PATHOPHYSIOLOGY APPENDICITIS

Pathophysiology
Now, let’s proceed to the pathophysiology of this disease. The simple pathophysiology of
appendicitis follows the typical pathophysiology of infection.
Appendicitis is typically caused by direct luminal obstruction. When obstructed,
commensal bacteria in the appendix can multiply, resulting in acute inflammation. ,
Commonly identified bacteria associated with acute appendicitis include Escherichia coli,
Peptostreptococcus, Bacteroides and Pseudomona The inflammatory process increases
intraluminal pressure, initiating progressively severe, generalized, or periumbilical pain.
Eventually, the inflamed appendix fills with pus. Reduced venous drainage and localised
inflammation can result in increased pressure within the appendix, in turn can result in
ischaemia.
 Obstruction. The appendix becomes inflamed and edematous as a result of
becoming kinked or occluded by a fecalith, tumor, or foreign body. Wall of the
appendix becomes ischemic and necrotic
Bacterial infection then occurs in the obstructed appendix, Commonly identified
bacteria associated with acute appendicitis include Escherichia
coli, Peptostreptococcus, Bacteroides and Pseudomonas
 Inflammation. The inflammatory process increases intraluminal pressure,
initiating progressively severe, generalized, or periumbilical pain.
 Pain. The pain becomes localized to the right lower quadrant of the abdomen within
a few hours.
 Pus formation. Eventually, the inflamed appendix fills with pus.
Etiology
Obstruction of the appendiceal lumen followed by bacterial infection.
 A blockage in the lining of the appendix that results in infection is the likely cause of
appendicitis. The bacteria multiply rapidly, causing the appendix to become
inflamed, swollen and filled with pus. Possible causes of the obstruction include:

o Can be from an appendicolith or some other mechanical etiologies

o Appendiceal tumors (benign or malignant)
o Intestinal parasites
o Hypertrophied lymphatic tissue
Other uncommon causes include
carcinoid tumor of the appendix, pinworm, eosinophilic appendicitis, granulomas

Epidemiology
 Incidence is approximately 233/100,000 people
  M ale is more predisposed than female and a lifetime incidence of 8.6% for men and
6.7% for women
 Appendicitis commonly occurs between the ages 10 and 30 years
 Approximately 300,000 hospital visits yearly in the United States for appendicitis
related issues;
 Appendicitis Deaths in Philippines reached 276 or 0.04% of total deaths.

CLINICAL FEATURES:
 Abdominal pain is the main symptom of appendicitis.
- Initially colicky, periumbilical abdominal pain is experienced by the patient, this is
classically dull and poorly localized
- Pain later migrates and localizes to right lower quadrant, typically sharp and well
localized
 Other symptoms
- Nausea
- vomiting (typically occurs after the pain, not preceding it)
- anorexia
- diarrhea
- constipation
- fever
 Severe symptoms
- features of sepsis
- being tachycardic
- hypotensive
 Clinical features On examination involves four
- rebound tenderness and percussion pain over McBurney point. McBurney
point as shown in the picture is located two thirds the distance from the
navel to the right anterior superior iliac spine, or the bony projection of the
right hip bone
- Rovsing sign: palpation of the left lower quadrant of a patient’s abdomen
increases the pain felt in the right lower quadrant
- Psoas sign: right iliac fossa pain with extension of the right hip
- Obturator sign: pain with internal rotation of the right hip
These four examination, and positive signs of these, is generally indicative of
appendicitis.
COMPLICATIONS
 If left untreated, acute appendicitis can cause perforation
 Perforation of the appendix. This is a major complication of appendicitis, which
can lead to peritonitis, abscess formation, or portal pylephlebitis. A rupture spreads
infection throughout your abdomen (peritonitis). Possibly life-threatening, this
condition requires immediate surgery to remove the appendix and clean your
abdominal cavity.

Perforation generally occurs 24 hours after the onset of pain.

Symptoms include a fever of 37.7⁰C or greater, a toxic appearance, and continued
abdominal pain or tenderness.

Further complication caused by perforation include

Peritonitis - If your appendix bursts, the lining of your abdomen (peritoneum) will
become infected with bacteria. It can also damage your internal organs

Abscesses - This is a painful collection of pus that forms when the body tries to fight
the infection. In most cases, a surgeon drains the abscess by placing a tube through
your abdominal wall into the abscess. The tube is left in place for about two weeks,
and you're given antibiotics to clear the infection.