The Dangers of Untreated Appendicitis – Symptoms Example

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"The Dangers of Untreated Appendicitis" is a great example of a paper on symptoms. Early Stage Appendicitis During this stage, the subserosal appendix vessels become congested due to increasing intraluminal pressure, causing a mild perivascular neutrophilic infiltrate within the organ’ s wall. This inflammatory process causes a poorly localized, visceral, cramping periumbilical pain usually lasting for 4-6 hours. Appendicitis is caused by a progressive increase in intraluminal pressure that affects venous outflow, leading to ischemic injury of the appendix and the surrounding structures (Kumar et al. , 2010). The diagram below summarizes the stages of acute appendicitis and its corresponding clinical manifestations   Suppurative Appendicitis When intraluminal pressures exceed capillary perfusion pressure, a bacterial infection of the appendiceal wall occurs, leading to the formation of focal abscesses within the wall (suppurative appendicitis).

During this stage, the pain becomes localized from the periumbilical to the right lower quadrant of the abdomen. The pain becomes steady and severe, with nausea and vomiting in 50% of the cases. Low-grade fever and diarrhea may also occur. Ruptured Appendicitis This stage is characterized by the perforation of the appendiceal wall causing life-threatening complications. Patients with ruptured appendicitis usually present with pain duration > than 2 days, localized abdominal tenderness outside the right lower quadrant, body temp > 38.3 oC, and increasing tachycardia.

A localized mass may also develop.   Grangrenous Appendicitis Further inflammatory and vascular compromise may result in large areas of hemorrhagic ulceration and necrosis extending up to the serosa within 24- 48 hours. Pain and tenderness over the location of the appendix become more intense. Movement and coughing may aggravate the pain. Persistent vomiting is also common.                                                             Diffused Peritonitis This condition refers to inflammation of the peritoneum caused by infectious agents gaining access to the peritoneal cavity.

Symptoms include generalized abdominal tenderness, absence of bowel sounds, diffused abdominal rigidity, hypotension, dehydration, and marked tachycardia. Figure 1. Schematic diagram of the stages of acute appendicitis and its corresponding symptoms.                               Untreated appendicitis may eventually result in peritonitis, an inflammatory condition of the peritoneum (Fauci et al. , 2008). Remember that the pathogenesis of appendicitis is initiated by luminal obstruction of the appendix, usually but not limited to fecalith (Kumar et al. , 2010). This obstruction eventually increases intraluminal pressure and compromises venous outflow.

In addition, the obstruction causes stasis of luminal contents, providing a nidus for bacterial proliferation which then triggers an inflammatory response of the appendiceal walls (Kumar et al. , 2010). By virtue of this inflammatory response and the progressive rise in intraluminal pressure, the integrity of the appendiceal walls is compromised and eventually gives way and burst open to relieve the pressure (Fauci et al. , 2008; Craig, 2011). Along with the release of pressure, the luminal contents of the appendix’ such as abscesses and infected fluids are expelled within the peritoneal cavity (Bower, 1939; Kumar et al. , 2010).

Bacteria from these contaminated materials infect and irritate the peritoneum causing inflammation, hence, the peritonitis.

References

Bower, J. 1939. A clinical pathological classification of acute appendicitis and peritonitis complicating perforative appendicitis. The American Journal of Surgery. 45(1):66-71

Craig, S. 2011. Appendicitis Clinical Presentation. Medscape Reference. Accessed at: http://emedicine.medscape.com. Date accessed: April 29, 2012

Fauci, A., Kasper, D., Longo, D., Braunwald, E., Hauser, S., Jameson, J., and Loscalzo, J. 2008. Harrison’s Principles of Internal Medicine. 17th edition. The McGraw-Hill Companies. Ch 294

Humes, D., and Simpson, J. 2006. Acute Appendicitis: Clinical Review: BMJ. 333(7567): 530-534

Kumar, R., Abbas, A., Delancey, A., and Malone, E. 2010. Robbins and Cotran Pathologic Basis of Disease. 8th edition. Saunders Elsevier. 1600 John F. Kennedy Blvd. Philadelphia. Ch17

Oliak, D., Yamini, D., Udani, V., et al. 2000. Can perforated appendicitis be diagnosed preoperatively based on admission factors? JGS. 4:470-474

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