Pathophysiology of Appendicitis

The various abnormal physical procedures that lead to the inflammation of the appendix and cause acute Appendicitis are collectively known as the pathophysiology of the condition. Understanding the pathophysiology of a physical disorder helps to explain the symptoms and signs as well as the complications of that condition. This article deals with the step-by-step physical procedures that finally cause Appendicitis.

The basic factor that leads to this disorder is the compromised blood supply to the appendix because of the obstruction of the lumen. This makes the appendix highly vulnerable to attack and invasion of bacteria generally found in the intestine.

Sometimes, the appendix lumen may become blocked by an enlarged lymph node, fecalith, tumor, worms or some foreign objects. This blockage causes the appendix wall to become distended by increasing the intra-luminal pressure.

Appendectomy Picture

Despite this blockage, the normal mucus secretion continues within the appendix lumen which further increases the intra-luminal pressures. The lymphatic channels become occluded due to this raised pressure due to fluid build-up. This in turn obstructs the venous return which has a negative impact on the normal arterial supply.

Decrease in the blood supply to one’s appendix wall denotes that there is little or no oxygen and nutrition supply to the appendix. It also leads to extremely low levels of natural infection fighters found within the blood, like WBC (white blood cells), in the blood that is supplied to the appendix.

As a result of these abnormalities, the appendix wall starts breaking up and rotting. Bacteria found within the intestine then begin to multiply in numbers and attack the damaged appendix within thirty-six hours from the time when the luminal was first obstructed. This worsens the condition by accelerating the rate of advancement of Appendicitis.

This causes necrosis along with perforation of the infected appendix. The immune system gets activated because of the bacterial invasion and the nearby WBCs are sent to the affected area to fight the infection. But, the WBCs are destroyed when they reach the area, resulting in pus formation. The pus is made up of a combination of dead tissue, bacteria and dead WBCs.

The contents of the appendix (pus, mucus secretions and fecalith) then get released into the abdominal cavity which leads to peritonitis.

So, in case of acute Appendicitis bacterial colonization occurs only after the commencement of the process. All the above mentioned stages of the disorder occur within a very short time with the entire pathophysiology taking around 1 to 3 days to complete. Due to this reason, Appendicitis should be treated surgically on an emergency basis.

So, the symptom of severe pain caused by this condition initially results from distension of the appendix wall and later from the rubbing of the inflamed appendix on the parietal peritoneum (overlying abdominal inner wall). In more advanced stages, the pain is caused by the release of the appendix contents into the abdominal cavity (peritonitis).


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