Pathology of Appendicitis: Case Study Analysis | Desklib

Understand the pathology of appendicitis through a case study analysis. Learn about the infection process, acute inflammatory response, wound healing, and potential for chronic inflammation.

Running head: PATHOLOGY
PATHOLOGY
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Introduction:
Appendicitis is demarcated as the serious illness. It is an infection which is spread from
the abdomen also known as peritonitis (Bhangu et al., 2015). If not treated within the time period
it can become life threatening. In this condition, surgery of the appendix is conducted which
includes the removal of appendix and after that the abdominal cavity is cleaned, which is the
pocket like structure filled of the pus (Salminen et al., 2015). The primary focus of the essay is to
evaluate the relevant information of the patient which is gathered from the case study which
includes, signs and symptoms, vital signs assessment and all the gathered information is linked
with the pathology of the infection. The pathogenesis of the disease from which the patient is
suffering that is appendicitis is mentioned is the discussion along with the immunological
response. The discussion includes, the pathogenesis of the disease, the infection process, the
acute inflammatory response of the disease on the body of the patient, the wound healing and the
ability for the response by the chronic inflammatory. The discussion is based on the case study of
a 28 year old man who has been suffering from appendicitis and has been admitted to the
hospital and the other complaints of the patient include, fever, watery bowl and the pain in right
flank. The disease is diagnosed by ultrasound and the increased rate of white blood cell is also
observed.
Humans have immune system as their first line of defence to any foreign particle. The
immune system locates the foreign particle and destroys it to prevent the body from diseases.
They develop specific antibodies to fight against these antigens, and thus generates an immune
response. They prevent the entry of toxic substances through the mucosal surfaces, providing
immunity to the host body. In order to fight the infections and inflammations the immune
response play a major role, by generating antibodies in terms of WBC (5.0-10.0x109L),

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Lymphocytes (3.0-4.0x109L) and Granulocytes (5.0-7.0x109L). In the given case study, the
patient has high levels of Granulocytes (9.7x109L), Lymphocytes (5.7x109L) and White Blood
Cells (12.6x109L), which are the results of severe inflammation and infections. The
immunological response to High WBC count is fever, bruising, pain, weight loss and bleeding
(Notkins, 2014). The major cause behind the high levels of WBC is because of infections, in
order to fight the infections, the body’s immune system generates more number of WBC,
resulting increased levels. Another cause is Stress, the patient’s stress elevates the WBC levels,
but the increased levels due to stress is not very serious because as the patient relaxes and the
stress is gone, the levels return to the normal state. The increased level of Lymphocytes causes
Lymphocytosis, which is temporary and harmless. The increased levels are mostly because of
chronic infections or inflammations due to autoimmune disorders, which in this case is
appendicitis. Similarly, increased levels of Granulocytes depicts responses to infections and
autoimmune diseases. The increased levels of blood components, explains the occurrence of
severe infections and inflammation (Sanders et al., 2013), it also suspects that the patient is in
stress and pain. The presence of slight inflammation in the right lower abdominal quadrant and
iliac fossa and mild CVA tenderness on the right side and a strong positive psoas sign on the
right in the patient explained the reason behind the increased levels of blood components
(Martin, 2014). The levels of WBC, Lymphocytes, and Granulocytes was increased in order to
fight the patient’s mild inflammations and infections and to relieve him from pain which is
caused because of appendicitis (Yilmaz et al., 2013). But these immunological responses of
increased levels of blood components, to cure the infections and inflammations, might counter
effect by causing or indicating several other disorders like trauma, allergy, stress, fever,

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abnormal bleeding, loss of appetite, Lymphocytosis, Granulocytosis and many more, which
might lead to certain severe diseases.
Infection Process:
In most of the patients, the primary pathogenic event which takes place is because of
Luminal Obstruction, which might be the results of lymphoid hyperplasis, foreign bodies
invasion, parasites, facaliths and metastatic tumors. This obstruction results in the occurrence of
inflammation, increased levels of intraluminal pressures and ischemia. These inflammations
leads to the enlargement of appendix and further causes infections and inflammations in the
surrounding cells and tissues, like peritoneum and pericecal fat (Alemayehu et al., 2014).
Perforation occurs if the appendix is not treated, by the generation of non-crushable, hard and
calcified stones (true appendiceal calculi). The perforation usually occurs in younger patients
because of adequate amount of lymphoid tissue. Because of the little capacity of the luminal and
intraluminal, pressures reach 65 mm Hg which further causes quick distension of appendix. With
the increase in luminal pressure, the pressure of venous also increases and development of
mucosal ischemia takes place. If the pressure of the luminal is increased further to 85 mm Hg,
the appendix is drained due to thrombosis of the venules. If the drainage of appendix is constant
then the manifestation of the appendix engorgement occurs (Gaetke-Udager Maturen &
Hammer, 2014). All these occurrence leads to the hypoxicity of the mucosa, which further starts
to ulcerate resulting in destruction of the mucosal walls and allows the entry of the appendiceal
wall through intraluminal bacteria. These intraluminal bacteria (Escherechia coli) are mostly
gram negative and causes bacterial infection (Charfi et al., 2014). The inflammation caused is
further spread to serosa and adjacent organs resulting in the stimulation of visceral affferent
nerve fibres which infuses inside the spinal cord at T8 and T10 causing periumbilical and

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epigastric pain, administered by the dermatomes. After this, the somatic pain is increased
superseding the earlier pain causing the patient to feel maximum pain. Further, if the treatment id
not provided, then compromisation and infarction of the arterial blood flow usually takes place,
causing perforation and gangrene. The pathophysiology worsens with the occurrence of nausea,
vomiting and anorexia.
Acute Inflammatory Response:
To acknowledge the molecular patterns of the microbe and to circulate the local response,
the role of appendix in immune system includes systemic and local responses, which enhance
and generates the leukocytes, embraces the vascular permeability, increases the flow of blood to
the tissues which are infected and elicits pain. The most important components of the immunity
are connected to the genome, because without any modifications of gene it responds to the
signals of microbes. In many genes of innate immunity, allelic polymorphisms are concerned but
the risk of acquiring infectious disease is increased. The severity of the inflammation during
appendicitis is highly affected by the IL-6-174 C- allele (Branescu et al., 2013) and TNF-alpha.
Tissue necrosis, gangrene and local micro-vascular thrombosis is enhanced by the reduction in
the expression of tissue factor pathway inhibitor and increased in the expressions of TF.
Wound healing:
In case of appendix, wound infection is quite frequent occur due to abscess. From the
case study, it is observed that the pre-operative administration of the antibiotics reduces the
chance of wound infection. However after the surgery the wound is left open and is washed like
that only which increases the risk of infection and delayed the wound healing process. In order to

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heal the wound of the patient, the patient is administered with antibiotics for a specific period of
time. The wound healing process is divided into four phases which includes:
Hemostasis: In this phase, the blood starts to clot with the activation of fibrin (Key, Makris &
Lillicrap, 2017).
Inflammation: In this stage, the dead tissue of the wound is removed
Proliferation: This stage is characterized by contraction of wound by the action of angiogenesis
(Augustine et al., 2015).
Maturation: The wound is recovered with the help of collagen fibre
Potential for chronic inflammatory response:
In the case of perforated appendix, there is high chances of the chronic inflammation
(Meyers, de Crescenzo & Cocanour, 2017). Here in the case study, surgery has been done to
remove the appendix. After that the wound of the patient is left open followed by washing which
might lead to chronic inflammation. It might also lead to the neurological proliferation. In case
of open wound, the inflammation might also occur due to the encounter of bacteria. In the case
study, it is noted that the patient has been administered with intravenous antibiotic for continuous
five days which protects the injury from the invasion of the bacteria (Sharma et al., 2016). The
wound of the patient is also managed with precaution which prevents the wound from any
further inflammation due to the secondary intention. After the proper management of the wound,
the patient has been discharged.

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Conclusion:
From the above discussion, it is concluded that appendicitis is the pernicious illness
which if not treated might lead to life threatening disease. The pathology of the disease is
included in the case study which focusses on the process of the infection, response due to acute
inflammation, wound healing process and the response of the chronic inflammation. The
pathogenesis of the disease is based on the patient who was diagnosed with appendicitis and is
suffering from high fever and increased heart rate. In the case of the immunological response due
to the acute inflammation, the rate of the granulocytes, lymphocytes and WBC has been
increased in to the body which is the result of the acute inflammation of the appendix. The
increase of this substance in the body result to the acute inflammation. The wound healing
process of the patient is also mentioned in the discussion, which is done by administrating of the
antibiotics. The chronic inflammation response which was observed post operation which made
the wound open and is healed by secondary intention which leads to chronic infection.

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Reference:
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unexpected pathology findings after appendectomy. Journal of pediatric surgery, 49(9),
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Augustine, R., Dominic, E. A., Reju, I., Kaimal, B., Kalarikkal, N., & Thomas, S. (2015).
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Key, N., Makris, M., & Lillicrap, D. (Eds.). (2017). Practical hemostasis and thrombosis. John
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