Respiratory Infections
may cause reactive hyperplasia of lymph follicles dellappendice that cause lostruzione and then set in motion the cause of the inflammatory process.
It should be remembered that lappend has a large amount of lymphatic tissue, compared to the rest of the colon.
The lymphatic tissue reacts with liperplasia (with subsequent obstruction of the appendicular lumen) at various disease states including extra-appendicular as respiratory infections, viral infections (mononucleosis, measles), typhoid, amoebiasis, mesenteric adenitis, chronic inflammatory diseases dellintestino, gastroenteritis etc..

Lostruzione causes increased intraluminal pressure causing damage to the vascular plexus, lymphatic stasis, edema and ischemia of the mucosa with an appearance of ulcers (acute catarrhal appendicitis). Lappend looks swollen, hyperemic with serous still lucid.
Now you have the bacterial invasion with secondary infection. Start a suppurative processes caused by germs such as E. coli and streptococcus lescherichia fecalis. Lappend fills with pus because outbreaks suppurative merge with each other and colliquano emptying into the lumen. Serosa becomes opalescent up to be covered by a fibrin purulent (suppurative acute appendicitis).
If the process evolves there is venous thrombosis, further reduction of arterial flow mainly to the tip and the anti-mesenteric margin: what causes the outbreaks gangrenous. In these cases also are virulent anaerobic bacteria such as Bacterioides fragilis or the peptostreptococci (acute gangrenous appendicitis).

The next step is the drilling that occurs with easy to tip as this is an area less vascularized, and will lead to a frank contamination of the peritoneal cavity.
Usually the spread of the inflammatory process leading to perforation and barred from the viscera, and mainly from the surrounding peritoneum and bowel loops dellomento adhesions that form between them can limit the outbreak.
This gives rise to a palpable mass in right iliac fossa, the so-called “plate” that can contain within it collected abscess.

Many germs are regular guests nellinfezione involved dellintestino. In the early and late aerobic bacteria predominate anaerobes.
E. Coli + Lassociazione anaerobes are found frequently.

Lappendicite rare in childhood, and common nelladolescenza and reaches its peak between 15 and 25 years.
Subsequently lincidenza is reduced, although present in adults and the elderly.
It is estimated that before 20 years of age the disease affects a person every 5 and 20 years after one of 10.

Adolescents and young adults, the incidence ratio of male / female edi 3: 2.
After 25 years lincidenza and equal in both sexes.

Symptoms

The symptoms and varies but usually starts with a vague epigastric and periumbilical pain which then moves into the right iliac fossa.
And this nausea and sometimes vomiting. The pain and persistent but not severe, it becomes localized and can create trouble if the patient walks, moves or coughs.
This is why the patient prefers to stay still in bed.
Peristalsis is present or slightly reduced.

Lesame decisive goal for diagnostic purposes and constituting a delicate moment for whether or not there is an inflammatory condition appendicular. Lesame requires skill and experience nellinterpretare symptoms just mentioned, because at the outset or because altered by specific situations such as let neonatal, infant or advanced, the state of obesity or pregnancy advanced.
What is more useful in doubtful cases may be to repeat the visit unattenta supervision after a few hours. Even more important, prompt diagnosis, the search for an initial peritoneal resentment to this end they have in common are maneuvering to bring into contact with the inflamed peritoneum lappend surroundings and to stimulate the nerve endings of this irritated by the inflammatory process:

A. Blumberg’s sign. This maneuver is palpated with the hand fully supported sulladdome gradually and profoundly, the painful area and then drop sharply in the hand. Is positive when the pc. feels a violent pain because sensory nerve endings are stimulated parietal peritoneum by the sudden relaxation.
B. The psoas sign. In the course of the attack appendicular pcs. prefers to keep the leg slightly flexed for a reason analgesic. Extension / leg but can cause pain by stimulating the region inflamed.
C. The sign of Roswing. It is produced by compressing the iliac fossa sn. at the sigmoid and descending colon, by rotating the hand to LALT so as to compress air contamination present in the colon and thereby stretch the Czech lappend and advance toward the parietal peritoneum.

The average white blood cell count of 15,000 / L and about 90% of patients exceeding 10,000 / L.

The 3 / 4 of patients have neutrophils that exceed 75%.

The white blood cell count and normal in 1 patient in 10 with acute appendicitis, and many have even normal differential count of white people.

The average temperature does not exceed 38 C. (the average is around 37.8 C) in the absence of perforation.

Although there has always maintained that lappendicite position retrocecale it causes symptoms other than that caused in treating antececale normal position, is now thought that this is untrue and that symptoms and signs are independent of the position dellappendice.

Regarding the diagnosis, the highest% of false positives equal to 30-40% occurs in women occurs between 20 and 40 years and is attributable to the presence of pelvic inflammatory disease or other gynecological diseases.
If you compare with lappendicite, pelvic inflammatory disease are most often associated with painful tension in the lower abdominal quadrants, with an onset within 5 days dallultima menstruation and lack of nausea and vomiting.