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Category Archives: Appendix
Appendicitis
Appendicitis
Acute Appendicitis
Clinical presentation
- young adults with periumbilical to right lower quadrant pain, nausea, vomiting, fever, increased white blood cells
Gross appearnace
- fibrinopurulent exudate on serosa, perforation, fecalith
Histology
- acute and chronic inflammation of varying age with fibrosis and granulation tissue if late, xanthogranulomatous inflammation
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Tagged Acute appendicitis, Appendicitis, Appendix inflammation, Fecalith, pain, Periumbilical pain, Right lower quadran pain
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Appendix Histology
Appendix Histology
- same 4 layers as gut
- large bowel type epithelium with goblet cells
- lamina propria has irregularly distributed crypts (glands)
- rich lymphoid tissue in mucosa and submucosa
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Tagged Appendix, Appendix histology, Appendix normal histology, histology, normal histology
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Mucocele Appendix
Mucocele Appendix
- a mucocele is basically a viscus filled with mucin
- important thing about appendiceal mucoceles is not to confuse them with mucinous cystadenomas of the appendix, which can look deceptively benign
- any adenomatous change in the epithelial lining then you do not have a mucocele but a mucious cystadenoma
- if mucinous cystadenoma pushes beyond the muscularis mucosa, without any obvious invasion or desmoplastic reaction, this is a mucinous cystadenocarcinoma of the appendix
Posted in Appendix
Tagged , appendix cancer, carcinoma of the appendix, cystadenocarcinoma, cystadenoma, Mucocele, Mucocele Appendix
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Carcinoid syndrome
Carcinoid syndrome
Symptoms of Carcinoid Syndrome
- skin flushing
- diarrhea
- right sided heart disease due to fibrosis of the tricuspid valve and stenosis of the pulmonary valve
- bronchoconstriction
Detection of Carcinoid Syndrome
Serotonin secretion is confirmed by measuring the 24 hour urine levels of 5-HIAA (5-hydroxyindoleacetic acid), which is a breakdown product of the hormone, serotonin.
Management of Carcinoid Tumors
Low risk Carcinoid
Local excision for small lesions < 2 cm, with no mesoappendix invasion and no lymphovascular invasion.
Uncertain behavior if > 2 cm or lymphovascular invasion, no mesoappendix invasion.
High risk lesions have at least a cecal resection. These high risk tumors are found at the base of the appendix with caecal margin involvement.
Higher risk lesions require hemicolectomy. These include carcinoid lesions above 2 cm or with invasion of mesoappendix.