AAPENDIX |
What is the appendix?
The appendix is a closed-ended,
narrow tube that attaches to the cecum (the first part of the colon) like a worm. (The
anatomical name for the appendix, vermiform appendix, means worm-like
appendage.) The inner lining of the appendix produces a small amount of mucus that flows through the
appendix and into the cecum. The wall of the appendix contains lymphatic tissue
that is part of the immune
system for making antibodies. Like the rest of the colon, the wall of the
appendix also contains a layer of muscle.
What are the symptoms of appendicitis?
The
main symptom of appendicitis is . The pain is at
first diffuse and poorly localized, that is, not confined to one spot. (Poorly
localized pain is typical whenever a problem is confined to the small intestine or colon,
including the appendix.) The pain is so difficult to pinpoint that when asked to
point to the area of the pain, most people indicate the location of the pain
with a circular motion of their hand around the central part of their
abdomen.
As appendiceal inflammation increases, it extends through the appendix to its
outer covering and then to the lining of the abdomen, a thin
membrane called the
peritoneum. Once the peritoneum
becomes inflamed, the pain changes and then can be localized clearly to one
small area. Generally, this area is between the front of the right hip bone and
the belly button. The exact point is named after Dr. Charles
McBurney--McBurney's point. If the appendix ruptures and infection spreads
throughout the abdomen, the pain becomes diffuse again as the entire lining of
the abdomen becomes inflamed.
Nausea and vomiting also occur in appendicitis and may be due to intestinal
obstruction.
How is appendicitis treated?
Once a diagnosis
of appendicitis is made, an appendectomy usually is performed. Antibiotics
almost always are begun prior to surgery and as soon as appendicitis is
suspected.
There is a small group of patients in whom the inflammation and infection of
appendicitis remain mild and localized to a small area. The body is able not
only to contain the inflammation and infection but to resolve it as well. These
patients usually are not very ill and improve during several days of
observation. This type of appendicitis is called "confined appendicitis" and may
be treated with antibiotics alone. The appendix may or may not be removed at a
later time.
On occasion, a person may not see their doctor until appendicitis with
rupture has been present for many days or even weeks. In this situation, an
abscess usually has formed, and the appendiceal perforation may have closed
over. If the abscess is small, it initially can be treated with antibiotics;
however, the abscess usually requires drainage. A drain usually is inserted with
the aid of an ultrasound or CT scan that can determine the exact location of the
abscess. The appendix is removed several weeks or months after the abscess has
resolved. This is called an interval appendectomy and is done to prevent a
second attack of appendicitis.