Difference between revisions of "Acute appendicitis"

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Acute appendicitis (view source)

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| Assdx      =
| Assdx      =
| Syndromes  =
| Syndromes  =
| Clinicalhx = periumbilical pain, usu. younger patients
| Clinicalhx = classically periumbilical pain then right lower quadrant pain, usu. younger patients
| Signs      = rebound tenderness, tenderness at McBurney's point
| Signs      = rebound tenderness, tenderness at McBurney's point, Rovsing sign, psoas sign, obturator sign
| Symptoms  =
| Symptoms  =
| Prevalence =
| Prevalence = common
| Bloodwork  = leukocytosis
| Bloodwork  = leukocytosis
| Rads      = periappendiceal stranding, increased diameter
| Rads      = periappendiceal fat stranding, increased appendiceal diameter
| Endoscopy  =
| Endoscopy  =
| Prognosis  =
| Prognosis  = good
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    = symptomatic [[Meckel diverticulum]], [[epiploic appendagitis]], [[ectopic pregnancy]], ruptured ovarian cyst, [[ovarian torsion]], pelvic inflammatory disease, benign fecal impaction
}}
}}
'''Acute appendicitis''' is very common. It keep surgeon busy.
'''Acute appendicitis''', abbreviated '''AA''', is an acute inflammation of the [[vermiform appendix]]. It is very common and keeps general surgeons busy.


==General==
==General==
*Bread 'n butter of general surgery.
*Bread 'n butter of [[general surgery]].
*Interesting factoid: appendicitis is considered protective against [[ulcerative colitis]].<ref name=pmid19685454>{{Cite journal  | last1 = Beaugerie | first1 = L. | last2 = Sokol | first2 = H. | title = Appendicitis, not appendectomy, is protective against ulcerative colitis, both in the general population and first-degree relatives of patients with IBD. | journal = Inflamm Bowel Dis | volume =  | issue =  | pages =  | month = Aug | year = 2009 | doi = 10.1002/ibd.21064 | PMID = 19685454 }}</ref><ref name=pmid19273505>{{Cite journal  | last1 = Timmer | first1 = A. | last2 = Obermeier | first2 = F. | title = Reduced risk of ulcerative colitis after appendicectomy. | journal = BMJ | volume = 338 | issue =  | pages = b225 | month =  | year = 2009 | doi =  | PMID = 19273505 }}</ref>
*Interesting factoid: appendicitis is considered protective against [[ulcerative colitis]].<ref name=pmid19685454>{{Cite journal  | last1 = Beaugerie | first1 = L. | last2 = Sokol | first2 = H. | title = Appendicitis, not appendectomy, is protective against ulcerative colitis, both in the general population and first-degree relatives of patients with IBD. | journal = Inflamm Bowel Dis | volume =  | issue =  | pages =  | month = Aug | year = 2009 | doi = 10.1002/ibd.21064 | PMID = 19685454 }}</ref><ref name=pmid19273505>{{Cite journal  | last1 = Timmer | first1 = A. | last2 = Obermeier | first2 = F. | title = Reduced risk of ulcerative colitis after appendicectomy. | journal = BMJ | volume = 338 | issue =  | pages = b225 | month =  | year = 2009 | doi =  | PMID = 19273505 }}</ref>


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**Symptomatic [[Meckel diverticulum]].
**Symptomatic [[Meckel diverticulum]].
**Epiploic appendagitis.
**Epiploic appendagitis.
**Benign fecal impaction of the appendix.<ref name=pmid17875592>{{Cite journal  | last1 = Park | first1 = NH. | last2 = Park | first2 = CS. | last3 = Lee | first3 = EJ. | last4 = Kim | first4 = MS. | last5 = Ryu | first5 = JA. | last6 = Bae | first6 = JM. | last7 = Song | first7 = JS. | title = Ultrasonographic findings identifying the faecal-impacted appendix: differential findings with acute appendicitis. | journal = Br J Radiol | volume = 80 | issue = 959 | pages = 872-7 | month = Nov | year = 2007 | doi = 10.1259/bjr/80553348 | PMID = 17875592 }}</ref>
*Gynecologic tract:
*Gynecologic tract:
**[[Ectopic pregnancy]].
**[[Ectopic pregnancy]].
**Ruptured ovarian cyst.
**Ruptured ovarian cyst.
**Ovarian torsion.
**Ovarian torsion +/-[[ovarian tumour]].
***Pelvic inflammatory disease.
**Pelvic inflammatory disease.


==Gross==
==Gross==
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**Similar numbers are found in another study.<ref name=pmid17457270>{{Cite journal  | last1 = Huwart | first1 = L. | last2 = El Khoury | first2 = M. | last3 = Lesavre | first3 = A. | last4 = Phan | first4 = C. | last5 = Rangheard | first5 = AS. | last6 = Bessoud | first6 = B. | last7 = Menu | first7 = Y. | title = [What is the thickness of the normal appendix on MDCT?]. | journal = J Radiol | volume = 88 | issue = 3 Pt 1 | pages = 385-9 | month = Mar | year = 2007 | doi =  | PMID = 17457270 }}</ref>
**Similar numbers are found in another study.<ref name=pmid17457270>{{Cite journal  | last1 = Huwart | first1 = L. | last2 = El Khoury | first2 = M. | last3 = Lesavre | first3 = A. | last4 = Phan | first4 = C. | last5 = Rangheard | first5 = AS. | last6 = Bessoud | first6 = B. | last7 = Menu | first7 = Y. | title = [What is the thickness of the normal appendix on MDCT?]. | journal = J Radiol | volume = 88 | issue = 3 Pt 1 | pages = 385-9 | month = Mar | year = 2007 | doi =  | PMID = 17457270 }}</ref>


Image:
<gallery>
<gallery>
Image:Acute_Appendicitis.jpg | Acute appendicitis. (WC/euthman)
Image:Acute_Appendicitis.jpg | Acute appendicitis. (WC/euthman)
</gallery>
</gallery>
==Microscopic==
==Microscopic==
Features:
Features:
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Note:
Note:
*Eosinophils are very common.<ref name=pmid9444860>{{Cite journal  | last1 = Aravindan | first1 = KP. | title = Eosinophils in acute appendicitis: possible significance. | journal = Indian J Pathol Microbiol | volume = 40 | issue = 4 | pages = 491-8 | month = Oct | year = 1997 | doi =  | PMID = 9444860 }}</ref>
*[[Eosinophil]]s are very common.<ref name=pmid9444860>{{Cite journal  | last1 = Aravindan | first1 = KP. | title = Eosinophils in acute appendicitis: possible significance. | journal = Indian J Pathol Microbiol | volume = 40 | issue = 4 | pages = 491-8 | month = Oct | year = 1997 | doi =  | PMID = 9444860 }}</ref>
**Appendices with eosinophils but no apparent [[neutrophil]]s probably represent the same process.<ref name=pmid20551528>{{Cite journal  | last1 = Aravindan | first1 = KP. | last2 = Vijayaraghavan | first2 = D. | last3 = Manipadam | first3 = MT. | title = Acute eosinophilic appendicitis and the significance of eosinophil - Edema lesion. | journal = Indian J Pathol Microbiol | volume = 53 | issue = 2 | pages = 258-61 | month =  | year =  | doi = 10.4103/0377-4929.64343 | PMID = 20551528 }}</ref>
**Appendices with eosinophils but no apparent [[neutrophil]]s probably represent the same process.<ref name=pmid20551528>{{Cite journal  | last1 = Aravindan | first1 = KP. | last2 = Vijayaraghavan | first2 = D. | last3 = Manipadam | first3 = MT. | title = Acute eosinophilic appendicitis and the significance of eosinophil - Edema lesion. | journal = Indian J Pathol Microbiol | volume = 53 | issue = 2 | pages = 258-61 | month =  | year =  | doi = 10.4103/0377-4929.64343 | PMID = 20551528 }}</ref>


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*[[Adenovirus appendicitis]] - lymphoid hyperplasia.
*[[Adenovirus appendicitis]] - lymphoid hyperplasia.
*[[Mucinous_tumours_of_the_appendix|Mucinous tumour]] - usu. apparent on gross.
*[[Mucinous_tumours_of_the_appendix|Mucinous tumour]] - usu. apparent on gross.
*[[Neuroendocrine tumour]].
*[[Appendiceal neuroendocrine tumour]].
*[[Granulomatous appendicitis]].
*[[Granulomatous appendicitis]].
*[[Crohn's disease]] of the appendix.
*[[Crohn's disease]] of the appendix.
**Approximately of 40% colectomies for CD (that include an appendix) have involvement of the appendix.<ref name=pmid11956821>{{Cite journal  | last1 = Stangl | first1 = PC. | last2 = Herbst | first2 = F. | last3 = Birner | first3 = P. | last4 = Oberhuber | first4 = G. | title = Crohn's disease of the appendix. | journal = Virchows Arch | volume = 440 | issue = 4 | pages = 397-403 | month = Apr | year = 2002 | doi = 10.1007/s004280100532 | PMID = 11956821 }}</ref>
**Approximately of 40% colectomies for CD (that include an appendix) have involvement of the appendix.<ref name=pmid11956821>{{Cite journal  | last1 = Stangl | first1 = PC. | last2 = Herbst | first2 = F. | last3 = Birner | first3 = P. | last4 = Oberhuber | first4 = G. | title = Crohn's disease of the appendix. | journal = Virchows Arch | volume = 440 | issue = 4 | pages = 397-403 | month = Apr | year = 2002 | doi = 10.1007/s004280100532 | PMID = 11956821 }}</ref>
*[[Crypt cell carcinoma]] (goblet cell carcinoid) - may be subtle.


===Images===
===Images===
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Image:Appendicitis_-_low_mag.jpg | Appendicitis - low mag. (WC/Nephron)
Image:Appendicitis_-_low_mag.jpg | Appendicitis - low mag. (WC/Nephron)
Image:Appendicitis_-_very_high_mag.jpg | Appendicitis - very high mag. (WC/Nephron)
Image:Appendicitis_-_very_high_mag.jpg | Appendicitis - very high mag. (WC/Nephron)
Image:Appendix Appendicitis PA.JPG|Acute Appendicitis(SKB)
</gallery>
</gallery>


==Sign out==
==Sign out==
<pre>
Vermiform Appendix, Appendectomy:
- Acute appendicitis with acute periappendicitis.
</pre>
===Block letters===
<pre>
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
VERMIFORM APPENDIX, APPENDECTOMY:
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</pre>
</pre>


<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- ACUTE APPENDICITIS WITH FOCAL NECROSIS OF THE APPENDICEAL WALL.
- ACUTE PERIAPPENDICITIS.
</pre>
===Gangrenous===
<pre>
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
VERMIFORM APPENDIX, APPENDECTOMY:
- GANGRENOUS APPENDICITIS.
- GANGRENOUS APPENDICITIS.
- ACUTE PERIAPPENDICITIS.  
- ACUTE PERIAPPENDICITIS.  
</pre>
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- GANGRENOUS APPENDICITIS WITH PERFORATION.
- ACUTE PERIAPPENDICITIS.
</pre>
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- ACUTE APPENDICITIS WITH GANGRENOUS CHANGES.
- ACUTE PERIAPPENDICITIS.
</pre>
</pre>


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VERMIFORM APPENDIX, APPENDECTOMY:
VERMIFORM APPENDIX, APPENDECTOMY:
- ACUTE APPENDICITIS WITH PERFORATION AND ACUTE PERIAPPENDICITIS.
- ACUTE APPENDICITIS WITH PERFORATION AND ACUTE PERIAPPENDICITIS.
</pre>
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- PERFORATED ACUTE APPENDICITIS WITH ACUTE PERIAPPENDICITIS.
</pre>
</pre>


This is uncommon to see definitively on histology.
This is uncommon to see definitively on histology.
===Micro===
===Micro===
====Gangrenous appendicitis====
====Gangrenous appendicitis====
The sections shows appendiceal wall with marked acute transmural inflammation and necrotic appendiceal wall with large collections of neutrophils.  Several medium-sized blood vessels are thrombosed.  A thick layer of neutrophils cover the serosal aspect.
The sections shows appendiceal wall with marked acute transmural inflammation and necrotic appendiceal wall with large collections of neutrophils.  Several medium-sized blood vessels are thrombosed.  A thick layer of neutrophils cover the serosal aspect.
=====Alternate - less developed=====
The sections shows appendiceal wall with marked acute inflammation and a focally
necrotic appendiceal wall with large collections of neutrophils. Intravascular fibrin
is seen in medium-sized blood vessels. Clusters of neutrophils are seen on the serosal
aspect.


==See also==
==See also==
Michael
48,436

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