1. ACUTE APPENDICITIS (Incidence, Etiology and pathology)

Question 1

INCIDENCE of ACUTE APPENDICITIS

Answer 1

Commonest cause of acute abdomen.

Question 2

Variation in the position of the tip of the appendix

Answer 2

1. Retrocaecal 74%
2. pelvic 21%
3. Paracaecal
4. Subcaecal
5. Preilial
6. postilial
7. Subserous
8. Subhepatic

Question 3

Pathogenesis of Subserous appendix in Variation in the position of the tip of the appendix

Answer 3

when it lies beneath the serosa of the caecum

Question 4

Pathogenesis of Subhepatic appendix inVariation in the position of the tip of the appendix

Answer 4

failure of descent of the caecum

Question 5

Etiology of ACUTE APPENDICITIS

Answer 5

(A) Non-obstructive (1/3)

B) Obstructive (2/3

Question 6

Pathogenesis of Non-obstructive Etiology of ACUTE APPENDICITIS

Answer 6

Constipation.

Question 7

Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS

Answer 7

Obstruction may be in :
* Lumen :

• Wall:
• Outside the wall: .

Question 8

Lumen Obstruction in Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS

Answer 8

• F.B ( fruit seeds)
• parasites ( oxyuris or ascaris worms)
• faecal concretions.

Question 9

Wall Obstruction in Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS

Answer 9

• Stricture
• Tumour.
• Crohn’s
• Lymphoid tissue hyperplasia

Question 10

Outside the wall Obstruction in Pathogenesis of Obstructive Etiology of ACUTE APPENDICITIS

Answer 10

• Adhesions
• kinks
• mass

Question 11

PATHOLOGY of ACUTE APPENDICITIS

Answer 11

• Organisms
• Route of spread
• Pathological stages
• Fate

Question 12

Organisms in PATHOLOGY of ACUTE APPENDICITIS

Answer 12

• E. coli
• streptococcal faecalis
• streptococcal viridans

Question 13

Route of spread in PATHOLOGY of ACUTE APPENDICITIS

Answer 13

Direct from the lumen ( Rarely blood ).

Question 14

Pathological stages in PATHOLOGY of ACUTE APPENDICITIS

Answer 14

(1) Acute catarrhal :
(2) Acute suppurative.
(3) Acute gangrenous

Question 15

Pathogenesis of Acute catarrhal in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS

Answer 15

Inflammation is confined to the mucosa.

Question 16

Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS

Answer 16

• Leading to perforation
• ln non obstructive type
• ln obstructive type
• Perforation is more common with obstructive appendicitis

Question 17

perforation ln non obstructive type in Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS

Answer 17

Perforation occurs at the tip

Question 18

the reason why perforation ln non obstructive type occurs at the tip , in Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS

Answer 18

due to thrombosis of the appendicular artery.

Question 19

perforation ln obstructive type in Pathogenesis of Acute gangrenous in Pathological stages in PATHOLOGY of ACUTE APPENDICITIS

Answer 19

Perforation occurs at the site of obstruction.

Question 20

Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 20

A. Non-obstructive Type :

B. Obstructive Type :

Question 21

Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 21

• Inflammatory process
• The appendicular mass:
• Sequel

Question 22

Inflammatory process in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 22

1. The course of the inflammatory process is slow
2. The omentum surrounds the inflamed appendix
3. an “Appendicular Mass” forms on the 3rd day after the beginning of the attack of acute appendicitis

Question 23

The appendicular mass in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 23

• Alternative name

* Components

Question 24

Alternative name for The appendicular mass in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 24

peri-appendicular phlegmon

Question 25

Components of The appendicular mass in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 25

a) Appendix in center. b) Surrounded by loop of gut. c) And all are wrapped by omentum ( policeman of the abdomen) forming closed box preventing this inflamed focus from affecting other structures.

Question 26

Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 26

a) Complete resolution under medical treatment. | b) Perforation (at the tip) may however occur inside the mass causing " Appendicular Abscess".

Question 27

The Appendicular Abscess in Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 27

a) Its location B) Fate:

Question 28

Location of The Appendicular Abscess in Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 28

is governed by the location of the appendix thus it may be retrocaecal, pelvic, subcaecal, preilial and postilial

Question 29

Fate of The Appendicular Abscess in Sequel in Non-obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 29

A big abscess may point in the abdominal wall or may burst in the rectum or vagina or in the peritoneal cavity )> peritonitis

Question 30

Obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 30

The inflammatory process Sequel

Question 31

The inflammatory process in Obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 31

The course of the inflammatory process is rapid causing perforation (at the site of obstruction) before the defensive mechanism has occurred.

Question 32

Sequel in Obstructive Type Fate in PATHOLOGY of ACUTE APPENDICITIS

Answer 32

Perforation causes generalized peritonitis (Within the 1st 48 hours).