Appendicitis Flashcards
Appendicitis?
Inflammation of the appendix
Where is the appendix located?
In the right lower quadrant of the abdomen and is attached to the cecum (beginning of the large intestine)
What is theory for its function?
It stores good bacteria to regenerate normal flora in the gut after a diarrheal illness
Histology of the inner lining of the appendix?
Simple columnar epithelium with many mucin producing goblet cells
What does the submucosa consist of?
Almost entirely lymphoid tissue ->suggestive of its immune function
Is appendicitis acute or chronic?
It has an acute onset (occurs within a few days)
When is the onset + peak typically?
Common between 5-30 years; peaks between 20-30
Etiology of appendicitis?
- Idiopathic
- Two theories of obstruction:
1. A hard fecal particle (fecalith in the GIT) blocks the base of the appendix causing an intraluminal obstruction.
2. The appendix twist and blocks off the entrance and exit of secretions and blood flow.
Fecalith?
A hard fecal particle
Explain the pathology of appendicitis.
Drainage into the cecum is blocked by the lumen obstruction -> the goblet cells on the inner lining of the appendix secrete large amounts of mucin that builds up within the appendix if there is an obstruction. Due to the blocked drainage, the secretion of mucous is increased, which further increases the pressure. This build-up of fluid causes an increase in pressure within the appendix. The pressure begins to push on the outer wall which is richly vascularized. The blood vessels within the wall become pinched shut, resulting in venous stasis and a lack of blood flow. Ischemia results and eventually infarction if the obstruction is not relieved -> necrosis of the tissue wall. Bacteria that is stored within the appendix moves to the necrotic tissue in the wall and causes an infection within the wall of the appendix. Infection leads to inflammation of the appendix wall causing swelling and production of exudate.
What can cause the appendix to rupture?
Excessive pressure
What are the manifestations of appendicitis?
- Abrupt onset of referred pain that is usually felt in the epigastric or periumbilical regions, not in the vicinity of the appendix.
- Episodes of nausea (d/t pain)
- pain intensifies from an ache to colicky, spasmodic pain over the next 12 hours. After this, the pain localizes to the RLQ of the abdomen
- rebound pain + protected/guarding pain
- increased temperature (fever) with leukocytosis (b/c of bacterial infection)
Colicky pain?
Refers to “wave like” pain that starts abruptly and stops abruptly
Migrating pain?
Pain initiates and moves to another site
Referred pain?
Pain is occurring but you feel it somewhere else
