Vermiform appendix
Long, tubular structure that extends from the cecum in one of
several directions; it may lie
______ behind the cecum ______ behind the ileum and
mesentery Downward and _____ into the true pelvis
superior
medial
medial
Remnant of what was originally the apex of the cecum?
Vermiform Appendix
Vermiform Appendix:
Located on the abdominal wall under ________ point
Draw a line from the right anterosuperior iliac spine to
the umbilicus.
At approximately the midpoint of this line lies the root
of the appendix.
McBurney�s
Appendix:
Between 1 and 9 inches in length, averaging ___ inches
Held in position by a fold of the peritoneum that forms a mesentery
for it
This triangular structure covers two thirds of the appendix,
leaving the distal one third completely uncovered by peritoneum
3
Appendix:
A branch of the _________ artery, the artery of the appendix,
lies between the layers of this mesentery.
ileocolic
Appendix:
The small canal of the appendix communicates with the _______
by an orifice that is below and behind the ileocecal opening.
cecum
Appendix:
The cellular layers that make up the appendix are the serosa
or adventitia, muscularis propria, submucosal, and mucosal�the same
layers as in the _______.
An abundant amount of retiform tissue is found in the ______
layer.
intestine
mucosa
Colon:
A prominent fluid-filled colon may appear as a _____.
The _____-______ technique should be used to help determine
whether the mass is within the colon, separate from the colon, or
the colon itself.
mass
water-enema
Duplication Cyst:
Embryologic mistakes May or may not cause
________, depending on their size, location, and histologic
makeup.
symptoms
THREE Criteria for a duplication cyst are:
Is lined with _______ tract epithelium Has
a well-developed _______ wall Is contiguous with the
stomach
alimentary
muscular
Duplication Cysts:
May come from the ________ or ________.
Occurs more often in ________. Is usually found on
the _____ _________ of the stomach.
pancreas or duodenum
women
greater curvature
Duplication Cyst Symptoms:
High intestinal obstruction-______ Vomiting
Abdominal pain Hemorrhage and _____formation may also
occur
distention
fistula
Duplication Cysts Differentials? (7)
Mesenteric or omental cyst, Pancreatic cyst or pseudocyst, Enteric
cyst, Renal cyst, Splenic cyst,Congenital cyst of the left lobe of the
liver, and Gastric distention
Movable intraluminal masses of congealed ingested materials that are
seen on upper gastrointestinal radiographs?
Gastric Bezoars
Gastric Bezoar:
Divided into three categories
_________�hair balls in young women
__________�vegetable matter (e.g., unripe persimmons)
__________�inorganic materials (e.g., sand, asphalt, and
shellac)
Clinically, patient symptoms include nausea, vomiting, and pain.
Trichobezoars
Phytobezoars
Concretions
Small, tumorlike growth that projects from a mucous membrane surface?
Polyp
Polyp:
____ _____ is an outgrowth of tissue from the gastric
wall.
Patients are asymptomatic when the polyp is _____. As
the polyp grows, abdominal pain may be present.
Gastric polyp
small
Most common tumor of the stomach?
Leiomyoma
Leiomyoma:
Seen as a mass similar to _______; is usually small and
asymptomatic Associated with other gastrointestinal
abnormalities, such as cholelithiasis, peptic ulcer disease,
adenocarcinoma, and leiomyosarcoma
carcinoma
Gastric Carcinoma:
Carcinomas account for at least ___% to ___% of malignant
tumors of the stomach. 50% percent of tumors occur in the pylorus;
25% occur in the body; and 25% in the fundus of the stomach.
The _____ leading cause of death; occurs more often in older
men. Lesions may be ulcerated, diffuse, polypoid, or
superficial.
90% to 95%
sixth
Lymphoma:
Can occur as a primary tumor of the gastrointestinal tract
(___% of stomach tumors)
3%
Disseminated Lymphoma:
Primary tumor occurs as a ________ lesion in the
gastrointestinal tract. The stomach has enlarged and
thickened mucosal folds, multiple submucosal nodules, an ulceration,
and a large extraluminal mass. Clinical symptoms include
nausea and vomiting with ____ _____.
multifocal
weight loss
Second most common malignant GI tumor (1% to 5% of tumors).
Leiomyosarcoma
Leiomyosarcoma:
Occurs in the ____ to _____ decades of life. Mass is
generally globular or irregular. May become huge,
outstripping its blood supply, with central necrosis leading to
cystic degeneration and cavitation.
fifth to sixth
METs:
Metastatic disease to the stomach is _____. May come
from a __________ or from lung or breast cancer. Tumors are
found in the ______ layer, forming circumscribed nodules or
plaques.
rare
melanoma
submucosal
Lower GI Tract:
A small bowel obstruction is associated with dilation of the
bowel loops ______ to the site of the obstruction. In 6% of
patients, the dilated loops are _____-______ and can be mistaken for
a soft-tissue mass on x-ray examination.
proximal
fluid-filled
Acute Appendicitis:
Result of luminal obstruction and inflammation, leading
to _______ of the vermiform appendix. This ischemia may
produce ______, perforation, and subsequent abscess formation and
peritonitis.
ischemia
necrosis
In acute appendicitis, the appendix lumen may become obstructed by
what SEVEN things?
Fecal material, Foreign body, Carcinoma of the cecum, Stenosis,
Inflammation, Kinking of the organ, and Lymphatic hypertrophy
resulting from systemic infection
Acute Appendicitis:
The obstruction results in ______, which can compromise the
vascular supply to the appendix.
Subsequently, the permeability of the mucosa increases, and
bacterial invasion of the wall of the appendix results in ______ and
__________.
edema
infection and inflammation
Acute Appendicitis:
Increased __________ pressure may cause occlusion of the
appendicular end artery. If the condition persists,
necrosis of the appendix may result, leading to _______, rupture,
and subsequent local or generalized peritonitis.
intraluminal
gangrene
Acute Appendicitis:
Periappendiceal abscess or peritonitis does not necessarily
mean ________; the organism may permeate the wall in the absence of
perforation to cause these extraappendiceal complications.
perforation
Acute Appendicitis:
The symptoms are pain and _______ _________, which is usually
localized over the right lower quadrant (McBurney�s sign); typically
followed by nausea and vomiting, diarrhea, and systemic signs of
inflammation, such as leukocytosis and fever.
Acute appendicitis can occur at any age but is more prevalent
at _____ ages.
rebound tenderness
younger
Acute Appendicitis:
Progression of acute appendicitis to frank perforation is more
rapid in the younger child, sometimes occurring within ___ to ____
hours.
The rate of perforation in the preschool child can be as high
as 70% compared with the overall figure of 30% for children and 21%
to 22% for adults.
6 to 12
Acute Appendicitis:
Women ages ___ to ___ years are at high risk of having the
condition be misdiagnosed on initial physical examination.
20 to 40
Differential Diagnosis for Acute Appendicitis? (7)
Acute gastroenteritis, Mesenteric lymphadenitis in children,
Ruptured ectopic pregnancy, Mittelschmerz,Inflammation of Meckel
diverticulum, Regional enteritis, and Right ovarian torsion
Fecaliths or calculi in the appendix
Appendicoliths
Gross enlargement of the appendix from accumulation of mucoid
substance within the lumen
Mucocele
Diverticulum:
Pouchlike ______ through the muscular wall of a tubular
organ Occurs in the stomach, the small intestine, and most
commonly in the ______
herniation
colon
Meckel diverticulum
Located on the ___________ border of the ileum, approximately
2 feet from the ileocecal valve Present in __% of the
population
Adult symptoms may include intestinal obstruction, rectal
bleeding, or diverticular inflammation
antemesenteric
2%
Acute appendicitis and acute ______ diverticulitis may not be
distinguished clinically.
Meckel
Crohn's Disease:
Regional enteritis, a recurrent granulomatous inflammatory
disease that affects the terminal ileum, colon, or both at any
level.
The reaction involves the entire _____ of the bowel wall.
Clinical symptoms include diarrhea, fever, and right lower
quadrant pain.
thickness
A tumor that usually occurs late in life, near the sixth decade; it
is also the most common tumor of the gastrointestinal tract in
children under 10 years of age.
GI Lymphoma
GI Lymphoma:
The intraperitoneal masses frequently involve the mesenteric
______ that encase them.
Clinical signs and symptoms include intestinal blood loss,
weight loss, anorexia, and abdominal pain. The patient may have an
intestinal obstruction or palpable mass.
vessels
Leiomyosarcoma of Colon:
Represents ___% of all primary small bowel tumors.
10% to 30% occur in the duodenum; 30% to 45% occur in the
jejunum; 35% to 55% occur in the ileum
Patients with this tumor are in their __ to __ decades of
life.
10%
fifth to sixth