Appendix

2.  • Vermiform appendix is vestigial organ
It is a blind-ended muscular tube
containing mucosa, submucosa,
muscular layer and serosa attached to the
posteromedial wall of caecum, about 2cm
below ileocaecal junction.

3.  MEASUREMENTS • The appendix
varies in length between 7.5 – 10cm.
 EPITHELIUM : It is lined by columnar
cell intestinal mucosa of colonic type

4.  SURFACE ANATOMY • The base of appendix
is represented by a point about 2cm below the
intersection between the transtubercular and rt
lateral planes.
 McBurney’s point

6. 1) Retrocecal 74 %
2) Pelvic 21%
3) Subcecal 1.5 %
4) Paracecal 2%
5) Preileal 1%
6) Postileal 0.5%
7) Subileal

7. BLOOD SUPPLY : The blood supply of appendix
is appendicular artery, it’s a terminal branch of
ileocolic artery clinical pearls : appendicular artery
is an end artery thrombosis of which leads to
necrosis of appendix ( gangrenous appendix)
NERVE SUPPLY : Sympathetic fibers from T10
spinal segment therefore in appendicitis
visceral pain is referred to umbilicus
LYMPHATIC DRAINAGE : The lymphatic
drainage is by superior mesenteric nodes.

8.  ETIOLOGY: Appendicitis is clearly
associated with bacterial proliferation
within appendix. No single organism is
responsible but many aerobes and
anaerobes are responsible
 feacolith( appendicolith) :it is
composed of inspissated faecal material,
calcium phosphate, bacteria and epithelial
debris

9.  Stricture : A fibrotic stricture of the
appendix
 Tumor : particularly carcinoma of
caecum
 Parasites : oxyuris vermicularis

10.  Obstruction inflammation
lymphoid hyperplasia edema and
ulceration of wall bacterial
translocation to submucosa
distension of appendix venous
obstruction ischemia ACUTE
APPENDICITIS

11.  SIGN AND SYMPTOMS: Anorexia,
fever , periumblical pain with RLQ
tenderness. Elevated white count with
left shift

12.  M : Migratory pain to left
 A : Anorexia
 N : Nausea and vomiting
 T : tenderness at RLQ
 R : Rebound tenderness
 E : Elevated temperature
 L : leucocytosis
 S : Shift of WBC to left

13. DIAGNOSTIC TEST : Usually diagnose
clinically using mantrels score. But CT Scan is
most accurate test to perform.
TREATMENT :
conservative : bowel rest, hydration, IV
antibiotics ( metronidazole + 3rd generation
cephalosporin )
Surgery : Appendectomy