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Questions and Answers
Which type of appendiceal duplication involves complete duplication of the caecum?
Which type of appendiceal duplication involves complete duplication of the caecum?
What is a common cause of acute appendicitis?
What is a common cause of acute appendicitis?
What congenital condition may be associated with the absence of the appendix?
What congenital condition may be associated with the absence of the appendix?
Which of the following is a contributing factor to appendiceal septa formation?
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?
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?
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?
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?
In which age group is acute appendicitis most commonly diagnosed?
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What is the primary cellular response to bacterial peritonitis?
What is the primary cellular response to bacterial peritonitis?
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Which organisms are commonly identified in cases of bacterial peritonitis?
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?
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?
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?
Which of the following is a characteristic feature of sclerosing retroperitonitis?
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What distinguishes tuberculous peritonitis from other forms of peritonitis?
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?
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?
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?
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?
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?
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?
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?
What is spontaneous bacterial peritonitis characterized by?
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Endometriosis is linked to peritonitis through what mechanism?
Endometriosis is linked to peritonitis through what mechanism?
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Which condition is least likely to cause bacterial peritonitis?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
Which of the following is a primary malignant soft-tissue tumor?
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What distinguishes mesothelioma from metastatic adenocarcinoma?
What distinguishes mesothelioma from metastatic adenocarcinoma?
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Desmoplastic small round cell tumor is characterized by which genetic feature?
Desmoplastic small round cell tumor is characterized by which genetic feature?
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Which condition is considered a sequela of pancreatitis?
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?
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?
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?
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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