Difference between revisions of "Vermiform appendix"

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==Negative appendectomy==
==Negative appendectomy==
===General===
{{Main|Negative appendectomy}}
*Common.
An appendectomy done for presumed [[acute appendicitis]] that is pathologically within normal limits
*Use for quality control among general surgeons.{{fact}}
 
===Gross===
See ''[[normal vermiform appendix]]''.
 
===Microscopic===
See ''[[normal vermiform appendix]]''.
 
Notes:
*Should be ''[[submitted in total]]''.
 
DDx:
*[[Acute appendicitis]].
*[[Adenovirus appendicitis]].
*[[Appendiceal neuroendocrine tumour]].
*Non-appendiceal pathology - see DDx of ''[[acute appendicitis]].
**Isolated [[periappendicitis]].
*[[Crypt cell carcinoma]] - [[AKA]] ''goblet cell carcinoid''.
 
===Sign out===
<pre>
Vermiform Appendix, Appendectomy:
- Appendix within normal limits.
- One benign lymph node.
- NEGATIVE for acute appendicitis and NEGATIVE for periappendicitis.
 
Comment:
The specimen was submitted in total.
</pre>
 
=====Block letters=====
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- APPENDIX NEGATIVE FOR ACUTE APPENDICITIS AND NEGATIVE FOR ACUTE PERIAPPENDICITIS.
</pre>
 
<pre>
VERMIFORM APPENDIX, APPENDECTOMY:
- APPENDIX WITH LYMPHOID HYPERPLASIA AND FOCAL MUCOSAL EROSIONS.
- NEGATIVE FOR ACUTE APPENDICITIS.
- NEGATIVE FOR ACUTE PERIAPPENDICITIS.
</pre>
 
====Micro====
The sections show appendiceal wall with focal mucosa erosions and several intraluminal
neutrophil clusters.  Lymphoid hyperplasia is present. Fecal material is present within
the lumen of the appendix.
 
There are no neutrophils within the muscularis propria. There is no serositis. There is
no distortion of the crypt architecture. No granulomas are identified. No cryptitis is
identified.
 
=====Alternate=====
The section show appendiceal wall without increased numbers of neutrophils. The
appendiceal lumen has cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue
with germinal centre formation.
 
No intraluminal pathologic micro-organisms are seen. There is no serositis. There is no
distortion of the crypt architecture. No granulomas are identified. No cryptitis
is identified.


=Inflammatory pathologies=
=Inflammatory pathologies=

Revision as of 14:10, 5 May 2016

The vermiform appendix, usually just appendix, is a little thingy that is attached to the cecum. Taking it out is the bread 'n butter of general surgery.

The appendix is a vestigial structure that is thought to have arisen from a larger cecum. Larger cecae are often seen in herbivores and thought to facilitate better digestion of plant matter.[1]

Normal

Normal vermiform appendix

General

Gross

  • Shiny serosal surface.
    • No exudate.
  • Normal diameter.
    • 6.6 +/- 1.5 mm -- based on CT.[2]

Microscopic

Features:

  • +/-Lymphoid hyperplasia - mucosa or submucosa.
  • Normal colorectal-type mucosa.
  • Fatty submucosa.
  • Benign smooth muscle.
  • Serosa.

Negatives:

DDx:

Sign out

VERMIFORM APPENDIX WITHIN NORMAL LIMITS.

Negative appendectomy

Main article: Negative appendectomy

An appendectomy done for presumed acute appendicitis that is pathologically within normal limits

Inflammatory pathologies

Acute appendicitis

Main article: Acute appendicitis

Adenovirus appendicitis

Main article: Adenovirus appendicitis

Enterobius vermicularis

Main article: Enterobius vermicularis

General

  • May be found in the appendix.
  • The incidence is higher in normal appendices than inflamed ones.[3][4]
  • Clinically mimics appendicitis.[5]

Microscopic

Features:

Image

  • Enterobius - very low mag. (WC/Nephron)

  • Enterobius - high mag. (WC/Nephron)

  • Pinworm (WC/Uthman)

Granulomatous appendicitis

Main article: Granulomatous appendicitis

Inflammatory bowel disease

See Inflammatory bowel disease.

Periappendicitis

General

Definition: inflammation of tissues around the (vermiform) appendix.[6]

  • May be seen in association of appendicitis or alone.
    • With appendicitis it is suggestive of perforation.
    • Without concurrent appendicitis it is suggestive of another abdominal pathology.[7][8]

Microscopic

Features:

  • Acute inflammation of the serosa.

DDx:

Tumours of the appendix

Adenocarcinoma

Mucinous tumours of the appendix

Main article: Mucinous tumours of the appendix

This grouping includes mucinous cystadenoma and mucinous cystadenocarcinoma.

Goblet cell carcinoid

Main article: Crypt cell carcinoma

Neuroendocrine tumour of the appendix

  • Previously known as appendiceal carcinoid.
  • AKA appendiceal neuroendocrine tumour, abbreviated appendiceal NET.
Main article: Neuroendocrine tumour of the appendix

See also

References

  1. ↑ Dawkins, R. (2009). The Greatest Show on Earth: The Evidence for Evolution (1st ed.). Free Press. pp. 115. ISBN 978-1416594789.
  2. ↑ 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.
  3. ↑ 3.0 3.1 Wiebe, BM. (Mar 1991). "Appendicitis and Enterobius vermicularis.". Scand J Gastroenterol 26 (3): 336-8. PMID 1853157.
  4. ↑ 4.0 4.1 Dahlstrom, JE.; Macarthur, EB. (Oct 1994). "Enterobius vermicularis: a possible cause of symptoms resembling appendicitis.". Aust N Z J Surg 64 (10): 692-4. PMID 7945067.
  5. ↑ Ariyarathenam AV, Nachimuthu S, Tang TY, Courtney ED, Harris SA, Harris AM (2010). "Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review". Int J Surg 8 (6): 466–9. doi:10.1016/j.ijsu.2010.06.007. PMID 20637320.
  6. ↑ URL: http://www.medilexicon.com/medicaldictionary.php?t=66889. Accessed on: 1 June 2011.
  7. ↑ Fink, AS.; Kosakowski, CA.; Hiatt, JR.; Cochran, AJ. (Jun 1990). "Periappendicitis is a significant clinical finding.". Am J Surg 159 (6): 564-8. PMID 2349982.
  8. ↑ O'Neil, MB.; Moore, DB. (Sep 1977). "Periappendicitis: Clinical reality or pathologic curiosity?". Am J Surg 134 (3): 356-7. PMID 900337.
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