PATHOPHYSIOLOGY

Introduction The appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve. No definite functions can be assigned to it in humans. The appendix fills with food and empties as regularly as does the cecum, of which it is small, so that it is prone to become obstructed and is particularly vulnerable to infection (appendicitis). Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. About 7% of the population will have appendicitis at some time in their lives, males are affected more than females, and teenagers more than adults. It occurs most frequently between the age of 10 and 30. The disease is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates. The lower quadrant pain is usually accompanied by a low-grade fever, nausea, and often vomiting. Loss of appetite is common. In up to 50% of presenting cases, local tenderness is elicited at Mc Burneys point applied located at halfway between the umbilicus and the anterior spine of the Ilium. Rebound tenderness (ex. Production or intensification of pain when pressure is released) may be present. The extent of tenderness and muscle spasm and the existence of the constipation or diarrhea depend not so much on the severity of the appendiceal infection as on the location of the appendix. If the appendix curls around behind the cecum, pain and tenderness may be felt in the lumbar region. Rovsings sign maybe elicited by palpating the left lower quadrant. If the appendix has ruptured, the pain become more diffuse, abdominal distention develops as a result of paralytic ileus, and the patient condition become worsens. Constipation can also occur with an acute process such as appendicitis. Laxative administered in the instance may result in perforation of the in flared appendix. In general a laxative should never be given when a persons has fever, nausea or pain.

Anatomy
Appendix

The mucosa is the inner layer of any epithelially-lined hollow organ (e.g., mouth, gut, uterus, trachea, bladder, etc.). The mucosa consists of the epithelium itself and also the supporting loose connective tissue, called lamina propria, immediately beneath the epithelium. Deeper connective tissue which supports the mucosa is called the submucosa. In the GI tract (but not in other tubular organs), there is a thin layer of smooth muscle, the muscularis mucosae, at the boundary between mucosa and submucosa.

The mucosa is the most highly differentiated layer of the GI tract. Tissue specialization and surface shape are correlated with functional differentiation along the tract.

Appendicitis Anatomy
To better understand appendicitis, it helps to understand the anatomy of the intestines and the appendix. The intestine absorbs nutrients from food and liquids. The intestine is about 22 feet long in an adult. It includes the large intestine and the small intestine. The small intestine has three parts:

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Duodenum: o Connects to the stomach Jejunum: o Middle portion of the small intestine Ileum: o Lower portion of the small intestine that connects to the cecum (first part of the large intestine)

The large intestine is also known as the colon. It is the last portion of the intestine. The colon has several parts, including:
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Cecum: o The portion of the colon that connects to the ileum (small intestine). The appendix is a finger-like pouch that comes off of the cecum. Ascending colon: o The first section after the small intestine, located on the right side Transverse colon: o Sits horizontally across the upper abdomen Descending colon: o Located on the left side of the abdomen Sigmoid: o A short, S-shaped section above the rectum Rectum: o The lowest internal part of the colon

Intestinal anatomy:
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Entire gastrointestinal tract Intestines and other abdominal organs Blood vessels of the intestines The appendix is a small pouch that protrudes from the wall of the large intestine. It is located at the point where the small intestine turns into the large intestine.