Etiology and patoenesis

Distention of the
appendix stimulates
the
continuing normal
secretion by the nerve endings of
appendiceal visceral afferent
obstruction
stretch fibers,
mucosa rapidly producing vague,
produces distention
dull, diffuse pain in
the midabdomen or
lower epigastrium.

venous pressure is
exceeded.
he inflammatory
Capillaries and
process soon
venules are
involves the
occluded,
pressure in the serosa of the
but arteriolar inflow
organ increases appendix and in
continues, resulting
turn parietal
in engorgement
peritoneum in the
and
region
vascular
congestion.
impairment
bacterial infarction perforation
of blood
invasion progress. occurs
supply
Bacterology
 The
commonest bacteria that cause
appendicitis is Escherichia coli And
Bacteroides fragilis
CLINICAL MANIFESTATIONS
SYMPTOMS
 Abdominal pain (lower epigatrium or
umbilical area) Variations in the
anatomic location of the appendix
account for many of the variations in
the principal locus of the somatic
phase of the pain.
 Anorexia
 Vomiting is caused by both neural
stimulation and the presence of
ileus.
 History of obstpation or diarrhea
SIGNS
 Vital signs are minimally changed by
uncomplicated appendicitis.
Temperature elevation is rarely >1°C
(1.8°F) and the pulse rate is normal or
slightly elevated.
 Tenderness often is maximal at or near
the McBurney point.
 The Rovsing sign—pain in the right lower
quadrant when palpatory pressure is
exerted in the left lower quadrant—also
indicates the site of peritoneal irritation
 Cutaneous hyperesthesia in the area
supplied by the spinal nerves on the right
at T10, T11, and T12 frequently
ccompanies acute appendicitis
 The psoas sign indicates an irritative focus
in proximity to that muscle.
 a positive obturator sign of hypogastric
pain on stretching the obturator internus
indicates irritation in the pelvis. The test is
performed by passive internal rotation of
the flexed right thigh with the patient
supine.
Laboratory Findings
 Mild leukocytosis, ranging from 10,000 to 18,000
cells/mm3 and often is accompanied by a
moderate polymorphonuclear predominance
 White blood cell count to be >18,000
cells/mm3
 Urinalysis can be useful to rule out the urinary
tract as the source of infection.