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Which type of appendiceal duplication involves complete duplication of the caecum?
What is a common cause of acute appendicitis?
What congenital condition may be associated with the absence of the appendix?
Which of the following is a contributing factor to appendiceal septa formation?
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In acute appendicitis, which of the following infections is NOT associated?
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What is commonly seen in infants with diverticular disease of the appendix?
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Which condition is characterized by the presence of spindle cells within a collagenous and myxoid background?
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In which age group is acute appendicitis most commonly diagnosed?
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What is the primary cellular response to bacterial peritonitis?
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Which organisms are commonly identified in cases of bacterial peritonitis?
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What morphological change is observed in the serosal and peritoneal surfaces during bacterial infection?
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What can occur as a potential result of bacterial peritonitis if the inflammatory process does not resolve completely?
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Which of the following is a characteristic feature of sclerosing retroperitonitis?
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What distinguishes tuberculous peritonitis from other forms of peritonitis?
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Cysts in the abdominal cavity are often characterized by which of the following?
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Which condition may lead to bacterial peritonitis developing in children?
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What is one common cause of peritonitis associated with the leakage of pancreatic enzymes?
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Which bacterium is commonly implicated in bacterial peritonitis?
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Which of the following conditions is most likely to cause perforation leading to bacterial peritonitis?
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What type of reaction is caused by foreign materials introduced surgically into the peritoneal cavity?
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What is spontaneous bacterial peritonitis characterized by?
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Endometriosis is linked to peritonitis through what mechanism?
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Which condition is least likely to cause bacterial peritonitis?
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What contributes to the intense granulomatous reaction observed with ruptured dermoid cysts?
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What is the classic physical finding associated with acute appendicitis, characterized by deep tenderness?
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Which tumor is the most common type found in the appendix?
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Which condition might result from a mucinous cystadenocarcinoma of the appendix?
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What may cause mesenteric lymphadenitis, often seen as a differential diagnosis for appendicitis?
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Which complication is least likely associated with acute appendicitis?
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What results from the obstruction of the appendix and can contain inspissated mucin?
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Which of the following is associated with minor pelvic bleeding during ovulation?
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What is a rare condition that can result from advanced cases of mucinous cystadenocarcinoma?
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What is a common origin for cysts that can develop in the peritoneum?
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Which of the following is a primary malignant soft-tissue tumor?
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What distinguishes mesothelioma from metastatic adenocarcinoma?
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Desmoplastic small round cell tumor is characterized by which genetic feature?
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Which condition is considered a sequela of pancreatitis?
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What type of tumors are commonly associated with diffuse serosal implants in advanced cancer?
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In which demographic is desmoplastic small round cell tumor most commonly found?
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What is a common characteristic of benign soft-tissue tumors in the peritoneal cavity?
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Study Notes
Appendix Abnormalities
- First appendix arises from normal position; second may occur at various colon sites.
- Type C shows complete duplication of the caecum with two appendices, each having its own.
- Absence of appendix is rare; abnormal positioning should be ruled out.
- Congenital absence can coincide with congenital abnormalities like diaphragmatic hernia.
- Atresia often involves obstruction in the ileocaecal region.
Appendiceal Septa
- Formation of incomplete or complete septa within the appendiceal lumen, seen mainly in children and young adults.
- Factors include congenital defects, post-inflammatory fusion of mucosal folds, and ischemia due to thrombosed vessels.
Diverticular Disease and Obliteration
- Congenital diverticular disease results from muscular wall abnormalities; acquired forms can be tied to conditions like cystic fibrosis.
- Fibrous obliteration involves a loss of luminal space due to spindle cell proliferation within collagenous and myxoid stroma, usually affecting the appendix's distal tip.
Acute Appendicitis
- Most prevalent in adolescents and young adults; more common in males but can affect all age groups.
- Diagnosis often challenging prior to surgery.
Causes of Acute Appendicitis
- Commonly caused by obstruction followed by bacterial infection, potential sources include:
- Faecolith (stool mass)
- Foreign bodies
- Lymphoid hyperplasia
- Tumors or polyps
- Mucin accumulation, especially in cystic fibrosis.
- Parasitic infections (e.g., amoebiasis, Enterobius vermicularis) can also lead to appendicitis.
Clinical Features and Complications
- McBurney's sign: deep tenderness at McBurney's point, two-thirds from the umbilicus to the right iliac spine.
- Complications include pyelophlebitis, portal vein thrombosis, liver abscess, and bacteraemia.
Differential Diagnoses for Appendicitis
- Conditions to consider include mesenteric lymphadenitis, Mittelschmerz, salpingitis, ectopic pregnancy, Meckel diverticulitis, and incarcerated inguinal hernia.
Tumors of the Appendix
- Types of tumors include carcinoids, mucinous cystadenomas, mucinous cystadenocarcinomas, and non-mucin-producing adenocarcinomas.
Carcinoid Tumors
- Most common appendiceal tumor, often found incidentally during surgery.
- Typically affects the distal tip and can exhibit intramural and transmural extension; metastases are rare.
Mucocoele
- A dilated appendix filled with mucin, potentially obstructed or resulting from mucinous neoplasms.
- In severe cases, the abdomen can fill with mucin, leading to pseudomyxoma peritoneii, sometimes confused with ovarian tumors.
Peritonitis
- Inflammation from bacterial invasion or chemical irritation, commonly secondary to perforations or leakage from organs like the gallbladder or pancreas.
Common Causes of Peritonitis
- Perforation of abdominal viscera, acute hemorrhagic pancreatitis, foreign materials from surgical procedures, and endometriosis.
Bacterial Peritonitis
- Occurs when gastrointestinal bacteria enter the peritoneum, often after perforations related to conditions like appendicitis or diverticulitis.
- Common bacteria implicated include E. coli, Streptococcus, S. aureus, and Enterococcus.
Spontaneous Bacterial Peritonitis
- Develops without an obvious source; commonly observed in cirrhotic patients and children with nephrotic syndrome.
Morphology of Peritonitis
- Initial glistening serosal surfaces become dull; serous fluid accumulation occurs quickly post-infection, progressing to viscous suppurative material.
Sclerosing Retroperitonitis
- Also known as idiopathic retroperitoneal fibrosis; characterized by dense inflammation and fibrosis, often compressing ureters.
Cysts in the Abdominal Cavity
- Develop from diverse origins, can be large and palpable; may arise from lymphatic channels, diverticular pinch-offs, or wall-off infections.
Benign and Malignant Tumors
- Primary benign tumors in the peritoneum are rare.
- Primary malignant tumors, like mesothelioma and desmoplastic small round cell tumors, are less common but important.
Mesotheliomas
- Associated with asbestos exposure; histopathologic diagnosis can be challenging and must differentiate from metastatic adenocarcinoma.
Desmoplastic Small Round Cell Tumour
- Commonest primary malignant soft-tissue tumor in children and young adults; characterized by specific gene fusion resulting in aggressive behavior.
Secondary Tumors
- Common in advanced cancer; direct spread can occur, especially from ovarian and pancreatic carcinomas. Appendiceal mucinous carcinomas may lead to pseudomyxoma peritoneii.
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