Appendicitis The appendix is a small, tube-like organ attached to the first part of the large intestine, also called

the colon. It is located in the lower right area of the abdomen. It has no known function. A blockage inside of the appendix causes appe ndicitis. The blockage leads to increased pressure, problems with blood flow and inflammation. If the blockage is not treated, the appendix can break open and l eak infection into the body. Pathophysiology of Appendicitis The main cause of appendicitis is obstuksi blockage which can be caused by hyper plasia of the follicles lympoid is the most common cause of fekalit in appendix lumen. The presence of foreign objects such as: worms, stricture due to fibrosis , as a result of previous inflammation. For another example: malignancy (carcino id carcinoma). Appendix obstruction that causes mucus produced by mucous unstoppable, more and more mucus is unstoppable and suppress edema appendix wall and stimulate the tun ica serosa and visceral peritoneum. Therefore, the neural appendix with the inte stinal thorax X then stimulus is perceived as pain around the umbilicus. The collected mucus was then infected by the bacteria into pus, and then arise v enous flow disturbance, while the artery is not disturbed, the resulting widespr ead inflammation and the local parietal peritoneum, thus causing pain on the rig ht below, this condition is called acute suppurative appendicitis. When the arterial flow is disrupted then arise allergens and is called by append icitis gangrenosa. When the wall acute appendix had burst, called appendicitis p erforation. When the omentum adjacent bowel can surround the inflamed or perfora ted appendix will arise a local time, a condition called as appendicitis abscess . In children, because the omentum is still short and thin, relatively long appe ndix, the appendix wall is much thinner and stamina is still lacking, as well as in older people because there's been blood vessel disorders, the perforation oc curred more quickly. If these infiltrates appendicitis cure the symptoms disappe ar and then arise in the future will occur with chronic appendicitis.

The pathophysiology of appendicitis is the constellation of processes that leads to the development of acute appendicitis from a normal appendix. Understanding the pathophysiology of appendicitis helps to explain all the signs and symptoms as well as complications seen in appendicitis. The main thrust of events leading to the development of acute appendicitis lies in the appendix developing a compromised blood supply due to obstruction of its lumen and becoming very vulnerable to invasion by bacteria found in the gut norm ally. Obstruction of the appendix lumen by faecolith, enlarged lymph node, worms, tumo ur, or indeed foreign objects, brings about a raised intra-luminal pressure, whi ch causes the wall of the appendix to become distended. Normal mucus secretions continue within the lumen of the appendix, thus causing further build up of intra-luminal pressures. This in turn leads to the occlusion of the lymphatic channels, then the venous return, and finally the arterial sup ply becomes undermined.

Reduced blood supply to the wall of the appendix means that the appendix gets li ttle or no nutrition and oxygen. It also means a little or no supply of white bl ood cells and other natural fighters of infection found in the blood being made available to the appendix. The wall of the appendix will thus start to break up and rot. Normal bacteria fo und in the gut gets all the inducement needed to multiply and attack the decayin g appendix within 36 hours from the point of luminal obstruction, worsening the process of appendicitis. This leads to necrosis and perforation of the appendix. Pus formation occurs whe n 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 relea sed into the general abdominal cavity, bringing causing peritonitis. So, in acute appendicitis, bacterial colonisation 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 can be deadly! Pain in appendicitis is thus caused, initially by the distension 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 t he content of the appendix into the general abdominal cavity (peritonitis). Fever is brought about by the release of toxic materials (endogenous pyrogens) f ollowing the necrosis of appendicael wall, and later by pus formation. Loss of appetite and nausea follows slowing and irritation of the bowel by the i nflammatory process. The pathophysiology of appendicitis obviously correlates with the clinical pictu re. Acute appendicitis pathophysiology follows the same pattern, even in children an d pregnant women. In the elderly, the pathophysiology of appendicitis remains unaltered, but the i nflammatory response generated by the elderly is often less than that seen with young fit individuals, accounting for the often benign presentation froth with a tendency to miss the diagnosis, thus courting more complications. When the appendix is ??blocked, intraluminal pressure increases, causing decreas ed venous drainage, thrombosis, edema, and bacterial invasion of the intestinal wall. If the obstruction continues, the appendix becomes more hyperemic and warm and covered with exudate which so became gangrenous and perforated. (Esther Mon ika, 2002: 63). Blockage of the lumen by a foreign object will cause swelling of lymphoid tissue . Secretion will continue, resulting in appendix become stretched causing hypoxi a resulting in tissue death, gangrene perforation. In addition to the lumen obstruction by a foreign object, resulting in swelling of mucous secretions expenditure. Infection and swelling of intra-luminal pressu res usually lead to necrosis, gangrene and perforation. In a classic case append

iksitis acute onset of symptoms is sick or not feeling comfortable around the um bilicus followed by anorexia, nausea and vomiting. These symptoms usually last 1 -2 days. Within hours the pain shifts to the lower quadrant and may have muscle spasm and pain free. Usually found in low-grade fever and moderate leukocytosis. The main cause of appendicitis is obstruction or blockage that can be caused by: Hyperplasia from fecalith lymphoid, is the most common cause Fecalith existence, in the appendix lumen The presence of foreign objects such as worms Stricture due to fibrosis due to previous inflammation Other reasons, such as malignancy (carcinoma, carcinoid)