appendix and peritoneum

7/28/2019 Appendix and Peritoneum

1/12

Gastrointestinal Tract

GIT

Pathology

Esophagus StomachIntestines Appendix

Peritoneum


2/12

Intestines - Pathology

Appendix

Acute Appendicitis

Tumors


3/12

Appendix

Acute appendicitis

MC in adolescents & young adul ts

Characterized by=Obstruction of lumenMC by fecolith

Raised intraluminal pressure

Ischemic injury & Bacterial invasion

Morphology:

Acute supporativeappendicitis

Hyperemia, edema & PML inf il tration of all l ayersof the wall to theperitoneum

Acute gangrenousappendicitis

Thrombosis of appendicular vessels gangrene diffuse septic

peritonitis.

Localized or general izedperitonitis

When becomes covered by fibrino-purulent exudate

Clinical features =deceptively minimal in old age

Complications: perforation, pylephlebitis, liver abscess


4/12

Appendix

Tumors of the appendix

1. Mucocele:

Characterized by:

Distension of the appendiceal lumen by mucinous secretion.

Caused by:

Non -Neoplastic - Mucosal hyperplasia

Neoplastic (benign)- Mucinous cystadenoma

Neoplastic (Malignant) - Mucinous cystadenocarcinoma(fatal); mayrupture peritoneal implants,produce pseudomyxomaperitonei.

2. Carcinoid:

MC tumor of appendix

Almost always benign & discovered accidentally on appendicectomy

(curative).

3. Carcinoma:Adenocarcinomas, identical to their intestinal counterparts

Other conditions produce pseudomyxoma peritonei.


5/12

Intestines - Pathology

Peritoneum

Inflammation

Tumors


6/12

Appendix

Peritonitis

Sterile Peritonitis:

Caused by chemical irritation by bile, pancreatic juice, endometriosis (blood),

ruptured ovarian cysts (dermoid) or introduction of chemical substances fordiagnostic (laparoscopy, salpingo-graphy) ortherapeutic procedures(peritoneal dialysis)

Septic Peritonitis:

Bacterial infection of the peritoneum from acute appendicitis, ruptured PU,acute cholecystitis, diverticulitis, bowel strangulation, acute salpingitis, or

through evacuation of ascitic fluid or peritoneal dialysis. localized (loculated abscesses) & may heal by fibrous adhesionschronic

obstruction

Sclerosing Retroperitonitis:

Idiopathic

May be related to Anti migraine drugs (methysergide)

or may be autoimmune.

Characterized by = Excessive fibrous tissue proliferation (fibromatosis)

compromising retroperitoneal structures (uretershydronephrosis).


7/12

Peritoneal cysts

Mesenteric Cysts= Caused by blocked lymphatics, enteric diverticula,postinfectious cysts, postpancreatitis pseudocysts, or neoplastic cysts.

Peritoneal tumors

1. Primary = rare,

Mesothelioma, & is related to past asbestos exposure, identical to its

counterpart in the pleura

2. Secondary = Very common,

from advanced cancer of any abdominal viscera, e.g. cancer stomach, colon,

small intestine, pancreas, liver, gallbladder, uterus & breast

Diffuse seeding of the peritoneal cavity malignant effusions (mainly ovarian)

Cancer cells can be detected in the peritoneal fluid by cytological examination


8/12

Case - 5

20-year-old woman presented to the emergency roomwith only a one day history of lower abdominal pain,nausea with anorexia, and fever. On physicalexamination, there was periumbilical pain. Under active

observation over the next couple of hours, the painmigrated to the right lower quadrant, with reboundtenderness. Her vital signs showed T 38.5 C, P 90, R 18,and BP 110/70 mm Hg. Her WBC count was 11,500 with76% polys, 6% bands, 14% lymphs, and 4% monos. A

pregnancy test was negative. A stool sample wasnegative for occult blood. A urinalysis was normal. Theradiographic finding on abdominal CT scan is seen. Alaparoscopic procedure was performed and the grossappearance of the lesion is shown. The microscopic

appearance is seen.


9/12

5.1


10/12

5.2


11/12

5.3


12/12

5.4

appendix and peritoneum

Documents