Pathology: Acute Appendicitis Quiz

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Questions and Answers

What is the primary systemic effect of severe sepsis associated with appendicitis?

Severe abdominal pain

Leukocytosis

Increased blood pressure

Disseminated intravascular coagulation (correct)

Which type of pain is primarily responsible for the migration of appendicitis pain from the peri-umbilical area to the right iliac fossa?

Neuropathic pain

Somatic pain

Referred pain

Visceral pain (correct)

What is the main characteristic of granulation tissue during the healing process?

Proliferation of fibroblasts and new capillaries (correct)

Absence of inflammatory cells

Presence of necrotic tissue

Dense fibrosis with no blood vessels

Which option is not a cause of granulomatous inflammation?

Acute bacterial infections Signup and view all the answers

What is the most common cause of acute appendicitis in adults?

Fecalith obstruction Signup and view all the answers

What is the first-line management option for perforated appendicitis?

Surgical intervention Signup and view all the answers

Which cellular components are predominantly found in chronic inflammation?

Lymphocytes, plasma cells, and histiocytes Signup and view all the answers

Which of the following is NOT a systemic effect of inflammation associated with acute appendicitis?

Weight gain Signup and view all the answers

In the management of acute appendicitis, which treatment option is generally considered first-line?

Laparoscopic appendectomy Signup and view all the answers

What type of immune response characterizes granulomatous inflammation?

Type IV hypersensitivity reaction Signup and view all the answers

Which characteristic differentiates acute inflammation from chronic inflammation?

Duration of the inflammatory response Signup and view all the answers

What is a distinguishing feature of retro-caecal or pelvic appendix presentation?

Pain will not migrate from the peri-umbilical area Signup and view all the answers

What is a potential complication of untreated acute appendicitis?

Perforation of the appendix Signup and view all the answers

Which factor can contribute to the development of granulomatous inflammation in the appendix?

Autoimmune disease Signup and view all the answers

What role do neutrophils play in the inflammatory response of acute appendicitis?

Engulfing pathogens and debris Signup and view all the answers

What is the significance of an elevated WCC with a predominance of polymorphs in a patient suspected of having appendicitis?

Indicates a bacterial infection Signup and view all the answers

What is the primary cause of acute appendicitis in 98% of cases?

Obstruction to the lumen by a faecolith Signup and view all the answers

Which of the following represents the systemic effects of inflammation?

Pyrexia and production of acute phase proteins Signup and view all the answers

What is a common management option for a patient diagnosed with acute appendicitis?

Appendicectomy by open surgery or laparoscopy Signup and view all the answers

Chronic inflammation is typically characterized by which of the following?

Continuous cellular injury and repair process Signup and view all the answers

What is one of the potential complications of acute appendicitis?

Gangrenous transformation Signup and view all the answers

Which of the following is a characteristic feature of an abscess?

Localized collection of pus and dead tissue Signup and view all the answers

What does peritonitis following appendicitis generally indicate?

Severe disruption of the gastrointestinal tract Signup and view all the answers

In the context of inflammation, what are superoxide radicals primarily known for?

Killing pathogens during phagocytosis Signup and view all the answers

What is the primary cause of pain in acute appendicitis?

All of the above Signup and view all the answers

Which of the following is a classic symptom of acute appendicitis?

Periumbilical pain that migrates to the right iliac fossa Signup and view all the answers

In the context of acute appendicitis, guarding refers to:

Voluntary contraction of the abdominal muscles in response to pain Signup and view all the answers

What is the most common organism associated with appendicitis?

E. coli Signup and view all the answers

Which imaging technique is the first-line investigation for suspected acute appendicitis?

Abdominal ultrasound Signup and view all the answers

Which of the following laboratory findings is typically elevated in acute appendicitis?

Neutrophils Signup and view all the answers

The presence of air under the diaphragm on an erect X-ray indicates:

Abdominal perforation Signup and view all the answers

Which of the following is a potential complication of acute appendicitis?

Perforation leading to peritonitis Signup and view all the answers

Granulomas in the context of appendicitis may indicate: A) Acute appendicitis B) Chronic inflammation C) Normal healing process D) None of the above

Chronic inflammation Signup and view all the answers

What is the predominant inflammatory cell type seen in acute appendicitis?

Neutrophils Signup and view all the answers

Which of the following conditions can present with similar symptoms to acute appendicitis? A) Ectopic pregnancy B) Urinary tract infection C) Ovarian cyst rupture D) All of the above

All of the above Signup and view all the answers

CRP (C-reactive protein) is elevated in response to which of the following?

All of the above Signup and view all the answers

What is the primary purpose of conducting a pregnancy test in a female patient suspected of having appendicitis?

To exclude ectopic pregnancy Signup and view all the answers

In the context of acute inflammation, which immune cells primarily respond to the infection?

Neutrophils Signup and view all the answers

Which of the following statements about granulation tissue is correct?

It is a normal part of the healing process after tissue injury. Signup and view all the answers

Which of the following is the most common symptom of acute appendicitis?

Right lower quadrant pain Signup and view all the answers

Which laboratory finding is most characteristic of acute appendicitis?

Leukocytosis with neutrophilia Signup and view all the answers

Which of the following statements about the role of polymorphonuclear leukocytes (PMNs) in appendicitis is true?

They are the first responders to infection and contribute to phagocytosis. Signup and view all the answers

What complication is associated with gangrenous appendicitis?

Septicemia Signup and view all the answers

In the context of appendicitis, what does the term "peritonitis" refer to?

Inflammation of the peritoneum due to perforation Signup and view all the answers

What is the typical appearance of the appendix in a patient with acute appendicitis on ultrasound?

Thickened, non-compressible, and hypoechoic Signup and view all the answers

Which of the following factors does NOT contribute to the development of appendicitis? A) Obstruction of the appendiceal lumen B) Genetic predisposition C) Infection with enteric bacteria D) Low-fiber diet

Genetic predisposition Signup and view all the answers

What is the significance of a high level of C-reactive protein (CRP) in a patient suspected of having appendicitis?

It is a marker of inflammation that can support the diagnosis of appendicitis. Signup and view all the answers

Which age group is most commonly affected by acute appendicitis?

Adolescents and young adults Signup and view all the answers

In a case of suspected acute appendicitis, what would a digital rectal examination potentially reveal?

Tenderness in the right lower quadrant Signup and view all the answers

What role does the immune response play in the pathophysiology of acute appendicitis?

It triggers a non-specific inflammatory response involving neutrophils and cytokines. Signup and view all the answers

What is a classic sign of appendicitis observed during a physical examination?

All of the above Signup and view all the answers

A patient presents with right lower quadrant pain, fever, and nausea. What is the first-line management for suspected acute appendicitis?

Immediate surgery (appendectomy) Signup and view all the answers

Which histological feature is typically NOT seen in acute appendicitis?

Epithelioid cells Signup and view all the answers

Why does the pain of acute appendicitis migrate from the peri-umbilical area to the right iliac fossa (RIF)?

Visceral pain from the umbilicus and appendix innervated by the same segment Signup and view all the answers

In which situation might the presentation of appendicitis be atypical?

With a retrocaecal or pelvic appendix Signup and view all the answers

Chronic inflammation is characterized by the presence of which type of cells?

Lymphocytes, plasma cells, and histiocytes Signup and view all the answers

Which of the following is NOT a cause of chronic inflammation?

Acute viral infections Signup and view all the answers

Granulation tissue is characterized by all of the following EXCEPT:

Presence of necrotic tissue Signup and view all the answers

Which statement best defines a granuloma?

A collection of macrophages transformed into epitheloid cells Signup and view all the answers

Which of the following is a common cause of granulomatous inflammation?

All of the above Signup and view all the answers

Which condition is associated with granulomatous inflammation due to a foreign body response?

Splinter reaction Signup and view all the answers

Granulomas may form in response to which of the following?

All of the above Signup and view all the answers

Which type of pain is initially experienced in acute appendicitis before it localizes to the right iliac fossa (RIF)?

Visceral pain Signup and view all the answers

What mechanism leads to the transition of pain from the umbilical region to the right iliac fossa in appendicitis?

Both B and C Signup and view all the answers

Which of the following best describes chronic inflammation?

Involves a prolonged immune response with lymphocytes Signup and view all the answers

Which of the following conditions is commonly associated with chronic inflammation?

Rheumatoid arthritis Signup and view all the answers

Granulation tissue is primarily composed of which of the following?

Fibroblasts, capillaries, and chronic inflammatory cells Signup and view all the answers

What is a key feature of granulation tissue during the healing process?

Formation of new blood vessels Signup and view all the answers

Which type of hypersensitivity reaction is primarily involved in granuloma formation?

Type IV hypersensitivity Signup and view all the answers

Which of the following infections is commonly associated with granulomatous inflammation?

Tuberculosis Signup and view all the answers

Which of the following can cause granulomatous inflammation?

All of the above Signup and view all the answers

In granulomatous inflammation, what is the primary immune cell type involved?

Macrophages Signup and view all the answers

Which of the following is NOT a common cause of right iliac fossa (RIF) pain?

Peptic ulcer disease Signup and view all the answers

Which condition is characterized by right iliac fossa pain and is associated with reproductive issues in females?

Ovarian cyst rupture Signup and view all the answers

Which of the following conditions might present with right iliac fossa (RIF) pain due to bowel obstruction?

Mesenteric ischemia Signup and view all the answers

Histological examination of acute appendicitis typically reveals which of the following?

Neutrophilic infiltration of the mucosa and muscularis Signup and view all the answers

What histological change is most indicative of acute appendicitis?

Fibrinous exudate on the serosa Signup and view all the answers

Which of the following is a potential complication of untreated acute appendicitis?

All of the above Signup and view all the answers

What is a serious consequence of a perforated appendix?

Localized abscess formation Signup and view all the answers

Which of the following features is characteristic of granulation tissue?

High vascularity and fibroblast proliferation Signup and view all the answers

Granulomatous inflammation is primarily characterized by which histological feature?

Aggregation of epitheloid macrophages and lymphocytes Signup and view all the answers

Which of the following is a common infectious cause of granulomatous inflammation?

Mycobacterium tuberculosis Signup and view all the answers

Which of the following non-infectious conditions can cause granulomatous inflammation?

All of the above Signup and view all the answers

Study Notes

Acute Appendicitis Overview

Acute appendicitis is characterized by a blockage in the appendix that leads to inflammation, typically due to fecaliths.
Common symptoms include right iliac fossa (RIF) pain, nausea, and vomiting.

Learning Outcomes

Identify differential diagnoses for right iliac fossa pain including conditions like urinary tract infection and ectopic pregnancy.
Describe histological features such as the predominance of neutrophils in acute appendicitis.
Understand complications arising from inflammation, including perforation and abscess formation.
Differentiate between granulation tissue and granulomatous inflammation.

Patient Case

A 25-year-old female presented with RIF pain lasting 36 hours, beginning as periumbilical pain, accompanied by nausea and a single episode of vomiting.
Vital signs indicated mild pyrexia and normal heart rate and respiratory rate.

Physical Examination

Rebound tenderness and guarding in the RIF noted, but no rigidity or abnormal bowel sounds.

Differential Diagnosis for RIF Pain

Conditions associated with RIF pain include:
- Acute appendicitis
- Terminal ileitis
- Meckel’s diverticulum
- Urinary tract infections
- Ectopic pregnancy

Investigations Conducted

Full blood count (FBC) showed elevated white blood cell (WBC) count at 14,500 with 95% polymorphs; indicative of acute inflammation.
Urine microscopy revealed <5 pus cells and a culture showing E.coli and Staphylococcus, indicating no urinary tract infection (UTI).
CRP levels were elevated, signifying inflammation.

Diagnosis Confirmation

Diagnosis confirmed as acute appendicitis based on clinical and investigation findings.

Histological Features & Inflammatory Response

Acute appendicitis has predominant neutrophilic infiltration, leukocytosis, and systemic inflammatory signs.
Pain migration from periumbilical to RIF occurs due to visceral to somatic pain transition.

Treatment Modalities

Surgical intervention (appendicectomy) is indicated, with intravenous antibiotics used to manage potential perforation or sepsis.
Pain management and preoperative preparations are essential.

Complications of Appendicitis

Possible complications include:
- Gangrenous appendicitis
- Perforation leading to peritonitis
- Abscess formation

Chronic Inflammation and Granulation Tissue

Chronic inflammation features cells like lymphocytes and macrophages, potentially progressing from acute inflammation.
Granulation tissue arises as a nonspecific healing response, characterized by fibroblast proliferation and new capillary growth.

Granulomatous Inflammation

Granulomatous inflammation can result from infection, foreign material, malignancy, or idiopathic causes.
Types of infectious agents causing granulomas include bacteria (e.g., TB), fungi (e.g., Histoplasmosis), and parasites.

Systemic Effects of Inflammation

An acute phase response can result in systemic symptoms including fever and production of acute phase proteins triggered by infection or injury.

Summary Points on Management

Management includes timely surgical intervention and supportive care to prevent complications like septicemia or localized abscesses.

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Description

Test your knowledge on the differential diagnosis for right iliac fossa pain and the histological features of acute appendicitis. This quiz will also cover complications and the distinction between granulation tissue and granulomatous inflammation. Ideal for students in the Pathology course at RCSI.