendix may generate right flank or pelvic pain
• Malrotated colon may give rise to appendicitis in left upper quadrant
• Neutrophilic leukocytosis
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Complications• Appendiceal perforation• Pyelophlebitis• Portal venous thrombosis• Liver abscess• Bacteremia
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Clinical differential diagnosis
• Mesenteric lymphadenitis• Acute salpingitis• Ectopic pregnancy• Mittelschmerz (German: "middle
pain")-pain caused by minor pelvic bleeding at time of ovulation
• Meckel diverticulitis
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Tumors of the Appendix
• Most common tumor of appendix welldifferentiated neuroendocrine (carcinoid) tumor
• Usually discovered incidentally at the time of surgery or
• examination of resected appendix• carcinoid benign tumor, form solid
bulbous swelling at the tip of appendix
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Carcinoid tumor
Gross
Microscopic
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• Adenomas or non–mucin-producing adenocarcinomas also occur in appendix and may cause obstruction and enlargement that mimics acute appendicitis
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• Mucocele dilated appendix filled with mucin
• Represent obstructed appendix containing inspissated mucin or consequence of mucinous cystadenoma or mucinous cystadenocarcinoma
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• Invasion through appendiceal wall can lead to intraperitoneal seeding and spread
• In women resulting peritoneal implants may be mistaken for mucinous ovarian tumors
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• Most advanced cases abdomen fills with tenacious, semisolid mucin, a condition called pseudomyxoma peritonei