Difference between revisions of "Acute appendicitis"

From Libre Pathology
Jump to navigation Jump to search
(+cat.)
(split-out)
Line 1: Line 1:
#redirect [[Vermiform_appendix#Acute_appendicitis]]
{{ 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]]

Revision as of 13:33, 27 September 2013

Acute appendicitis
Diagnosis in short

Acute appendicitis. H&E stain.
LM neutrophils in the muscularis propria
LM DDx adenovirus appendicitis, negative appendectomy, Granulomatous appendicitis, Crohn's disease of the appendix, appendiceal neuroendocrine tumour, mucinous tumour of the appendix
Gross serosal surface dull, +/-fibrinous exudate, +/-perforation
Site vermiform appendix
Clinical history periumbilical pain, usu. younger patients
Signs rebound tenderness, tenderness at McBurney's point
Blood work leukocytosis
Radiology periappendiceal stranding, increased diameter

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.[1][2]

Short clinical DDx:

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.[3]
    • Similar numbers are found in another study.[4]

Microscopic

Features:

  • Neutrophils in the muscularis propria - key feature.
  • +/- Vascular thrombosis (and necrosis) - known as gangrenous appendicitis.[5]
  • +/- Findings suggestive of etiology - usu. absent:

Note:

  • Eosinophils are very common.[6]
    • Appendices with eosinophils but no apparent neutrophils probably represent the same process.[7]

DDx:

Images

  • Appendicitis - low mag. (WC/Nephron)

  • Appendicitis - very high mag. (WC/Nephron)

Sign out

VERMIFORM APPENDIX, APPENDECTOMY:
- ACUTE APPENDICITIS.
- ACUTE PERIAPPENDICITIS. 

VERMIFORM APPENDIX, APPENDECTOMY:
- GANGRENOUS APPENDICITIS.
- ACUTE PERIAPPENDICITIS.

Perforated appendicitis

VERMIFORM APPENDIX, APPENDECTOMY:
- ACUTE APPENDICITIS WITH PERFORATION AND ACUTE PERIAPPENDICITIS.

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

References

  1. ↑ Beaugerie, L.; Sokol, H. (Aug 2009). "Appendicitis, not appendectomy, is protective against ulcerative colitis, both in the general population and first-degree relatives of patients with IBD.". Inflamm Bowel Dis. doi:10.1002/ibd.21064. PMID 19685454.
  2. ↑ Timmer, A.; Obermeier, F. (2009). "Reduced risk of ulcerative colitis after appendicectomy.". BMJ 338: b225. PMID 19273505.
  3. ↑ Charoensak, A.; Pongpornsup, S.; Suthikeeree, W. (Dec 2010). "Wall thickness and outer diameter of the normal appendix in adults using 64 slices multidetector CT.". J Med Assoc Thai 93 (12): 1437-42. PMID 21344807.
  4. ↑ Huwart, L.; El Khoury, M.; Lesavre, A.; Phan, C.; Rangheard, AS.; Bessoud, B.; Menu, Y. (Mar 2007). "[What is the thickness of the normal appendix on MDCT?].". J Radiol 88 (3 Pt 1): 385-9. PMID 17457270.
  5. ↑ URL: http://emedicine.medscape.com/article/363818-overview. Accessed on: 21 June 2010.
  6. ↑ Aravindan, KP. (Oct 1997). "Eosinophils in acute appendicitis: possible significance.". Indian J Pathol Microbiol 40 (4): 491-8. PMID 9444860.
  7. ↑ Aravindan, KP.; Vijayaraghavan, D.; Manipadam, MT.. "Acute eosinophilic appendicitis and the significance of eosinophil - Edema lesion.". Indian J Pathol Microbiol 53 (2): 258-61. doi:10.4103/0377-4929.64343. PMID 20551528.
  8. ↑ Stangl, PC.; Herbst, F.; Birner, P.; Oberhuber, G. (Apr 2002). "Crohn's disease of the appendix.". Virchows Arch 440 (4): 397-403. doi:10.1007/s004280100532. PMID 11956821.
Retrieved from "https://librepathology.org/w/index.php?title=Acute_appendicitis&oldid=24400"