Appendicitis

Appendix inflammation was always surveyed as a lesion caused by bacterial flora, vegetans in an intestine. As the etiological moment pathogenic amebas, trichomonads can serve in appendicitis development balantidium.

Appendix lesion meets at an actinomycosis, a histoplasmosis. The specific inflammation of a process can arise at a tuberculosis, a bacillar dysentery, a typhoid, at collagenoses and a number of other diseases both infectious, and not infectious. However the concurrent infection participates in prevailing number of cases in pathological process (E. coli, staphilococcuses, streptococcuses, pneumococcuses, diplococcus, anaerobes) where on the foreground acts Escherichia coli. Subitaneous implication of pathogenic properties of this microflora which being constantly in an intestine, not only does not render harmful influence, but is necessary for normal digestion, spoke formation of the closed lumen in a process. Under such circumstances innoxious saprophytes show the pathogenic action because in the closed lumen find congenial medium for growth and reproduction. The part of scientists supported an enterogenous path of development of an acute appendicitis at which microbes take root into process sides immediately from its lumen. Other explorers insisted on a hematogenous, metastatic path of a parentage of an acute appendicitis, believing, that disease comes owing to drift of microorganisms in a side of an appendix from the remote locus.

In 1907 pathologist Aschoff has presented the theory of occurrence of an acute appendicitis. In its opinion process in a process begins in one of cryptas of its mucosa with development of the primary affect having the form of a wedge with the establishment, turned towards a serous cover. At wedge fastigium, on a mucosa, the insignificant erosion covered with a fibrinous exsudate with an admixing of cells is found. Within the clinoid locus the tissue is penetrated by leucocytes, sometimes with an admixing of erythrocytes. From it suppurative process extends in the parties, there is a phlegmon of a process with an ulceration of a mucosa and development of a flegmonozno-ulcerative stage of disease and a diffusive is purulent-ulcerative appendicitis. Further the necrosis and gangrenous disintegration that can lead to process punching is formed. Relative rest of the worm-shaped process, assuming absence of its peristalsis was considered as contributing cause of an acute appendicitis, that according to Aschoff, conducts to stagnation in a lumen of a process of intestinal contents. Same its physiological flexures promote also.

Further the neurovascular theory of occurrence of an acute appendicitis has been offered. According to this theory the necrosis and a gangrene of a process grow out not secondary, but the primary histic changes having a previous stage. All process first of all educes in vascular system, and at the heart of it the circulatory disturbance depending on a boring of the excitatory system, regulating a normal blood stream lays. Scientists have secured a stage of functional changes in a process which educe before obvious micro-and macroscopical changes. It is known, that in the beginning of an attack of a pain begin in the field of a belly-button or in an anticardium that specifies in pristine functional changes in the centres of a sympathetic innervation of a gaste - in ganglia coeliaca therefore there is a subsequent process and in a process. The neurogenic theory, certainly, helps to understand occurrence of some forms of an acute appendicitis. However for the majority of forms of the destructive appendicitis especially educing quickly, this theory is of little use.

Thus, neither theory Aschoff, nor the neurogenic theory cannot be accepted without reservations, and the majority of explorers pays attention on advantage to stagnation contained in a process, caused by the various causes (a process excess, dense contents, sometimes fecal stones, a lymphatic hyperplasia, a swelling of follicles, peristalsis retardation, a stasis in a caecum), that conducts to pressure rising in it, to a stasis in the intraparietal pots, to the enhanced reproduction of microbes.