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Appendix

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  • Appendix is a small tubular structure situated at the junction of small & large intestine in right lower quadrant of the abdomen

  • The average length of appendix is 9 cm in adults (can vary from 5 to 35 cm)

  • Exact function of the appendix is not known 

    • There are hypothesis that the appendix may play a role in the immune system and may serve as a reservoir of “good” intestinal bacteria 

    • However, removal of the appendix has not been definitively demonstrated to have any known adverse sequelae

  • Acute appendicitis is one of the most common surgical emergency

  • Although appendicitis can occur in age group it is commonly seen in 10-30 years of age

  • About 6% to 7% of the general population can develop appendicitis during their lifetime

What is appendicitis?

  • The suffix 'itis' means inflammation. So, appendicitis is inflammation of the appendix

How to diagnose appendicitis?

  • If typical symptoms and signs are present no further tests are needed to confirm appendicitis 

  • In doubtful cases or suspicion of complications imaging such as USG or CT may be necessary

  • Blood test - CBC may show leukocytosis

What is the patho-physiology of  appendicitis?

  • Appendicitis is caused by luminal obstruction

  • Due to its small luminal diameter in relation to length, appendix is prone for luminal obstruction

  • Obstruction lead to increased intra-luminal pressure leading to ischemic changes and bacterial overgrowth which may ultimately lead to perforation

What is the common age group to develop appendicitis?

  • Although appendicitis can occur in age group it is commonly seen in 10-30 years of age

What are the symptoms of appendicitis ?​​

  • Pain - initially in the central abdomen, later moves to right lower quadrant of the abdomen

  • Nausea/Vomiting

  • Anorexia (Loss of appetite)

  • Fever

 

(Patient with appendicitis usually have the one or more of the above symptoms. More the symptoms higher the probability of appendicitis)

How to treat appendicitis?

  • Surgery ( Appendicectomy) is the treatment of choice for acute appendicitis

  • Surgery can be done by both open or laparoscopic techniques

What happens if an appendicitis patient do not undergo surgery ?

  • Some patients may respond to initial medical management

  • However, if no response to medical management it may lead to complications, with increased hospital stay & treatment cost

  • Even if the initial medical management is successful there are chances of recurrent appendicitis

Will there be any physiological changes if I undergo surgery?

  • No

  • Removal of the appendix has not been definitively demonstrated to have any known adverse sequelae

What are the other disorders of appendix apart from appendicitis?

  • Appendicular tumors

    • Carcinoid tumors

    • Mucinous tumors

    • Adenocarcinoma etc.

What are the advantages of laparoscopic surgery over open surgery?

  • Less pain

  • Cosmetically better

  • Less wound related complications

  • Less hospital stay

  • Early return to work

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How is the recovery after appendicectomy surgery?

  • Surgery especially  after laparoscopic appendicectomy in experienced hands lead to smooth recovery & early return to work

What are the complications of appendicitis?

  • Appendicular lump formation

  • Appendicular perfoartion 

    • Abscess

    • Peritonitis

  • Gangrenous appendicitis​

Is it possible to treat appendicitis without surgery?

  • Surgery (appendicectomy) is the treatment of choice in acute appendicitis

  • Some patients may respond to initial medical management

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