APPENDIX

Embryology
In the 5-week-old embryo, the midgut is suspended from the dorsal abdominal wall by a
short mesentery and communicates with the yolk sac by way of the vitelline duct or yolk
stalk. Development of the midgut is characterized by rapid elongation of the gut and its
mesentery, resulting in formation of the primary intestinal loop. The cephalic limb of the
loop develops into the distal part of the duodenum, the jejunum, and part of the ileum. The
caudal limb becomes the lower portion of the ileum, the cecum, the appendix, the
ascending colon, and the proximal two-thirds of the transverse colon.
PHYSIOLOGICAL HERNIATION
Development of the primary intestinal loop is characterized by rapid elongation, particularly
of the cephalic limb. As a result of the rapid growth and expansion of the liver, the
abdominal cavity temporarily becomes too small to contain all the intestinal loops, and
they enter the extraembryonic cavity in the umbilical cord during the sixth week of
development (physiological umbilical herniation)
Coincident with growth in length, the primary intestinal loop rotates around an axis formed
by the superior mesenteric artery. When viewed from the front, this rotation is
counterclockwise, and it amounts to approximately 270 when it is complete. Even during
rotation, elongation of the small intestinal loop continues, and the jejunum and ileum form
a number of coiled loops.
RETRACTION OF HERNIATED LOOPS
During the 10th week, herniated intestinal loops begin to return to the abdominal cavity.
Although the factors responsible for this return are not precisely known, it is thought that
regression of the mesonephric kidney, reduced growth of the liver, and expansion of the
abdominal cavity play important roles. The proximal portion of the jejunum, the first part to
reenter the abdominal cavity, comes to lie on the left side. The later returning loops
gradually settle more and more to the right. The cecal bud, which appears at about the
sixth week as a small conical dilation of the caudal limb of the primary intestinal loop, is the
last part of the gut to reenter the abdominal cavity.
Temporarily it lies in the right upper quadrant directly below the right lobe of the liver. From
here it descends into the right iliac fossa, placing the ascending colon and hepatic flexure
on the right side of the abdominal cavity. During this process the distal end of the cecal bud
forms a narrow diverticulum, the appendix. Since the appendix develops during descent of
the colon, its final position frequently is posterior to the cecum or colon. These positions of
the appendix are called retrocecal or retrocolic, respectively.

Anatomy
The vermiform (L. worm-like) appendix, a blind intestinal diverticulum, extends from the
posteromedial aspect of the cecum inferior to the ileocecal junction. The appendix varies in
length and has a short triangular mesentery, the mesoappendix, which derives from the
posterior side of the mesentery of the terminal ileum. The mesoappendix attaches to the
cecum and the proximal part of the appendix. The position of the appendix is variable, but
it is usually retrocecal (posterior to the cecum). The base of the appendix most often lies
deep to a point that is one third of the way along the oblique line joining the right anterior
superior iliac spine to the umbilicus (spinoumbilical or McBurney point).
The appendix is supplied by the appendicular artery, a branch of the ileocolic artery. A
tributary of the SMV, the ileocolic vein, drains blood from the cecum and appendix. The
lymphat ic vessels from the cecum and appendix pass to lymph nodes in the mesoappendix
and to the ileocolic lymph nodes that lie along the ileocolic artery. Efferent lymphatic
vessels pass to the superior mesenteric lymph nodes. The nerve supply to the cecum and
appendix derives from sympathetic and parasympathetic nerves from the superior
mesenteric plexus. The sympathet ic nerve fibers originate in the lower thoracic part of the
spinal cord (T10-T12), and the parasympathetic nerve fibers derive from the vagus nerves.
Afferent nerve fibers from the appendix accompany the sympathetic nerves to the T10
segment of the spinal cord.

Histology

Layers:
1. Mucosa
Its consist of tubular intestinal gland which is less and shorter than any part of large
intestine. The tubular intestinal gland is lined by simple columnar epithelium without
villous and goblet cells. Therere also stem cells in the base of epithelium. The lamina
propria is composed mainly by lymphoid nodules. Moreover, theres muscularis
mucosa in below.
2. Submucosa
Its also occupied by lymphoid nodules and may be fatty tissue.
3. Muscularis externa
Its thinner compared other part of colon. Divided into 2, inner which is circular
smooth muscle and the outer is the longitudinal bands. Here, it doesnt form taenia
coli.
4. Serosa
Formed by visceral layer of peritoneum.

Physiology

Secretion
The Crypts also have large clearer cells, called goblet cells, which produce mucous,
which flows up and out of the crypt, washing the crypts, and then lubricating and
protecting the mucosa of the bowel from its contents.
Immune System
It has a very large number of lymphoid aggregates in the submucosa. It has a very
large number of lymphoid aggregates in the submucosa.
Peristalsis
The muscles of the gut are programed to squeeze in a rhythmic fashion creating a
wave, called peristalsis, which moves the contents within the lumen of that section
forward. Some of the stool may pass into the appendix, but appendiceal peristalsis
pushes it back into the colon. The appendix also makes mucous and antibodies
which are also pushed into the cecum by peristalsis.

Source:
-

Moore Anatomy
Langman Embryology
Histology Junqueira
Van De Graff Anatomy
http://www.proteinatlas.org/learn/dictionary/normal/appendix
http://www.histology.leeds.ac.uk/digestive/appendix.php
http://www.ncbi.nlm.nih.gov/pubmed/15228837
http://www.appendicitis.pro/the-john-hunter-memorial/the-anatomy-andphysiology.html

John Patria Maruli Sinaga

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