医学与人类健康：消化系统常见疾病.pptVIP

* Here is the resected appendix from laparoscopic surgery. Note that there is some tan-yellow exudate, but the main features of this early acute appendicitis are edema and hyperemia. * This appendix was removed surgically. The patient presented with abdominal pain that initially was generalized, but then localized to the right lower quadrant, and physical examination disclosed 4+ rebound tenderness in the right lower quadrant. The WBC count was elevated at 11,500. Seen here is acute appendicitis with yellow to tan exudate and hyperemia, including the periappendiceal fat superiorly, rather than a smooth, glistening pale tan serosal surface. * This is the tip of the appendix from a patient with acute appendicitis. The appendix has been sectioned in half. The serosal surface at the left shows a tan-yellow exudate. The cut surface at the right demonstrates yellowish-tan mucosal exudation with a hyperemic border. * Microscopically, acute appendicitis is marked by mucosal inflammation and necrosis. * Here, the mucosa shows ulceration and undermining by an extensive neutrophilic exudate. * Neutrophils extend into and through the wall of the appendix in a case of acute appendicitis. Clinically, the patient often presents with right lower quadrant abdominal pain. Rebound tenderness is noted on physical examination. An elevated WBC count is usually present. * * This is an in-situ photograph of the chest and abdominal contents. As can be seen, the liver is the largest parenchymal organ, lying just below the diaphragm. The right lobe (at the left in the photograph) is larger than the left lobe. The falciform ligament is the rough dividing line between the two lobes. * * This is the external surface of a normal liver. The color is brown and the surface is smooth. A normal liver is about 1200 to 1600 grams. * * The cut surface of a normal liver has a brown color. Near the hilum here, note the portal vein carrying blood to the liver, which branches at center left, with acc