MEPS 01 PHYSIOLOGY

HUMAN & DISEASES:

APPENDICITIS

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CLASSIFICATION OF APPENDICITIS
Appendicitis can be classified into two, acute appendicitis and chronic appendicitis.

Acute appendicitis
Acute appendicitis is an inflammation of a worm-shaped structure that located in the
lower right quadrant of the abdomen near the area where the small intestine joins the large
intestine called appendix.
Acute appendicitis is considered to be the most common cause of abdominal pain of
children and teenagers worldwide. This is because children and teenagers between 3 to 15 years
old for some reason are at risk of getting this acute appendicitis.
Acute appendicitis develops very fast and easier to diagnose than chronic appendicitis.
Acute appendicitis is a medical emergency that requires immediate surgery for treatment. The
appendix needs to be removed to prevent other life-threatening complications. Acute appendicitis
is a serious condition.

Chronic appendicitis
Chronic appendicitis is an inflammation of the appendix with repeating attack of
right-sided abdominal pain over a period of time.
Chronic appendicitis can be difficult to diagnose because the symptoms are lighter than
acute appendicitis and almost undetected. In addition, misdiagnosis sometimes occurs because
the symptoms of chronic appendicitis can be similar to other simple disease such as constipation
and diarrhea.
Chronic appendicitis is quite rare and develops slower. Most people that affected with
chronic appendicitis do not need surgery for the treatment. If it is discovered in time, chronic
appendicitis can often be cured with antibiotics to reduce the pain. However, chronic appendicitis
will attack continuously and therefore, ongoing treatment is required. Surgical removal of the
appendix also can be performed to prevent acute appendicitis

CAUSES
The cause of appendicitis is not always clear. Appendicitis usually occurs because of few
factors. It occurs when there is an obstruction in the appendix. The appendix becomes blocked,
often by hard piece of stool (fecal stone), a foreign object, and also by food waste.
Besides that, an infection also become as
one of the factors. Example of infection is a
gastrointestinal viral infection or it may result
from other types of inflammation.
The responsible agents of an infection that
leads to swelling of the tissues of the appendix wall
are bacteria, viruses, fungi and parasites. Yersinia
species,

adenovirus,

cytomegalovirus,

actinomycosis, Mycobacteria species, Histoplasma

species,

Schistosoma

species,

pinworms,

and

Strongyloides stercoralis are also including under

Figure shows the position of appendix in
human body.

type of responsible agents.

Not only that, swelling of the tissue from inflammatory bowel disease such as
Chrons disease may also cause appendicitis. It can also be caused by a cancer, which is
accumulation of tumour at the appendix.
In a nut shell, it appears that appendicitis is not hereditary or transmittable from person
to person.

SIGNS AND SYMPTOMS

The common symptom that usually appears is belly (abdominal) pain. This pain can
feel like indigestion or like you need to have a bowel movement or pass gas. A lot of people feel
the first pain near the belly button. Then it moves to the right lower quadrant of the abdomen.
However the pain can be in different parts of your belly or even on your side. The pain may get
worse if you move, walk, or cough. You may also have a fever or feel sick to your stomach.
However, the symptom that had been mentioned just now is only the first sign of the
appendicitis. Later symptoms that will be faced by the person include chills and shaking.
Besides that, vomiting blood or having bloody diarrhea is also the symptoms of it. Apart from
that, the person who suffered from this disease will also have nausea and lack of appetite. Then,
the person will experience an unintentionally losing of weight.
Having a chest, neck, or shoulder pain is one of the appendicitis symptoms. Next, a
rigid, hard abdomen that is tender to touch is also in the list. Other signs that will show whether
the person is having appendicitis or not also include having dizzied or light headed. This
situation happened due to the lack of oxygen supplying to the brain.
If your appendix ruptures, the pain may lessen briefly and you may feel better. But,
once the lining of your abdominal cavity becomes inflamed and infected (a condition called
peritonitis), the pain gets worse and you becomes sicker.
But, some people do not have the symptoms listed above. Older people, children
younger than 2 years old and pregnant women may not have pain in the lower right part of the
belly. Other people feel the pain in the side because their appendix is in a different position than
normal.
Things that the person has to take notes are symptoms of appendicitis may take 4-8
hours to develop. Early symptoms are often hard to separate from other conditions including
gastroenteritis1 . Many people admitted to the hospital for suspected appendicitis leave the
hospital with a diagnosis of gastroenteritis; initially, true appendicitis is often misdiagnosed as
gastroenteritis.
PATHOPHYSIOLOGY OF APPENDICITIS
1

An inflammation of the stomach and intestines

The pathophysiology of appendicitis is the collection of processes that leads to the

development from a normal appendix to an acute appendicitis.
The appendix is a blind-end organ from the functional and vascular standpoint. It is
particularly vulnerable to invasion by bacteria found in the gut, faecolith formation, parasitic
nesting in children, (trichuriasis), housing keratinized vegetable matter (corn, melon seeds, etc),
and other foreign bodies, and is prone to complete obstruction by these substances.
Normal mucus secretions continue within the lumen of the appendix, causing further
build up of intra-luminal pressures. This sequentially leads to the obstruction of the
lymphatic channels, then the venous return, and finally the arterial supply becomes
destabilized.
Reduced blood supply to the wall of the appendix means that the appendix gets little or
no nutrition and oxygen. It also means a little or no supply of white blood cells and other
natural fighters of infection found for the appendix.
The wall of the appendix will thus start to break up and rot. Normal bacteria found in
the gut gets all the incentive needed to multiply and attack the decaying appendix within 36
hours from the point of luminal obstruction, worsening the process of appendicitis.
This leads to necrosis and perforation (tear) of the appendix. 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.
The content of the appendix (faecolith, pus and mucus secretions) are then released
into the general abdominal cavity, causing peritonitis. So, in acute appendicitis, bacterial
colonization follows only when the process have commenced.
These events occur so rapidly, that the complete pathophysiology of appendicitis takes
about one to three days. This is why delay of treatment can lead to death.

Figure shows a diagram of an inflamed appendix.

Pain in appendicitis is caused by the swelling of the wall of the appendix, and later
when the grossly inflamed appendix rubs on the overlying inner wall of the abdomen
(parietal peritoneum) and then with the spillage of the content of the appendix into the
general abdominal cavity (peritonitis).
Fever is caused by the release of toxic materials (endogenous pyrogens) following the
tear of appendicael wall, and later by pus formation. Loss of appetite and nausea caused by the
irritation of the bowel due to the inflammatory process.
Acute appendicitis pathophysiology in children and pregnant women follows the same
pattern.
In the elderly, the pathophysiology of appendicitis remains unchanged, but the
inflammatory response generated by the elderly is usually less than that seen with young fit
individuals, which exposes to a tendency to misdiagnose, thus results to more complications.

PREVENTION

In general, there are no accurate methods to prevent appendicitis. However, once left
untreated, the infection may progress to cause the rupture of the appendix that will require
immediate surgical removal. Hence, it is vital to recognize these symptoms as a way to prevent
appendicitis to progress in its more serious condition by getting the right diagnosis and
treatment.
There are some suggested preventive measures but there are no standard ways to prevent
appendicitis from occurring. Eat food that is nutritious and constitutes a balanced diet can
prevent the appendicitis. There is high relationship between appendicitis and low fiber diet.
Therefore, increase intake of food which is rich in fibers consist of fruits and vegetables
wholes grain, wheat bread, carrots, cucumber and celery can gentle the digestive system and
reduce the chance of appendicitis.

But, eating spicy food will increase the chance of

appendicitis. Thus, avoid cooking food with unnecessary spices.

Fluid intake is also essential to keep the body sufficiently hydrated. Eight glasses or 2.5
liter of water must be taken daily to prevent constipation and minimize the risk of the appendix
infection. If the constipation occurs, faeces become very hard and dry, and difficult to be
expelled out through the anus. Prolong constipation results in the accumulation of faeces in the
colon. Thus, the toxic substances in the faeces are also accumulated in the colon. The risk of the
appendix becoming infected will increase. By taking two tablespoons of flax seeds daily will
keep stools soft and prevent constipation.
Consumption of raw food like fruits and vegetables also provide enzymes which help
boosting the immune system. Immune system can be boosted by taking garlic regularly while
eat lactic acid fermented foods such as natural yogurt regularly can help keeping the bacterial
culture in the colon healthy. Appendicitis can be prevented by taking the supplements like Beta
Carotene, Vitamin C and zinc. Those will keep the body resistance strong against infection that
can enhance the body immunity. The bodys process for detoxification can be aided by
coenzyme A.
By drinking of Fenugreek tea, we can keep our appendix healthy. It can be prepared by
mixing 1 tablespoon of fenugreek seeds in 1 litre of cold water. Heat it on a low flame for half an

hour, and it should be drank after a little cooling. Juice of vegetables such as carrot juice,
beetroot juice and cucumber juice are found to be very beneficial for preventing appendicitis too.

Figure shows a Fenugreek tea with its seeds.

According to the Chinese culture, obstruction in blood circulation is the cause of the
appendicitis. They believe that using acupuncture will help relieve pain, control peristalsis (the
wave-like movements of muscles in the intestine) and improve blood flow.