Appendix: How to Keep It Healthy and Avoid Infection

The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.

A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.

appendix

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A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you're given antibiotics to clear the infection.

The appendix (or vermiform appendix; also cecal [or caecal] appendix; vermix; or vermiform process) is a finger-like, blind-ended tube connected to the cecum, from which it develops in the embryo. The cecum is a pouch-like structure of the large intestine, located at the junction of the small and the large intestines. The term "vermiform" comes from Latin and means "worm-shaped". The appendix was once considered a vestigial organ, but this view has changed since the early 2000s.[1][2] Research suggests that the appendix may serve an important purpose. In particular, it may serve as a reservoir for beneficial gut bacteria.

The human appendix averages 9 cm (3.5 in) in length but can range from 5 to 35 cm (2.0 to 13.8 in). The diameter of the appendix is 6 mm (0.24 in), and more than 6 mm (0.24 in) is considered a thickened or inflamed appendix. The longest appendix ever removed was 26 cm (10 in) long.[3] The appendix is usually located in the lower right quadrant of the abdomen, near the right hip bone. The base of the appendix is located 2 cm (0.79 in) beneath the ileocecal valve that separates the large intestine from the small intestine. Its position within the abdomen corresponds to a point on the surface known as McBurney's point.

The appendix has been identified as an important component of mammalian mucosal immune function, particularly B cell-mediated immune responses and extrathymically derived T cells. This structure helps in the proper movement and removal of waste matter in the digestive system, contains lymphatic vessels that regulate pathogens, and lastly, might even produce early defences that prevent deadly diseases. Additionally, it is thought that this may provide more immune defences from invading pathogens and getting the lymphatic system's B and T cells to fight the viruses and bacteria that infect that portion of the bowel and training them so that immune responses are targeted and more able to reliably and less dangerously fight off pathogens.[19] In addition, there are different immune cells called innate lymphoid cells that function in the gut in order to help the appendix maintain digestive health.[20] Research also shows a positive correlation between the existence of the appendix and the concentration of cecal lymphoid tissue, which supports the suggestion that not only does the appendix evolve as a complex with the cecum but also has major immune benefits.[21]

Common diseases of the appendix (in humans) are appendicitis and carcinoid tumors (appendiceal carcinoid).[22] Appendix cancer accounts for about 1 in 200 of all gastrointestinal malignancies. In rare cases, adenomas are also present.[23]

Appendicitis is a condition characterized by inflammation of the appendix. Pain often begins in the center of the abdomen, corresponding to the appendix's development as part of the embryonic midgut. This pain is typically a dull, poorly localized, visceral pain.[24]

Appendicitis usually requires the removal of the inflamed appendix, in an appendectomy either by laparotomy or laparoscopy. Untreated, the appendix may rupture, leading to peritonitis, followed by shock, and, if still untreated, death.[24]

The surgical removal of the appendix is called an appendectomy. This removal is normally performed as an emergency procedure when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis. In some cases, the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix. This is a relative contraindication to surgery.

The appendix is also used as a means to access the colon in children with paralysed bowels or major rectal sphincter problems. The appendix is brought out to the skin surface and the child/parent can then attach a catheter and easily wash out the colon (via normal defaecation) using an appropriate solution.[27]

Charles Darwin suggested that the appendix was mainly used by earlier hominids for digesting fibrous vegetation, then evolved to take on a new purpose over time. The very long cecum of some herbivorous animals, such as in the horse or the koala, appears to support this hypothesis. The koala's cecum enables it to host bacteria that specifically help to break down cellulose. Human ancestors may have also relied upon this system when they lived on a diet rich in foliage. As people began to eat more easily digested foods, they may have become less reliant on cellulose-rich plants for energy. As the cecum became less necessary for digestion, mutations that were previously deleterious (and would have hindered evolutionary progress) were no longer important, so the mutations survived. It is suggested that these alleles became more frequent and the cecum continued to shrink. After millions of years, the once-necessary cecum degraded to be the appendix of modern humans.[28]

Recently ... improved understanding of gut immunity has merged with current thinking in biological and medical science, pointing to an apparent function of the mammalian cecal appendix as a safe-house for symbiotic gut microbes, preserving the flora during times of gastrointestinal infection in societies without modern medicine. This function is potentially a selective force for the evolution and maintenance of the appendix.Three morphotypes of cecal-appendices can be described among mammals based primarily on the shape of the cecum: a distinct appendix branching from a rounded or sac-like cecum (as in many primate species), an appendix located at the apex of a long and voluminous cecum (as in the rabbit, greater glider and Cape dune mole rat), and an appendix in the absence of a pronounced cecum (as in the wombat). In addition, long narrow appendix-like structures are found in mammals that either lack an apparent cecum (as in monotremes) or lack a distinct junction between the cecum and appendix-like structure (as in the koala). A cecal appendix has evolved independently at least twice, and apparently represents yet another example of convergence in morphology between Australian marsupials and placentals in the rest of the world. Although the appendix has apparently been lost by numerous species, it has also been maintained for more than 80 million years in at least one clade.[29]

In a 2013 paper, the appendix was found to have evolved at least 32 times (and perhaps as many as 38 times) and to have been lost no more than six times.[30] A more recent study using similar methods on an updated database yielded similar, though less spectacular results, with at least 29 gains and at the most 12 losses (all of which were ambiguous), and this is still significantly asymmetrical.[31] This suggests that the cecal appendix has a selective advantage in many situations and argues strongly against its vestigial nature. This complex evolutionary history of the appendix, along with a great heterogeneity in its evolutionary rate in various taxa, suggests that it is a recurrent trait.[32]

The appendix contains a particular type of tissue associated with the lymphatic system, which carries the white blood cells needed to fight infections. In recent years, scientists have found that lymphatic tissue encourages the growth of some beneficial gut bacteria, which play an important role in human digestion and immunity.

Researchers have recently found that numerous animals, including great apes, other primates, opossums, wombats, rabbits, and certain rodents all have structures similar to the appendix. (8) The appendix, it seems, may have independently evolved in different animals at least 32 times over the course of history, suggesting the organ does have an important function. (4)

Appendicitis is often the result of an abdominal infection that has spread to the tiny organ, or some kind of obstruction that has blocked the small opening of the appendix. Sources of blockage include, among other things:

Restriction of Appendix materials is intended to rectify inequities in the peer review process that can arise from submission of inappropriate or excessive appendix materials by some applicants and consideration of Appendix materials in peer review by some, but not all, reviewers.

All information submitted with an application except the cover letter, assignment request form, and appendix information is assembled into a single application image for funding consideration. The different sections within the application image are specified in the application instructions and correspond to the standard review criteria.

Some FOAs further restrict allowable appendix materials and/or may specify that some materials listed above must be provided in another part of the application. Applications submitted to those FOAs must follow instructions in the FOA and must not put those items in the Appendix.

The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts.

You may never have given much thought to your appendix, the little pouch that's attached to the top of your large intestine. And you wouldn't have much reason to think about it, because it doesn't seem to do anything. But if your appendix were to become swollen and inflamed, it would probably move to the front of your mind. The pain of appendicitis can make you quickly, and unpleasantly, familiar with this organ. You can get appendicitis if your appendix becomes blocked. That blockage could be from feces, a foreign object, or, in rare cases, a tumor. When your appendix is blocked up, bacteria that normally live inside it start multiplying like crazy, and cause an infection. If you've got appendicitis you'll usually have pain that's centered around the area of your belly button. At first the pain may be minor, but it can get very severe and will usually drift downward to the bottom right part of your abdomen. You may also have nausea, vomiting, diarrhea or constipation, and a low fever. Your pain may let up for a time. This relief can be misleading, though. Just when you think you're getting better, your appendix may have actually burst. If that's the case, the pain will get start to get more and more intense. To diagnose appendicitis, your doctor will ask about your symptoms and press on your abdomen, which will feel very tender. You may need imaging tests, such as a CT scan or ultrasound of your abdomen, so the doctor can see if the problem is with your appendix. If you have appendicitis, the number one way to treat it is with surgery to remove your appendix. In fact, appendicitis is the number one cause of emergency abdominal surgery in the U.S. You may be treated for an infection first, before your surgery. It's important to treat the appendicitis quickly because you can develop a collection of pus called an abscess in your abdomen once your appendix bursts. Don't worry about going through life without an appendix. People live healthy lives without it. Once you've had your appendix taken out, you should feel a lot better. If your appendix has ruptured, it may take you longer to recover. You may also develop an abscess or other complications. That's why you don't want to wait until your appendix has already burst to get treated. Call your doctor for any severe pain in your abdomen, especially if you also have a fever, vomiting, constipation, dizziness, or other severe symptoms. 2ff7e9595c