Vermiform appendix: Difference between revisions

The '''vermiform appendix''', usually just '''appendix''', is a little thingy that is attached to the [[cecum]].  Taking it out is the bread 'n butter of [[general surgery]].

The appendix is a vestigial structure that is thought to have arisen from a larger cecum.  Larger cecae are often seen in herbivores and thought to facilitate better digestion of plant matter.<ref>{{cite book |author=Dawkins, R. |title=The Greatest Show on Earth: The Evidence for Evolution |publisher=Free Press |location= |year=2009 |pages=115 |edition=1st |isbn=978-1416594789 |oclc= |doi= |accessdate=}}</ref>  

=Normal=

==Normal vermiform appendix==

*Seen in:

***[[Crohn's disease]].

**Surgeries for ovarian mucinous tumours.

**No exudate.

*Normal diameter.

**6.6 +/- 1.5 mm -- based on CT.<ref name=pmid21344807>{{Cite journal  | last1 = Charoensak | first1 = A. | last2 = Pongpornsup | first2 = S. | last3 = Suthikeeree | first3 = W. | title = Wall thickness and outer diameter of the normal appendix in adults using 64 slices multidetector CT. | journal = J Med Assoc Thai | volume = 93 | issue = 12 | pages = 1437-42 | month = Dec | year = 2010 | doi =  | PMID = 21344807 }}</ref>

*+/-Lymphoid hyperplasia - mucosa or submucosa.

*Normal colorectal-type mucosa.

*Fatty submucosa.

*Benign smooth muscle.

*Serosa.

*No [[neutrophil]]s in the muscularis propria.

*No lesion in appendiceal tip.

*No serosal inflammation ([[periappendicitis]]).

*No organisms in the appendiceal lumen, e.g. [[Enterobius vermicularis]].

*[[Cryptosporidiosis]].

*Mild colitis.

===Sign out===

VERMIFORM APPENDIX WITHIN NORMAL LIMITS.

Note:

*This is for a normal appendix within a larger operation. The article ''[[negative appendectomy]]'' deals with a normal appearing appendix that was removed for presumed appendicitis.

==Negative appendectomy==

{{Main|Negative appendectomy}}

=Inflammatory pathologies=

==Acute appendicitis==

==Enterobius vermicularis==

===General===

*May be found in the appendix.

*The incidence is higher in normal appendices than inflamed ones.<ref name=pmid1853157>{{Cite journal  | last1 = Wiebe | first1 = BM. | title = Appendicitis and Enterobius vermicularis. | journal = Scand J Gastroenterol | volume = 26 | issue = 3 | pages = 336-8 | month = Mar | year = 1991 | doi =  | PMID = 1853157 }}</ref><ref name=pmid7945067/>

*Clinically mimics appendicitis.<ref>{{cite journal |author=Ariyarathenam AV, Nachimuthu S, Tang TY, Courtney ED, Harris SA, Harris AM |title=Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review |journal=Int J Surg |volume=8 |issue=6 |pages=466–9 |year=2010 |pmid=20637320 |doi=10.1016/j.ijsu.2010.06.007 |url=}}</ref>

===Microscopic===

*Usu. the appendiceal wall has no inflammation, i.e. there is no appendicitis.<ref name=pmid1853157/><ref name=pmid7945067>{{Cite journal  | last1 = Dahlstrom | first1 = JE. | last2 = Macarthur | first2 = EB. | title = Enterobius vermicularis: a possible cause of symptoms resembling appendicitis. | journal = Aust N Z J Surg | volume = 64 | issue = 10 | pages = 692-4 | month = Oct | year = 1994 | doi =  | PMID = 7945067 }}</ref>

*''[[Enterobius vermicularis]]'' organisms.

 

Image:Pinworms_in_the_Appendix_%281%29.jpg | Pinworm (WC/Uthman)

{{Main|Granulomatous appendicitis}}

 

==Inflammatory bowel disease==

: See ''[[Inflammatory bowel disease]]''.

 

==Periappendicitis==

===General===

Definition: inflammation of tissues around the (vermiform) appendix.<ref>URL: [http://www.medilexicon.com/medicaldictionary.php?t=66889 http://www.medilexicon.com/medicaldictionary.php?t=66889]. Accessed on: 1 June 2011.</ref>

*May be seen in association of appendicitis or alone.

**With appendicitis it is suggestive of perforation.

**Without concurrent appendicitis it is suggestive of another abdominal pathology.<ref name=pmid2349982>{{Cite journal | last1 = Fink | first1 = AS. | last2 = Kosakowski | first2 = CA. | last3 = Hiatt | first3 = JR. | last4 = Cochran | first4 = AJ. | title = Periappendicitis is a significant clinical finding. | journal = Am J Surg | volume = 159 | issue = 6 | pages = 564-8 | month = Jun | year = 1990 | doi = | PMID = 2349982 }}</ref><ref>{{Cite journal  | last1 = O'Neil | first1 = MB. | last2 = Moore | first2 = DB. | title = Periappendicitis: Clinical reality or pathologic curiosity? | journal = Am J Surg | volume = 134 | issue = 3 | pages = 356-7 | month = Sep | year = 1977 | doi =  | PMID = 900337 }}</ref>

*Acute inflammation of the serosa.

**[[Neutrophil]]s in the serosa.

*[[Acute appendicitis]].

=Tumours of the appendix=

==Adenocarcinoma==

*Like ''colorectal adenocarcinoma'' - see ''[[colorectal tumours]]''.

This grouping includes ''mucinous cystadenoma'' and ''mucinous cystadenocarcinoma''.

*Previously known as ''goblet cell carcinoid''.

*Previously known as ''appendiceal carcinoid''.

*[[AKA]] ''appendiceal neuroendocrine tumour'', abbreviated ''appendiceal NET''.  

{{Main|Neuroendocrine tumour of the appendix}}

=See also=

=References=