Acute Appendicitis

Slide #3470

C.C.:RLQpain.
H.P.I.: A 68-year-old man with a history ofHTN, NIDDMpresented withRLQpain x 5 hours, increasing in severity, with fevers to 102 F. He reported one episode of non-bilious, non-bloody vomiting on the morning of admission, with continued nausea. He reported having a normal BM on the same morning, and denied a history of diarrhea, hematochezia or melena. His physical exam was notable for T 101.5, P 95, BP 140/85, R 14, a non-distended abdomen with guarding and rebound in theRLQ. Labs demonstrated an elevatedWBCat 17 (nl=3.5-9.0 × 109) with a left shift,PMNs=86%, lymphs=9% (nl:PMN 40-70%, lymphs 20-50). All other lab work was within normal limits. He was taken to theOR,where an appendectomy was performed. He had a satisfactory post-operative course and was discharged home 4 days later.

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Questions

  1. The changes in the appendix involve which portion or portions of the wall?
  2. Examine the serosa. Describe the major pathologic findings:
  3. What is the predominant inflammatory cell in the appendix in this case?
  4. What is the pathogenesis of this appendiceal condition?
  5. This condition is an example of which of the following: inflammation, repair or neoplasia?
  6. Should this process be considered acute or chronic, and why?

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