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Appendicitis
Jonathan Bland
Pathophysiology
Prof. Lori McGowan

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Appendicitis, a common acute problem in young adults, occurring in 10% of the

population, appendicitis is an inflammation and infection in the vermiform appendix (Gould,
2006). The main events leading to the development of acute appendicitis starts in the appendix
itself when compromised blood supply develops due to obstruction of its lumen and becoming
very vulnerable to invasion by bacteria found in the gut normally. The bacteria find their way
into the appendix and start to multiply. Obstruction of the appendix lumen by faecolith,
enlarged lymph node, worms, tumor, or indeed foreign objects, brings about a raised intraluminal pressure, which causes the wall of the appendix to become distended
(ABDOPAIN.com, 2011).
Ones body normal mucus secretions continue with the lumen of the appendix. This causes
further build-up of luminal pressures from within side. This leads to the occlusion of the
lymphatic channels, then venous return, and finally the arterial supply becomes undermined.
With reduced blood supply to the wall of the appendix also means the appendix get no oxygen
and nutrients. Which in turn means no white blood cells can fight off any infection that is
occurring from with the tissues. The wall of the appendix will thus start to break up and rot.
Normal bacteria found in the gut gets all the inducement needed to multiply and attack the
decaying appendix within 36 hours from the point of luminal obstruction, worsening the
process of appendicitis (ABDOPAIN.com, 2011).
From this point the appendix will start necrosis and eventually perforation of the appendix.
This is true medical emergency. The inner lining of the stomach will start being attacked by the

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bacteria that is normally held in check inside the small and large intestine. This causes
peritonitis inside the general abdominal cavity. Pus formation occurs when nearby white blood
cells are recruited to fight the bacterial invasion. A combination of dead white blood cells,
bacteria, and dead tissue makes up pus. In acute appendicitis, bacterial colonization follows
only when the process have commenced (ABDOPAIN.com, 2011).
The events of appendicitis occur rather rapidly, the complete breakdown of the appendicitis
can take about one to three days. This is why this is a medical emergency that can cause death
if treatment is delayed.
Flow Chart
1. Early stage of appendicitis, obstruction of the appendiceal lumen leads to mucosal
edema mucosal ulceration, bacterial diapedesis, appendiceal distention due to
accumulated fluid, and increasing intraluminal pressure. The visceral afferent nerve
fibers are stimulated, and the patient perceives mild visceral periumbilical or epigastric
pain, which usually lasts 4-6 hours (Incesu, 2009)
2. Suppurative appendicitis: Increasing intraluminal pressures eventually exceed capillary
perfusion pressure, which is associated with obstructed lymphatic and venous drainage
and allows bacterial and inflammatory fluid invasion of the tense appendiceal wall.
Transmural spread of bacteria causes acute Suppurative appendicitis. When the
inflamed serosa of the appendix comes in contact with the parietal peritoneum, patients
typically experience the classic shift of pain from the periumbilicus to the right lower

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abdominal quadrant (RLQ), which is continuous and more severe than the early visceral
pain (Incesu, 2009).
3. Fever is brought about by the release of toxic materials (endogenous pyrogens)
following the necrosis of appendices wall, and later by pus formation (ABDOPAIN.com,
2011).
4. Loss of appetite and nausea follows slowing and irritation of the bowel by the
inflammatory process (ABDOPAIN.com, 2011).
The pathophysiology of appendicitis obviously correlates with the clinical picture. Acute
appendicitis pathophysiology follows the same pattern, even in children and pregnant
women.

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Works Cited
ABDOPAIN.com. (2011). Pathophysiology of Appendicitis . Retrieved March 15, 2011, from
ABDOPAIN.com: http://www.abdopain.com/Pathophysiology-of-appendicitis.html

Gould, B. E. (2006). Pathophysiology for the Health Professionals, 3rd Edition. Philadelphia: W.B.
Sauders.

Incesu, L. M. (2009, March 12). Appendicitis. Retrieved March 15, 2011, from Emedicine:
http://emedicine.medscape.com/article/363818-overview