Difference between revisions of "Vermiform appendix"

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Vermiform appendix (view source)

Revision as of 13:23, 27 September 2013

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→‎Acute appendicitis: split-out
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=Inflammatory pathologies=
=Inflammatory pathologies=
==Acute appendicitis==
==Acute appendicitis==
===General===
{{Main|Acute appendicitis}}
*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>
 
Short clinical DDx:
*GI tract:
**Symptomatic [[Meckel diverticulum]].
**Epiploic appendagitis.
*Gynecologic tract:
**Ectopic pregnancy.
**Ruptured ovarian cyst.
**Ovarian torsion.
***Pelvic inflammatory disease.
 
===Gross===
Features:
*Serosal surface dull.
*May be perforated (best determined on gross).
*+/-Fibrinous exudate.
 
Note:
*Normal diameter of appendix (based on CT): 6.6 +/- 1.5 mm.<ref name=pmid21344807>{{Cite journal  | last1 = Charoensak | first1 = A. | last2 = Pongpornsup | first2 = S. | last3 = Suthikeeree | first3 = W. | title = Wall thickness and outer diameter of the normal appendix in adults using 64 slices multidetector CT. | journal = J Med Assoc Thai | volume = 93 | issue = 12 | pages = 1437-42 | month = Dec | year = 2010 | doi =  | PMID = 21344807 }}</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>
 
===Microscopic===
Features:
* Neutrophils in the muscularis propria - '''key feature'''.
* +/- Vascular [[thrombosis]] (and [[necrosis]]) - known as ''gangrenous appendicitis''.<ref>URL: [http://emedicine.medscape.com/article/363818-overview http://emedicine.medscape.com/article/363818-overview]. Accessed on: 21 June 2010.</ref>
* +/- Findings suggestive of etiology - usu. absent:
** +/- Fecalith.
** +/- Viral inclusions (extremely rare)
*** See ''[[adenovirus appendicitis]]''.
 
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>
**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>
 
DDx:
*Mucinous tumour.
*[[Neuroendocrine tumour]].
*[[Granulomatous appendicitis]].
*[[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>
 
====Images====
<gallery>
Image:Appendicitis_-_low_mag.jpg | Appendicitis - low mag. (WC/Nephron)
Image:Appendicitis_-_very_high_mag.jpg | Appendicitis - very high mag. (WC/Nephron)
</gallery>
 
===Sign out===
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- ACUTE APPENDICITIS.
- ACUTE PERIAPPENDICITIS.
</pre>
 
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- GANGRENOUS APPENDICITIS.
- ACUTE PERIAPPENDICITIS.
</pre>
 
====Perforated appendicitis====
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- ACUTE APPENDICITIS WITH PERFORATION AND ACUTE PERIAPPENDICITIS.
</pre>
 
This is uncommon to see definitively on histology.
====Micro====
=====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.


==Adenovirus appendicitis==
==Adenovirus appendicitis==
Michael
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