Central-South University
Pathophisiology
Simple appendicitis Suppurative appendicitis Gangrenous appendicitis Perforated appendicitis Peritonitis Abscess around the appendix Mucocele of appendix
Central-South University
Pathophysiology
Acute appendicitis is thought to begin with obstruction of the lumen
Obstruction can result from food matter, adhesions, or lymphoid hyperplasia
Obstruction → high pressure→ limph obstructed, ischemia →mucosa damage→ bacteria invade（70%～80%）
Central-South University
Artery
The appendix artery has no branches, is easily to be obstacled
Length: 5~10 cm, narrow lumen
Epidemiology
The most common acute abdomen disease The incidence of appendectomy appears to
be declining due to more accurate preoperative diagnosis. Despite newer imaging techniques, acute appendicitis can be very difficult to diagnose.
End result is perforation and spillage of infected appendiceal contents into the peritoneum
Central-South University
Pathophysiology
Initial luminal distention triggers visceral afferent pain fibers, which enter at the 10th thoracic vertebral level.
microbes：Ecoli, streptococcus, Pseudomonas, anaerobe
Central-South University
Etiology
Increased pressure also leads to arterial stasis and tissue infarction
Appendix is twisted, and Lumen of appendix is narrow, result in obstruction
Mucosal secretions continue to increase intraluminal pressure
Central-South University
This pain is generally vague and poorly localized.
Pain is typically felt in the periumbilical or epigastric area.
Central-South University
பைடு நூலகம்
Pathophysiology
Central-South University
Etiology
Eventually the pressure exceeds capillary perfusion pressure and venous and lymphatic drainage are obstructed.
With vascular compromise, epithelial mucosa breaks down and bacterial invasion by bowel flora occurs.
As inflammation continues, the serosa and adjacent structures become inflamed
This triggers somatic pain fibers, innervating the peritoneal structures
Etiology
1. The anatomy characteristics 2. The tissue features 3. fecality, foreign body obstruction 4. Parasites cause the mucosa damage 5. adhesion, pressure cause appendix distorted
surgery
Acute Appendicitis
Central-South University
Central-South University
Anatomy
Central-South University
Varied anatomy
haustra of colon
Central-South University
Typically causing pain in the RLQ
Central-South University
Pathophysiology
The change in stimulation form visceral to somatic pain fibers explains the classic migration of pain in the periumbilical area to the RLQ seen with acute appendicitis.