Appendicular abscess pathophysiology: Difference between revisions
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{{CMG}};{{AE}}{{ADG}} | {{CMG}};{{AE}}{{ADG}} | ||
==Overview== | ==Overview== | ||
An appendicular abscess is a complication of [[acute appendicitis]]. It is resulted due to the invasion of the [[appendix]] | 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 intestine|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]] [[Mass|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== | ||
*Obstruction of the tubular space inside the [[Vermiform appendix|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. <ref name="pmid626573">{{cite journal |vauthors=Bradley EL, Isaacs J |title=Appendiceal abscess revisited |journal=Arch Surg |volume=113 |issue=2 |pages=130–2 |year=1978 |pmid=626573 |doi= |url=}}</ref> | *[[Obstruction]] of the [[tubular]] space inside the [[Vermiform appendix|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]]. <ref name="pmid626573">{{cite journal |vauthors=Bradley EL, Isaacs J |title=Appendiceal abscess revisited |journal=Arch Surg |volume=113 |issue=2 |pages=130–2 |year=1978 |pmid=626573 |doi= |url=}}</ref> | ||
*Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its cellular components.<ref> Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526 </ref> | *Once these blood vessels are obstructed, appendiceal tissue starts to die and leak out its [[cellular]] components.<ref> Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526 </ref> | ||
*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]] mediators along with various bacterial [[toxins]] and [[Proteolytic enzyme|proteolytic]] enzymes from the [[neutrophils]] are released, resulting in the formation of abscess in appendix. | *[[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. | ||
===Duration=== | ===Duration=== | ||
*The risk of perforation or abscess formation is negligible within the first 12 | *The risk of perforation or abscess formation is negligible within the first 12 hours of untreated symptoms, but then increases to 8.0% within the first 24 h.<ref name="pmid626573">{{cite journal |vauthors=Bradley EL, Isaacs J |title=Appendiceal abscess revisited |journal=Arch Surg |volume=113 |issue=2 |pages=130–2 |year=1978 |pmid=626573 |doi= |url=}}</ref> | ||
===Gross Pathology=== | ===Gross Pathology=== | ||
*The serosal surface of the appendix looks pale with rough edges and yellowish [[exudate]] along with [[hyperemia]] | *The serosal surface of the [[appendix]] looks pale with rough edges and yellowish [[exudate]] along with [[hyperemia]] | ||
===Microscopic findings=== | ===Microscopic findings=== | ||
*A focally necrotic appendiceal debris is seen in the [[Mucosa|mucosal]] wall. | *A focally [[necrotic]] appendiceal debris is seen in the [[Mucosa|mucosal]] wall. | ||
*[[Intravascular|Intravascular fibrin]] is seen in medium-sized blood vessels. | *[[Intravascular|Intravascular fibrin]] is seen in medium-sized [[blood vessels]]. | ||
*Clusters of [[neutrophils]] are seen on the [[Serosa|serosal]] aspect. | *Clusters of [[neutrophils]] are seen on the [[Serosa|serosal]] aspect. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 14:22, 6 April 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 hours 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.