The appendix is a small tube located near the cecum. It develops in the 8th week of gestation and rotates 270 degrees before settling in the right iliac fossa. The appendix has numerous lymphoid follicles and goblet cells but its function in adults is unknown. Acute appendicitis presents with migratory abdominal pain, anorexia, nausea and tenderness near the right iliac fossa. Diagnosis is suggested by elevated white blood cell count and confirmed by CT scan or ultrasound showing a swollen, non-compressible appendix. Treatment is surgical removal of the appendix (appendectomy). Complications can include abscess, perforation or gangrene if not treated promptly.

1. Appendix

3. • Appendix
• Caecum
• mesoappendix

4. CT

5. Remember
•Length of appendices –
•2 – 20 cm
•average – 9 cm
•Development –
•8th week of gestation
•as outpouching of cecal wall

6. Position
•appendix undergoes 270◦ rotation before going to
right iliac fossa. So arrest in rotation indicates ectopic
position of appendices
•Region –
Left ileac fossa
Umbilicus
Sub-hepatic region

8. Position
Retro coecal – 70%
Pelvic – 30%
Retro peritoneal – 7%

9. Mucosa of appendices contain numerous goblet cells
– kulchitsky cells
Sub-mucosa contain numerous lymphoid follicles –
called abdominal tonsil
In adult appendix have no known function

10. Blood supply
•appendicular artery- branch of Inferior division of Ilea-
colic artery
•pass behind the terminal part of ileum, enter into the
meso-appendix upto tip
•It is end-artery
•Accessory appendicular artery branch of Posterior cecal
artery (called Artery of seshachalam)

11. Appendicular carcinoid
It is a neuro-endocrinal tumour
 It secretes S100
 <1 cm – Appendectomy suffice
aggressive behavior / >1cm / at the base – right
hemicolectomy

13. Pathogenesis

14. Clinical feature
 Few patients present with anorexia,diarrhea,frequency of micturition

15. On examination
i. Patient looks ill,lying still in bed
ii. Tenderness-max at MacBurney’s point
iii. Rebound Tenderness-always pathognomic
iv. Voluntary muscle guarding
In pelvic type of appendicitis,due to irritation of
bladder,patient may produce with diarrhea and
micturition.

16. Rofsin’s sign-palpation of left iliac fossa produce pain in rt
iliac fossa
Psoas test-Extension of hip produce pain at rt iliac
fossa(more in retrocaecal position)
Obturator’s sign-internal rotation of hip produce pain.
seen in pelvic type of appendicitis

17. Alvardo scoring system
• MNEMONIC---MANTRELS
• TOTAL 10 POINT
• IF > 7 POINT – ACUTE APPENDICITIS

18. M – Migratory pain - 1
A – Anorexia - 1
N – Nausea, Vomiting - 1
PATIENT

19. DOCTOR
T – Tenderness at Right iliac
fossa - 2
R – Rebound tenderness - 1
E – Elevated temperature - 1

20. LAB
L – Leukocytosis - 2
S – Left shift [progenitor WBC
cell in periphery] - 1

21. Diagnosis

22. Peripheral Blood Count
URINE
1. PUS CELL
2. MICROSCOPIC HEMATURIA

23. X-ray
Plain X-ray abdomen
shows :---
fecolith / appendicolith
Ureteric stone / Intestine obstruction, perforation

24. USG
1) Specificity > 90%
2) AP diameter > 7 mm
3) Non-compressibility
4) Target lesion
5) Appendicolith
6) Periappendiceal fluid collection

25. CT
Specifity- 85-90%
Above +
1. + Appendicolith
2. + Abscess
3. + Any mass
Indication of proplylactic appendicectomy
When doubtful, diagnostic laproscopic
Barium meal X-ray – replaced by CT

26. MANAGEMENT

33. Complications / fate
1. Resolution
2. Appendicular lump
3. Appendicular abscess
4. Perforation
5. Gangrenous
6. Peritonitis
7. Portal pyemia
8. Sepsis
9. Mucocoele of appendicitis