Appendicular abscess pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
An appendicular abscess is a complication of [[acute appendicitis]]. It is resulted due to the invasion of the [[appendix]] by [[bacteria]] following an obstruction. The appendix exists at the junction of the s[[Intestines|mall and large intestine]] and is a natural habitat of wide variety of bacteria. It is therefore prone to develop complications when blocked and coupled with an [[infection]], [[acute appendicitis]] can be life threatening, [[gangrene]], appendicular masses, [[rupture]] and [[Peritonitis|general peritoneal infections]] are some other complications that may develop when the medical attention is neglected in cases of appendicitis. | An appendicular abscess is a complication of [[acute appendicitis]]. It is resulted due to the invasion of the [[appendix]] by [[bacteria]] following an obstruction. The appendix exists at the junction of the s[[Intestines|mall and large intestine]] and is a natural habitat of wide variety of bacteria. It is, therefore, prone to develop complications when blocked and coupled with an [[infection]], [[acute appendicitis]] can be life threatening, [[gangrene]], appendicular masses, [[rupture]] and [[Peritonitis|general peritoneal infections]] are some other complications that may develop when the medical attention is neglected in cases of appendicitis. | ||
==Pathophysiology== | ==Pathophysiology== | ||
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*This leads to an increase in endoluminal and intramural pressure, which can result in an occlusion of the venules in the appendiceal wall resulting in [[thrombosis]] and occlusion and [[stasis]] of blood and lymphatic flow. | *This leads to an increase in endoluminal and intramural pressure, which can result in an occlusion of the venules in the appendiceal wall resulting in [[thrombosis]] and occlusion and [[stasis]] of blood and lymphatic flow. | ||
*The stasis favors the bacterial growth leading to infection of the appendix . | *The stasis favors the bacterial growth leading to infection of the appendix . | ||
*[[Inflammation|Inflammatory]] | *[[Inflammation|Inflammatory]] mediators along with various bacterial [[toxins]] and [[Proteolytic enzyme|proteolytic]] enzymes from the [[neutrophils]] are released, resulting in the formation of abscess in appendix. | ||
===Transmission=== | ===Transmission=== | ||
*The abscesses usually contain a mixture of [[Aerobic bacteria|aerobic]] and [[anaerobic bacteria]] from the [[Gastrointestinal tract|gastrointestinal trac]]<nowiki/>t. | *The abscesses usually contain a mixture of [[Aerobic bacteria|aerobic]] and [[anaerobic bacteria]] from the [[Gastrointestinal tract|gastrointestinal trac]]<nowiki/>t. | ||
Revision as of 17:48, 31 March 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
An appendicular abscess is a complication of acute appendicitis. It is resulted due to the invasion of the appendix by bacteria following an obstruction. The appendix exists at the junction of the small and large intestine and is a natural habitat of wide variety of bacteria. It is, therefore, prone to develop complications when blocked and coupled with an infection, acute appendicitis can be life threatening, gangrene, appendicular masses, rupture and general peritoneal infections are some other complications that may develop when the medical attention is neglected in cases of appendicitis.
Pathophysiology
- Obstruction of the tubular space inside the appendix is the main inciting event, this initial problem leads to the inflammation of the appendix, obstruction of the blood vessels supplying it, and finally infection. [1]
- Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components.[2]
- This leads to an increase in endoluminal and intramural pressure, which can result in an occlusion of the venules in the appendiceal wall resulting in thrombosis and occlusion and stasis of blood and lymphatic flow.
- The stasis favors the bacterial growth leading to infection of the appendix .
- Inflammatory mediators along with various bacterial toxins and proteolytic enzymes from the neutrophils are released, resulting in the formation of abscess in appendix.
Transmission
- The abscesses usually contain a mixture of aerobic and anaerobic bacteria from the gastrointestinal tract.
Duration
- The risk of perforation or abscess formation is negligible within the first 12 h of untreated symptoms, but then increases to 8.0% within the first 24 h.[1]
Gross Pathology
- The serosal surface of the appendix looks pale with rough edges and yellowish exudate along with hyperemia
Microscopic findings
- A focally necrotic appendiceal debris is seen in the mucosal wall.
- Intravascular fibrin is seen in medium-sized blood vessels.
- Clusters of neutrophils are seen on the serosal aspect.