Appendicitis pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
# On the basis of experimental evidence, acute appendicitis seems to be the end result of a primary obstruction of the appendiceal [[lumen]]<ref> Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526 </ref><ref> Pieper R, Kager L, Tidefelt U.Obstruction of appendix vermiformis causing acute appendicitis: An experimental study in rabbit. Acta Chir Scand 1982;148:63-72 </ref> | # On the basis of experimental evidence, acute appendicitis seems to be the end result of a primary obstruction of the appendiceal [[lumen]].<ref> Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg 1937;34:496-526 </ref><ref> Pieper R, Kager L, Tidefelt U.Obstruction of appendix vermiformis causing acute appendicitis: An experimental study in rabbit. Acta Chir Scand 1982;148:63-72 </ref> | ||
# Once this obstruction occurs, the appendix subsequently becomes filled with mucus and distends, causing increased intraluminal and intramural pressures. | # Once this obstruction occurs, the appendix subsequently becomes filled with mucus and distends, causing increased intraluminal and intramural pressures. | ||
# The increase in pressure leads to [[thrombosis]] and [[occlusion]] of the small vessels, and stasis of lymphatic flow. | # The increase in pressure leads to [[thrombosis]] and [[occlusion]] of the small vessels, and stasis of lymphatic flow. | ||
Revision as of 13:14, 16 May 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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. If the disease is not treated, eventually the appendix will rupture and can lead to death.
Pathophysiology
- On the basis of experimental evidence, acute appendicitis seems to be the end result of a primary obstruction of the appendiceal lumen.[1][2]
- Once this obstruction occurs, the appendix subsequently becomes filled with mucus and distends, causing increased intraluminal and intramural pressures.
- The increase in pressure leads to thrombosis and occlusion of the small vessels, and stasis of lymphatic flow.
- As these clots and blockages progress, the appendix becomes ischemic and then necrotic.
- Rarely, spontaneous recovery can occur at this point. As bacteria begin to leak out through the dying walls, pus forms within and around the appendix (suppuration).
- The end result of this cascade is appendiceal rupture causing peritonitis, which may lead to septicemia and eventually death.
Associated Conditions
Associated conditions of appendicitis include:
- Intestinal obstruction
- Inflammatory bowel disease
- Pelvic inflammatory disease and other gynecological disorders
- Intestinal adhesions
- Constipation