Reasons for the development of appendicitis in adults
Currently, it has not been established what exactly triggers the inflammatory process in the appendix. Various authors offer many theories, each of which has a right to exist.
According to this theory, appendicitis develops due to the fact that there is an activation of the intestinal microflora, which is facilitated by the obstruction of the appendix lumen. Most often, the organ is clogged with fecal stones, less often there is an increase in lymph nodes (a lot of lymphoid tissue is concentrated in the process, for which it is sometimes called “intestinal tonsil”). Much less often, a parasite is found in the appendix (in most cases, a helminth), which is the cause of the development of the disease.
Separately, scars and adhesions are considered as the cause of the development of inflammation, the formation of which is facilitated by a number of diseases of the abdominal organs (colitis, cholecystitis, gastroenteritis, inflammation of the uterine appendages). Due to the development of sclerosis, the process may bend and obturation of its lumen.
The casuistically rare causes of the development of the disease include swallowed foreign bodies, tumors of the appendix and cecum.
Pathogenesis of appendicitis development as a result of mechanical obturation:
The blocked process is filled with mucus, which the mucous membrane of the organ continues to produce. A thick mucus secret leads to the fact that the diameter of the appendix increases from 4-6 mm to 2 cm or more. He becomes tense due to overflow, which provokes the entire cascade of reactions.
The pressure inside the lumen of the organ gradually increases, as a result of which the veins and lymphatic vessels in the wall of the appendix are compressed. This causes an increase in edema and sweating of the contents of the vessels inside the appendix, which further exacerbates the situation (a “vicious circle” is formed).
The compressed wall becomes inflamed and gradually dies (especially when it comes to the effect of fecal stones). So the zone of necrosis is gradually formed.
The dead wall of the appendix cannot withstand the effects of aggressive microflora, which is present in large quantities in the colon. Scientists have counted more than 500 types of bacteria and fungi, the number of which reaches 10 million microbial bodies per gram. That is why the process of seeding the wall and its destruction is rapid (can occur in as little as 12 hours). If everything develops according to this scenario, and the appropriate measures are not applied, then the gradually increasing pressure causes the wall of the appendix to rupture and its infected contents enter the abdominal cavity, resulting in severe peritonitis.
If you eat an insufficient amount of plant food, then the formation of feces is disrupted, constipation is often disturbed, and the likelihood of the formation of fecal stones increases. Therefore, it is necessary to ensure a balanced diet, which will help prevent the development of appendicitis.
Proponents of this theory believe that individual pathogens are capable of independently causing appendicitis (tuberculosis, typhoid fever, amoebiasis and other parasitic diseases). However, until now, no specific microflora has been found that is likely to cause inflammation.
Systemic vasculitis is a severe disease that affects blood vessels throughout the body. According to this theory, such diseases can provoke changes in the vessels of the appendix, disrupt the outflow of blood from it and become the cause of inflammation – appendicitis.
It has already been proven that the intestinal mucosa contains cells with endocrine properties and secreting hormones into the blood (APUD system). In the appendix, these cells are present in large numbers, and one of their hormones is serotonin, a powerful mediator of inflammation, which, under certain circumstances, can provoke damage to the appendix itself.