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This entry was posted by Sulav Shrestha on July 9, 2011 at 2:11 pm and filed under
Anatomy category.
Home Anatomy
The lumen of the appendix is relatively wide in the infant and is frequently
completely obliterated in the elderly. Since obstruction of the lumen is the
usual precipitating cause of acute appendicitis it is not unnatural,therefore,
that appendicitis should be uncommon at the two extremes of life. It is seen
more commonly in older children and young adults.
Location of Appendix:
Right lower quadrant of abdomen and more specifically right iliac fossa.
McBurneys point lying at the junction of lateral one-third and the medial two-thirds
of the line joining the umbilicus to the right anterior superior iliac spine roughly
corresponds to the position of the base of the appendix.
Clinical
Retrocecal: Extension of the hip joint may cause pain because the appendix is
disturbed by stretching of the psoas major muscle. Pain usually localizes in
the right flank.
Pelvic: Pain may be felt when the thigh is flexed and medially rotated,
because the obturator internus is stretched. Pelvic appendix may irritate the
bladder or rectum causing suprapubic pain, pain with urination, or feeling the
need to defecate.
Retroileal: In some males, it can irritate the ureter and cause testicular pain.
Pregnancy: the appendix can be shifted and patients can present with RUQ
(Right upper quadrant) pain.
Arterial Supply:
1. Appendicular artery: The mesoappendix, containing the appendicular branch of the
ileocolic artery (branch of superior mesenteric artery), descends behind the ileum.
2. Accessory appendicular artery: An accessory appendicular artery can branch from
the posterior cecal artery which is also a branch of ileocolic artery.
Clinical
Venous drainage:
Appendicular vein > Ileocolic vein > Superior mesenteric vein > Portal vein
Lymphatic drainage:
A few of them pass indirectly through the appendicular nodes situated in the
mesoappendix.
Clinical
Appendicular dyspepsia: Chronic appendicits produces dyspepsia resembling disease of
stomach, duodenum or gall bladder. It is due to passage of infected lymph to the subpyloric
lymph nodes which causes irritation of pylorus.
Nerve supply:
1. Sympathetic nerves: T9 and T10 spinal segments through the celiac plexus
2. Parasympathetic nerves: Vagus
Clinical
Both the appendix and the umbilicus are innervated by segment T10 of the spinal cord and
hence the pain caused by appendicitis is first felt in the region of umbilicus (referred pain).
With increasing inflammation pain is felt in the right iliac fossa due to involvement of the
parietal peritoneum of the region which is sensitive to pain in contrast to pain insensitive
visceral peritoneum.
Histology: Inside to outside
1. Mucosa:
No villi
Epithelium invaginates to form crypts of Liberkuhn but the crypts do not occur as
frequently as in the colon
2. Submucosa:
Large accumulations of lymphoid tissue in the lamina propria and submucosa. Hence
appendix is also called abdominal tonsil.
There is often fatty tissue in the submucosa.
3. Muscularis externa:
Outer longitudinal smooth muscle layer does not aggregate into taenia coli