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Difference between revisions of "Acute appendicitis"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Appendicitis_-_very_high_mag.jpg | |||
| Width = | |||
| Caption = Acute appendicitis. [[H&E stain]]. | |||
| Micro = neutrophils in the muscularis propria | |||
| Subtypes = | |||
| LMDDx = [[adenovirus appendicitis]], [[negative appendectomy]], [[Granulomatous appendicitis]], [[Crohn's disease]] of the appendix, [[appendiceal neuroendocrine tumour]], [[Mucinous tumours of the appendix|mucinous tumour of the appendix]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = serosal surface dull, +/-fibrinous exudate, +/-perforation | |||
| Grossing = | |||
| Site = [[vermiform appendix]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = periumbilical pain, usu. younger patients | |||
| Signs = rebound tenderness, tenderness at McBurney's point | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = leukocytosis | |||
| Rads = periappendiceal stranding, increased diameter | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = | |||
}} | |||
'''Acute appendicitis''' is very common. It keep surgeon busy. | |||
==General== | |||
*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_tumours_of_the_appendix|Mucinous tumour]] - usu. apparent on gross. | |||
*[[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. | |||
==See also== | |||
*[[Vermiform appendix]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Vermiform appendix]] | |||