Q3. All are Ultrasonic features of Acute Appendicitis except?
a) A compressible blind ending tube
b) Diameter of more than 7 mm
c) Loss of submucosal echogenicity
d)
Q4. What is not true as differentail diagnosis for appendicits in the elderly
a) Adenocarcinoma appendix
b) Diverticulitis
c) Pyelonephritis
d) Colitis
Q5. Which of the following statement id not true regarding pathophysiology of acute appendicitis?
a) Appendicitis results from obstruction of the lumen of appendix followed by infection.
b) Once the mucus becomes infected by bacteria in the lumen of appendix shifting of pain occurs.
c) Venous obstruction and Arterial obstruction in the appendix lead to gangrenous appendicitis
d) Perforation of appendix increases the morbidity and mortality.
Answers
1.a
Retroileal position of the appendix is seen in only .2% of the cases. Most common position of the appendix is retrocaecal 65% followed by Pelvic (20%), preileal and post ileal.
2. b
It was previously believed that carcinoid tumors are the most common tumors of the appendix ( Sabiston 17th) but now data from SEER ( Surveillane, epidimology and End results) show that mucinous adenocarcinomas are more common
Sabiston 18th page 1344.
3.
All these are true
4.a)
Altough adenocarcinoma of appendix can present as appendicitis, it is never kept as a differential diagnosis when appendicits is contemplated.
5.) b
Shifting of pain occurs when the venous obstruction occurs and edema of the wall of appendix occurs
The proposed pathophysiological chain of events in acute appendictis is.
Obstruction of the lumen of appendix ---------- Mucus accumulation in the lumen---------- Conversion of mucus to pus----------Lymphatic obstruction -----Edema of the wall of appendix------and muosal ulcers. Till this time the pain is visceral and localised to periumbilical area.
Venoous obstruction ensues due to continues edema of the wall of appendix, ischaemia and bacterial translocation occurs and suppurative appendicitis occurs. Now the pain is somatic and shifting occurs.
Final stage is arterial obstruction as well , gangrene and perforation
