2. CAUSES
• Obstruction of the lumen is the dominant causal factor. The obstructing object can
be:
*fecalith ; the most common
*lymphoid tissue hypertrophy
*inspisated barium from previous study
*tumors
*seeds
ANATOMY OF APPENDIX
1. Part of gastrointestinal or digestive system
2. 8 to 10 cm hallow tube that is closed at one end and is attached at other end to
cecum
Appendix is located near the junction of small intestine and large intestine in
right lower quadrant of the abdomen near the right hip done
Appendix position within the abdomen corresponds to a point on the surface known
as Mc Burney’s point.
Mc Burney’s point 1/3 of the distance from anterior superior iliac spine to umbilics
The relationship of base of appendix to cecum remains constant, whereas the tip
can be found in rectrocecal, plevic, subcecal, perileal or right precolic position
Found at a point where taniae coli converges on posteromedial wall of cecum
Mesoappendix
peritoneal fold enclosing appendicular vessels
It is prolongation of the mesentry of terminal ileum
BLOOD SUPPLY TO THE APPENDIX
Arterial supply to appendix is by means of the appendicular artery, inferior
branch of ileocolic artery of superior mesentirc trunk
Appendicular vein, branch of ileocolic vein drains appendiceacl venous network
into superior mesentric vein and eventually into portal circulation
LYMPH SUPPLY
Lymph vessel drains into one or two nodes lying in the mesoappendix, from
there lymph passes to no of mesentric nodes to reach superior mesentric node
NERVE SUPPLY
The nerve of appendix are derived from sympathetic and parasympathetic (vagus) nerve
from superior mesenteric plexus
4. in Rocky Davis incision the incision is placed transversely (as opposed to obliquely, like
the McBurney’s incision) between the junction of the lower and middle third of a line from
the superior anterior iliac spine to the umbilicus and the lateral border of the rectus
abdominis muscle.
In case of presence of abscess the incision is laterally displaced to allow
retroperitoneal drainage. Taeniae coli is converged at the base of the appendix.
Mesoappendix is divided and the appendix is mobilized with ligation of the appendiceal
artery.
Laparoscopic Appendectomy: The laparoscopic (minimally invasive) surgical technique
involves making several tiny cuts in the abdomen and inserting a miniature camera and
surgical instruments. Three incisions are made in the abdomen where ag po
port or nozzle is inserted with carbon dioxide in order to inflate appendix then
through second port laparoscope is inserted, camera projects a magnified image of
the area onto a television monitor which helps guide the surgeons as they remove
the appendix then in third port surgical instrument is inserted and appendix is
removed.
Port Placement:
10mm trocar placed through umbilicus (this port holds camera)
5mm trocar placed at suprapubic region
5mm trocar placed at lower left quadrant.
Instrument used in Laparoscopy:
Atraumatic grasper
Laparoscopic scissors
Dissector
Endo GIA (or stapler, or endoloop ligature applicator)
Suction/irrigation device
Extraction tube
Extraction bag
Zerodegree scope
3 Trocars (two 5mm and one 10mm)
Alternately, electrocautery tools may also be used.
5. Appendix can also be treated non surgically usually in the early signs and
symptoms of appendicitis before its rupture. The antibiotics used according as
prescribed during this early phase within 46 weeks can treat the appendix. These
are numerous types of antibiotics that can be used for the treatment of appendix:
imipenemcilastatin
metronidazole
ciprofloxacin
ampicillin
clindamycin
levofloxacin
cefoxitin
cefazolin
cefotetan
ampicillinsulbactam
ertapenem
ticarcillinclavulanata
Preventions
•
There is no sure way to prevent appendicitis because it comes on suddenly and the
cause is usually unknown. However, eating a diet that includes fresh vegetables
and fruit with high fibers may lower your risk of getting appendicitis that makes
stool softer and prevents the chances of wastes to be sticked in the appendix.
•
To decrease the rate of rupture, get medical care right away for severe abdominal
pain.
6. Appendix can also be treated non surgically usually in the early signs and
symptoms of appendicitis before its rupture. The antibiotics used according as
prescribed during this early phase within 46 weeks can treat the appendix. These
are numerous types of antibiotics that can be used for the treatment of appendix:
imipenemcilastatin
metronidazole
ciprofloxacin
ampicillin
clindamycin
levofloxacin
cefoxitin
cefazolin
cefotetan
ampicillinsulbactam
ertapenem
ticarcillinclavulanata
Preventions
•
There is no sure way to prevent appendicitis because it comes on suddenly and the
cause is usually unknown. However, eating a diet that includes fresh vegetables
and fruit with high fibers may lower your risk of getting appendicitis that makes
stool softer and prevents the chances of wastes to be sticked in the appendix.
•
To decrease the rate of rupture, get medical care right away for severe abdominal
pain.