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Difference between revisions of "Acute appendicitis"
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| Prognosis = good | | Prognosis = good | ||
| Other = | | Other = | ||
| ClinDDx = symptomatic [[Meckel diverticulum]], epiploic appendagitis, [[ectopic pregnancy]], ruptured ovarian cyst, ovarian torsion, pelvic inflammatory disease | | ClinDDx = symptomatic [[Meckel diverticulum]], [[epiploic appendagitis]], [[ectopic pregnancy]], ruptured ovarian cyst, [[ovarian torsion]], pelvic inflammatory disease, benign fecal impaction | ||
}} | }} | ||
'''Acute appendicitis''' is an acute inflammation of the [[vermiform appendix]]. It is very common and keeps general surgeons busy. | '''Acute appendicitis''', abbreviated '''AA''', is an acute inflammation of the [[vermiform appendix]]. It is very common and keeps general surgeons busy. | ||
==General== | ==General== | ||
| Line 38: | Line 38: | ||
**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. | |||
==Gross== | ==Gross== | ||
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Note: | Note: | ||
* | *[[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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*[[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: | ||
| Line 93: | Line 102: | ||
</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> | ||
| Line 103: | Line 131: | ||
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== | ||