Pathophysiology of Appendicitis

Lymphoid Hyperplasia s/t infections

Fecaliths
Fecal stasis
IBD
Parasites
Foreign bodies
Neoplasms

Obstruction

Appendiceal Venous Outflow

Intestinal Bacteria Multiplication
Increased Secretions of Fluids and Mucus Tract Obstruction

Stagnation
Recruitment of Engorgement and
WBCs and Pus Vascular Congestion
Formation
Distension

Ellipsoidal Infarctions
Stimulation of Visceral Stimulation of
Afferent Stretch Fibers Parietal
Peritoneal
Fibers Ischemia of the Appendiceal Wall

Vague, dull, diffuse pain in

Loss of Epithelial Integrity
the midabdomen or
epigastrium

Bacterial Invasion

Right Lower
Vomiting
Quadrant Pain
Thrombosis of the Appendiceal Artery and Veins

Perforation and Gangerene

Peritonitis Periappendicular Abscess

 Appendicitis is caused by obstruction of the appendiceal lumen due to a
variety of causes (see Figure above). Despite of the various etiologies, obstruction is
believed to cause an increase in pressure within the lumen. Such increase is related
to secretions of fluids and mucus from the mucosa and the stagnation of such
material.
At the same time the intestinal bacteria within the appendix multiply and
lead to the recruitment of WBCs and formation of pus and subsequent higher
intraluminal pressure.
Persistence of such obstruction, intraluminal pressure and ultimately
appendiceal veins lead to venous outflow obstruction. A consequence of such lead to
ischemia of the appendiceal wall, which results in loss of epithelial integrity and
allowing bacterial invasion of the appendiceal wall.
Within a few hours, the localized condition may worsen due to thrombosis of
the appendiceal artery and veins, which leads to perforation and gangrene of the
appendix which may progress to a periappendicular abscess or even peritonitis.