Appendicitis

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Acute appendicitis results in severe acute inflammation of the appendix

Acute appendicitis is a common cause of abdominal pain.
A predisposing factor is obstruction of the lumen of the appendix, sometimes by a faecolith, but such obstruction is not seen in all cases.

The complications of acute appendicitis are:

Necrosis of appendix wall (gangrenous appendicitis), leading to perforation, with subsequent generalized peritonitis.

Involvement of adjacent bowel loops, causing perforation of small bowel.

The omentum may become adherent, localizing the peritonitis to the right iliac fossa. Fibrosis and continued inflammation cause development of a mass in the right iliac fossa (appendix mass). This may resolve with scarring, may form an abscess that drains to the surface, or may rupture, with development of generalized peritonitis.

Spread of infection by portal vein branches may propagate to the liver; this was formerly an important cause of portal pyaemic abscesses in the liver.

In early acute appendicitis there is acute inflammation of the mucosa of the appendix which undergoes ulceration.
Pus may be present in the lumen. At this stage the patient experiences an ill-defined central abdominal pain.
Macroscopically the appendix is usually swollen and serosal vessels are dilated.
As the acute inflammation develops, it spreads through the full thickness of the appendix wall to reach the serosal surface.
This causes a localized acute peritonitis, which is perceived as a sharp pain, localized to the right iliac fossa.
Macroscopically the appendix shows dilated serosal vessels and a rough, yellow, fibrinous exudate in the surface.
If the appendicitis progresses, there is necrosis of the wall of the appendix (gangrenous appendicitis).
The muscle layer is replaced by an acute inflammatory infiltrate and necrotic muscle. The resulting weakness leads to appendix perforation, liberating bowel contents into the peritoneal cavity.
This causes a generalized peritonitis and leads to a severe deterioration in clinical condition.
Macroscopically the appendix is typically plum-coloured or black, and a site of perforation may be seen.

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