A 22-year-old Caucasian male presents to the ER with abdominal pain that started around his bellybutton, then moved to the right lower abdominal quadrant. After initial evaluation, laparotomy is performed, which reveals the following findings (see the slide below). Which of the following most likely initiated this patient's condition?

Question

A 22-year-old Caucasian male presents to the ER with abdominal pain that started around his bellybutton, then moved to the right lower abdominal quadrant.  After initial evaluation, laparotomy is performed, which reveals the following findings (see the slide below).  Which of the following most likely initiated this patient's condition?

Quizplus · Accepted Answer

An inflamed, hyperemic, and edematous appendix is shown above. This macroscopic appearance, along with periumbilical pain that migrates to the right lower quadrant, is classic for acute appendicitis. This condition occurs in all age groups, with peak incidence in children 6-10 years old. The abdominal pain tends to appear in the periumbilical area (visceral pain) and shifts to the right lower quadrant a few hours later. Acute appendicitis is caused by an obstruction of the appendicular lumen. The most common obstructing agents are fecaliths. Obstruction by hyperplastic lymphoid follicles, foreign bodies, nematodes, and carcinoids may also cause acute appendicitis. Retained mucus causes the appendicular wall to distend, which impairs venous outflow. The resulting hypoxia causes ischemia and associated bacterial invasion. Inflammation and edema of the appendicular wall occur, causing further distention. Necrosis of the wall with rupture may follow. In this case, inflammatory fluid and bacterial contents spill into the peritoneal cavity, causing peritonitis. (Choice A) Bacterial infection plays an important role in the pathogenesis of acute appendicitis. It is not, however, the initiating event. (Choice B) Peptic ulceration is implicated in the development of lower intestinal bleeding due to Meckel diverticulum, not acute appendicitis. (Choices D and E) Both venous thrombosis and arterial spasm can cause mesenteric ischemia; however, neither of these factors lead to acute appendicitis. Educational Objective: Obstruction of the lumen of the appendix is the first event in pathogenesis of acute appendicitis. Fecaliths, hyperplastic lymphoid follicles, foreign bodies, or tumors may cause the obstruction. Right lower quadrant abdominal pain, nausea, vomiting, diarrhea, and fever are the typical manifestations of acute appendicitis.

A 22-Year-Old Caucasian Male Presents to the ER with Abdominal