appendix and peritoneum Flashcards
Describe the clinical findings and pathophysiology of the common inborn errors of metabolism (Wilson disease, hemochromotosis, alpha-one antitrypsin deficiency) Compare and contrast the clinicopathologic features of benign liver tumors (Hemangioma, focal nodular hyperplasia, adenoma) Compare and contrast the clinicopathologic features of malignant liver tumors (metastasis, cholangiocarcinoma, hepatoceulluar carcinoma)
things that can obstruct the appendix
fecalith, gallstone, tumor, worms
process of acute appy
obstruction (possible) –> increased intra-luminal presure and collapse of draining veins –> ischemia, bacterial proliferation, further inflammation
key histological criterion of acute appy
neutrophils in the muscular wall
late result of untreated appy
rupture and peritonitis
sx of appy
n/v (,may come on later). anorexia, RLQ pain and tenderness at mcBurney point
complications of appy
perforation, pyleophlebitis and thrombosis of the portal venous drainage, liver abcess and bacteremia
ddx of appy
gasteroenteritis ECTOPIC meckel diverticulum meserwnteric lyphadenitis diverticulitis
appy tumor types (4)
carcinoid
mucocele
pseudomyxoma peritonei
adenocarcinoma
most common appy tumor
carcinoid
“salt and pepper” tumor with nests of tumor cells withut atypia and no mitosis
carcinoid
prognisis for carcinoid appy tumor
excellent
plump cells containing mucin vaculoes
goblet cell carcinoid
dilated appendix filled with mucin
mucocele
globular enlargement of the appy by mucus
simple mucocele
mucinous mucosa replaces the appendiceal mucosa. No malignant cells
benign mucinous cystadenoma
mucin-filled cystic dilation of appendix with pernetration of the appendiceal wall by invasive cells and spread beyond the appendix
malignant mucinous cystadenocarcinoma
ruptured mucinous cystadenocarcinoma can lead to
psuedomyxoma peritonei
psuedomyxoma peritonei prognosis
aggresive and fatal
mucin secretion that fills the peritoneum
psuedomyxoma peritonei
def of secondary peritonitis
perforation of hollow viscus with direct dissemination of contamiinated material
can cause sterile peritonitis
blood, bile, pancreatic fluid, drugs
can cause infective peritonitis
anything that pokes a hole in the GU tract
bugs that cause infective peritonitis
e coli, strep, gram neg rods, c perfringes
can cause spontaneus bacterial peritonitis
kids with nephrotic syndrome, cirrohis with ascites
possible outcomes of peritonitis
self-resolution
walled off abcesses
adhesions
tx of peritonitis
surgery, antibiotics, ICU and management of comorbidities
dense fibrous overgrowth of peritoneal retroperitoneal tissue
sclerosing retroperitonitis
can cause secondary peritoneal tumors
seeding and penetration from other sites (particularly the ovary and pancreas)
highly malignant peritoneal tumor in young males
desmoplastic small round cell
gene for desmoplastic small round cell tumor
EWS and WT1 gene fusion
firm hard neoplastic tissue with myxoid change and necrosis
desmoplastic small round cell tumor
aggregates of malignant small cells surrounded by a cellular desmoplastic stroma
desmoplastic small round cell tumor
