1.

Definition / Definition
The appendix is a small finger-like tip about 10 cm (94 inches) long, attached
to the cecum just below the ileocecal valve. The appendix contains food and empties
itself regularly into the cecum. Because emptying is not effective and the lumen is
small, the appendix tends to become blocked and prone to infection. (Smeltzer, 2002).
Appendicitis is inflammation of the vermivormis appendix, and is the most
frequent cause of acute abdomen. This disease can affect all ages, both men and
women, but more often attacks men aged between 10 and 30 years (Mansjoer, Arief,
et al., 2007).
Appendicitis is an infection of the appendix due to blockage of the lumen by
fecalith (stool stones), hyperplasia of lymphoid tissue, and intestinal worms. Lumen
obstruction is the main cause of appendicitis. Appendix mucous membrane erosion
can occur due to parasites such as Entamoeba histolytica, Trichuris trichiura, and
Enterobius vermicularis (Ovedolf, 2006).
Appendicitis is an inflammation of the vermiform appendix, because of its
twisted structure, the appendix is an ideal place for bacteria to gather and multiply
(Chang, 2010)
Appendicitis is inflammation of the appendix that can occur without a clear
cause, after obstruction of the appendix by feces or due to twisting of the appendix or
blood vessels (Corwin, 2009).

2. Causes / Predisposing Factors

There is no definite or specific cause of appendicitis but there are predatory
factors, namely:
a. The most common factor is lumen obstruction. In general, this obstruction
occurs because:
1) Hyperplasia of lymphoid follicles, this is the most common cause.
2) The presence of faecolites in the lumen of the appendix
3) The presence of foreign objects such as grains
4) Sternal lumen due to fibrous due to previous inflammation.
b. The most common infections of colon bacteria are E. Coli and
Streptococcus
 c. Men are more than women. The most at the age of 15-30 years (adult
adolescents). This is caused by an increase in limpoid tissue at that time.
d. Depends on the shape of the appendix:
1) Appendic that is too long
2) Short mass of appendix
3) Protrusion of limpoid tissue in the lumen of the appendix
4) Valve abnormalities at the base of the appendix
(Nuzulul, 2009)

3. Classification
a. Acute appendicitis
Acute appendicitis is: inflammation of the appendix tissue. Acute appendicitis
is basically obstruction of the lumen which will then be followed by an infection
process from the appendix.
The cause of the obstruction can be:
1) Lymph node hyperplasia of the appendix wall mucosa.
2) Fecalite
3) Foreign objects
4) Tumors.
The presence of obstruction resulting in mucin / mucous fluid produced
cannot come out of the appendix, this further increases the intra-luminaire pressure
which causes higher intra-mucosal pressure.
High pressure will cause infiltration of germs into the wall of the appendix so
that suppurative inflammation results in pus / pus on the appendix wall. Besides
obstruction, appendicitis can also be caused by the spread of infection from other
organs which then spread hematogenously to the appendix.

b. Purulenta Appendicitis (Supurative Appendicitis)

The pressure in the lumen which continues to increase with edema causes the
constriction of venous flow in the appendix wall and causes thrombosis. This
condition aggravates ischemia and edema in the appendix. Microorganisms in the
large intestine that invade the appendix wall cause serous infection so serous becomes
bleak because it is coated with exudate and fibrin. In the appendix and
mesoappendiks there is edema, hyperemia, and inside the lumen there is a
fibrinopurulent exudate. Marked by local peritoneal stimuli such as tenderness, loose
pain at Mc Burney's point, muscular defans, and pain in active and passive motion.
Muscular pain and defects can occur throughout the abdomen accompanied by signs
of general peritonitis

c. Chronic appendicitis
A new diagnosis of chronic appendicitis can be established if all conditions
are met: a history of right lower abdominal pain for more than two weeks, chronic
inflammation of the appendix macroscopically and microscopically, and complaints
disappear after an appendectomy.
The microscopic criteria of chronic appendixitis are complete fibrosis of the
appendix wall, partial or total lumen obstruction of the appendix, presence of scarring
and old ulcers in the mucosa, and chronic inflammatory cell infiltration. The
incidence of chronic appendicitis is between 1-5 percent.

d. Recurrent appendicitis
A recurrent diagnosis can only be considered if there is a history of attacks of
recurrent pain in the lower right abdomen which encourages apeomy and the
pathology results show acute inflammation. This disorder occurs when acute
appendicitis attacks first heal spontaneously. However, appendicitis does not return to
its original form because of fribosis and scar tissue. The risk for more attacks is
around 50 percent. The incidence of recurrent appendicitis is usually carried out by an
appendectomy that is examined pathologically.
In recurrent appendicitis, an appendectomy is usually performed because
patients often come in acute attacks.
e. Mukokel Appendix
The appendiceal mucocele is a cystic dilation of the appendix containing
mucin due to the presence of chronic obstruction of the base of the appendix, which is
usually fibrous tissue. If the lumen contents are sterile, mucin will be buried without
infection. Although rare, mukokel can be caused by a cystadenoma that is suspected
to be malignant.
Patients often come with mild form of discomfort in the lower right abdomen.
Sometimes the elongated mass is palpated in the right iliac region. Once when an
infection occurs, there will be a sign of acute appendicitis. The treatment is an
appendectomy.

f. Appendix Tumor / Appendix Adenocarcinoma

This disease is rarely found, usually found accidentally when an
appendectomy is indicated by acute appendicitis. Because it can be metastatic to
regional lymph nodes, right hemicolectomy is recommended which will give a much
better life expectancy than just an appendectomy.

g. Carcinoid Appendix
This is an argentafine cell appendix tumor. This disorder is rarely diagnosed
with prabedah, but is found incidentally on pathological examination of the appendix
specimen with a diagnosis of prabedah acute appendicitis. Carcinoid syndrome in the
form of reddish stimulation (flushing) on the face, shortness of breath due to
bronchial spasm, and diarrhea which is only found in about 6% of cases of stomach
carcinoid tumors. Tumor cells produce serotonin which causes the above symptoms.
Even though it is doubtful as malignancy, carcinoid turns out to provide
residif and the presence of metastasis, so radical surgery is needed. If the pathologic
specimen of the appendix shows carcinoid and the base is not tumor free, resection of
ileocecal resection or right hemicolectomy is performed.