Appendicitis pathophysiology

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Appendicitis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]

Overview

Appendicitis is caused by the obstruction of the tubular space inside the appendix. This initial problem is compounded into a cascade of events that lead to the inflammation of the appendix, the obstruction of the blood vessels supplying it, and infection. Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components.

Pathophysiology

Pathogenesis

• On the basis of experimental evidence, acute appendicitis is the end result of a primary obstruction of the appendiceal lumen.
• Appendiceal luminar obstructions are a common inciting event leading to inflammation.
  • Appendiceal obstructions can be caused by:
    • Fecaliths
    • Lymphoid Hyperplasia
    • Benign or malignant tumors
    • Infectious processes
  • Obstructions can lead to an increase in endoluminar and intramural pressure, which can result in an occlusion of the venules in the appendiceal wall.
    • The appendix can fill with mucus and distends.
    • The increase in pressure leads to thrombosis and occlusion of the small vessels, and stasis of lymphatic flow.

Associated Conditions

Associated conditions of appendicitis include:

• Intestinal obstruction
• Inflammatory bowel disease
• Pelvic inflammatory disease and other gynecological disorders
• Intestinal adhesions
• Constipation

Gross Pathology

• Inflammation of the appendiceal wall can result in perforation and development of a contained abscess or generalized peritonitis.
• The wall of the appendix can become ischemic as vascular and lymphatic occlusion progress.

Inflammed appendix
source:Case courtesy of Dr Andrew Dixon, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/9644">rID: 9644</a>

References