Appendicitis Overview and Pathophysiology

Appendicitis: Inflammation of the Vermiform Appendix

• Appendicitis is a common cause of acute abdominal pain, affecting 6.7% of females and 8.6% of males over a lifetime.
• Most common in adolescents and young adults.
• The vermiform appendix is a tube-like pouch attached to the cecum, located in the right iliac region at McBurney's point.
• Function not fully understood, but plays a role in the immune system as part of the gut-associated lymphoid tissue system.

Pathophysiology of Appendicitis

• Appendicitis results from an obstruction in the appendiceal lumen.
• Obstruction leads to distention, impaired blood supply, inflammation, edema, ulceration, and infection.
• Purulent exudate forms, further distending the appendix.
• Without treatment, tissue necrosis and gangrene occur within 24 to 36 hours, leading to perforation.
• Perforation allows the contents of the GI tract to enter the peritoneal cavity, causing peritonitis.
• Classified as simple, gangrenous, or perforated depending on the stage of inflammation.

Etiology of Appendicitis

• Obstruction is the primary cause, varying with age:
  • Children: Twisting, mucus, or feces.
  • Young adults: Lymphoid tissue hyperplasia.
  • Older adults: Fibrosis, fecaliths, or tumors.
• Parasites can cause appendicitis in areas where they are endemic.

Risk Factors and Prevention

• Adolescent males are at greatest risk followed by adolescent females.
• No known prevention methods.
• High fiber diet may reduce risk, although further research is needed.

Appendicitis

• Inflammation of the vermiform appendix, a tubelike pouch attached to the cecum, is a common cause of acute abdominal pain.
• Affects 6.7% of females and 8.6% of males over a lifetime.
• More common in adolescents and young adults.
• The appendix's exact function is unknown, but it contains B-cells and T-cells, and produces immune proteins like IgA, making it part of the gut-associated lymphoid tissue system.
• Located in the right iliac region at McBurney point.

Pathophysiology

• Obstruction of the appendix's lumen is the primary cause of appendicitis.
• Obstruction leads to distention with fluid, impairing blood supply and causing inflammation, edema, ulceration, and infection.
• Untreated, this can progress to tissue necrosis and gangrene within 24-36 hours, leading to perforation (rupture).
• Perforation allows GI tract contents into the peritoneal space, causing peritonitis—inflammation and bacterial infection of the entire abdominal area.
• Appendicitis is classified as simple, gangrenous, or perforated depending on the stage.

Etiology

• Obstruction causing appendicitis varies with age:
  • Children: twisting, mucus or feces, and parasites.
  • Young Adults: hyperplasia of lymphoid tissue.
  • Older Adults: fibrosis, fecaliths, or tumor.

Risk Factors and Prevention

• Adolescent boys have the highest risk followed by adolescent girls.
• Appendicitis can't be prevented, but a high-fiber diet, including fresh fruits and vegetables, may help.

Acute Appendicitis

• Pain is often the initial symptom and starts as mild, generalized or upper abdominal pain
• Pain intensifies and moves to the right lower quadrant (RLQ) of the abdomen within 4 hours.
• Movement, walking, or coughing increases pain.
• Rebound tenderness and localized tenderness are noted at McBurney point (between the umbilicus and anterior superior iliac spine)
• Extension or internal rotation of the right hip increases pain.
• Other symptoms include a low-grade fever, anorexia, nausea, and vomiting.
• The diagnosis can be delayed in older adults due to less acute pain and tenderness.
• Older adults are at increased risk of complications and higher mortality from acute appendicitis since the course of the disease is more virulent.
• Pregnant women may experience pain in the RLQ, periumbilical, or right subcostal region due to the distended uterus displacing the appendix.
• In adolescents and young women, symptoms must be differentiated from ovulation (mittelschmerz), ruptured ectopic pregnancy, and pelvic inflammatory disease.
• Possible complications include perforation, peritonitis, and abscess.
• Perforation manifests as increased pain and a high fever, and can lead to abscess, local peritonitis or generalized peritonitis.

Clinical Therapies for Acute Appendicitis

• Provide analgesics for pain.
• Administer antibiotics and/or perform surgery.

Peritonitis

• Peritonitis can occur when the appendix ruptures and bowel contents leak into the abdominal cavity.
• It is a serious condition that can lead to death if not treated aggressively and rapidly.
• Symptoms include high fever, acute severe abdominal pain, and abdominal distention.

Clinical Therapies for Peritonitis

• Remove the ruptured appendix.
• Manage pain.
• Administer antibiotics.
• Provide fluid resuscitation.
• Provide supportive treatment to maintain vital signs.

Chronic Appendicitis

• Characterized by chronic recurrent abdominal pain over several months.

Clinical Therapies for Chronic Appendicitis

• Appendectomy (surgical removal of the appendix)
• Manage pain.
• Administer antibiotics.

This quiz covers the essential aspects of appendicitis, including its definition, prevalence, and the anatomical features of the vermiform appendix. It also explores the pathophysiology behind appendicitis, detailing how obstruction leads to inflammation and potential complications. Test your understanding of this common medical condition and its implications!