Acute appendicitis

Inflammation:
It is the protective response intended to terminate initial cause of cell injury as well as to
remove necrotic tissue resulting from initial insult is called inflammation.

Acute inflammation:
It is the immediate or early response of blood vessels and supporting tissue elements to
injury and result in the formation of protein with exudates.
Vascular changes:

Changes in vascular flow and caliber:

Emigration of lymphocytes from microvasculature and accumulation in the locus of injury:

Inflammatory cells in acute inflammation:

 Neutrophills
 Eosinophills
 Basophills
 Monocytes
 Macrophages
 Natural killer cells

Acute appendicitis:
It is an acute inflammatory condition of vermiform appendix.
Causes:

 Obstruction (caused by calculus, tumor, or some worms )

 Sharp angulations of appendix
 Laminal obstruction of food, stones
 Fibrous bands
 External adhesion
 Lymphoid hyperplasia e.g in viral infection
 Retrocaecal position of appendix

Normal histology:
A transverse section shows the following layers:
1. Mucosa: Simple columnar epithelium, lamina propria and muscular mucosa
2. Submucosa: Contains loose connective tissue with lymphoid follicles, Blood
vessels and glands. Crypts of …… are also present.
3. Muscularis mucosa: Composed of two layers
 Inner circular and outer longitudinal layer
4. Serosa: Composed of loose connective tissue and blood vessels.

Histopathology:
When appendix is obstructed, continuous secretion of mucous increases the
interluminal pressure which destructs blood flow.
The ischemia injury favors bacterial invasion which adds an element in inflammatory
edema and exudation, thus further impeding blood flow. In this way a fiscious cycle
starts leading to inflammatory changes in appendix, related both to bacterial invasion
and ischemic injury.

Gross features:
 Loss of glistering surfaces
 Bluish discoloration of specimen
 Fibrinopurulent exudates on serosa and prominent vessels can also be seen
 Blood tinged pus in lumen
 Variably perforations, mucosal ulcerations and fecal material can be seen in
lumen.

Microscopic points of identification:

 Mucosal ulceration
 Pink homogenous necrotic tissue
 Lymphoid hyperplasia
 Infiltration of neutrophills in the mucosal layer resulting in separation of smooth
muscle cells
 Hyperactive germinal centers of lymphoid tissues
 Dilated large vessels and lymphatic’s in serosa

Complications:
 Perforations
 Peritonitis