Acute Appendicitis And Tumors Of The Appendix.

                                       A normal appendix
  The Appendix is the normal diverticulum of the cecum and is prone for acute and chronic inflammation .
What is Acute Appendicitis?

•   Inflammation of the appendix .It is an emergency condition .
• Occurs in adolescents and young adults mostly.
• Males have a slightly higher risk .
• Should not be confused with mesentric lymphadenitis, acute salpingitis , ectopic pregnency, meckel's diverticulum.

Pathogenesis:

• Progressive increase in the intraluminal pressure which compromises the venous outflow.
• Normally associated with overt luminal obstruction, fecalith ,gall stone , tumours, and worm infestation .
• Ischemic injury and Stasis of blood favours the bacterial growth and hence forth leads to inflammation including tissue edema and neutrophil infiltrate of the lumen , muscular wall and the periappendiceal soft tissue.

Morphology:

• In Early Acute Appendicitis subserosal vessels are congested and there is modest perivascular infiltrate .
• The glisening serosa is hence forth turned dull , granular , and erythematous .
• Diagnosis involves neutrophil infiltrate into the lamina propria.
• Sometimes there is serosal fibrinopurulent reaction and hence this leads to focal abscess (Acute Suppurative Appendicitis)
• Further compromise leads to hemorragic ulceration and gangrenous necrosis (Acute Gangrenous Appendicitis) followed by rupture and suppurative peritonitis.

Clinical features:

• Periumbilical pain localised to lower right quadrant pain .
• Nausea ,vomiting .
• Low grade fever .
• Mildly elevated peripheral white cell count .
• Classical physical finding is McBurney's sign. deep tenderness located two thirds of the distance from the umbilicus to the right superior iliac spine (Mcburney's point).
• In a retro cecal appendix the pain may be to right flank or a pelvic pain.
• In a malrotated appendix the pain is in the left upper quadrant.
• Complications include pyelophlebitis, bacteremia, portal venous thrombosis, liver abscess.

The diagnosis of acute appendicitis in young adults is difficult as there are lots of other causes for abdominal emergencies. Even highly skilled surgeons remove normal appendices .This is preferred  to the delayed resection of a diseased appendix
Tumors of the Appendix:

• The most common one is the Carcinoid.
• Involves the distal tip of the appendix .
• Produces a solid bulbous swelling showning a intramural and transmural extension.
• Adenomas and non mucin producing Adenocarcinomas also occur leading to obstruction and enlargement.
• Mucocele,a dilated appendix that contains mucin and may be a complication of Mucinous cystadenoma or Mucinous cystadenocarcinoma.
• the above condition maylead to sesding in the pritonium and leads to the spred of the tumor although it is rare in the other conditions associated with the appendix.
• Psuedo myxoma peritonii,abdomen filled with tenacious semisolid mucin.This can be held in check by debulking but mostly it leads a fatal course.