Pathophysiology

Obstruction of the appendiceal lumen is the inciting factor in appendicitis, and leads to perforation and peritonitis. After the appendiceal orifice is obstructed, bacterial overgrowth of the distal lumen takes place. Intraluminal pressure rises according the Laplace's law. This results in venous hypertension, which perpetuates the cycle by contributing to wall thickening. Once the venous pressure exceeds capillary oncotic pressure, the appendix becomes ischemic, necrotic, and eventually perforates. This sequence of events occurs over 24-36 hours. Inflammation of appendiceal lymphoid tissue results in the majority of cases of appendicitis, about 60%. This can be caused by something as simple as gastroenteritis or may be a manifestation of more advanced colonic disease such as Crohn's.

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