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What Is an Appendix? Anatomy and Complications

The appendix is an intestinal tube attached where the small intestines connect to the large intestines. The pouch-like appendix was previously thought to be entirely unnecessary. Read on to find out what your appendix is, how it influences your digestive system and general wellness, and what happens when it becomes inflamed.

The appendix is a pouch-like structure at the bottom of the cecum, which is where the small intestines connect to the large intestines. The wall of the appendix consists of four layers: a smooth outer layer (serosa), muscular layer (muscularis externa), connective layer (submucosa), and inner lining (mucosa).

Because all bodies are different, the appendix might be in a different place or position in different people. Other factors influence where the appendix is at any given moment, including breathing, swelling of the surrounding intestines, and posture.

The inside of the appendix is called the lumen. The lumen is narrow, worm-like, and a rich source of biofilms, which continuously shed helpful bacteria into your large intestines.

Until recently, the appendix was thought to be a primitive part of the large intestines with little or no practical function. However, over the last few years, several clinical studies have suggested that it may be important for preserving and developing the intestines’ immune system.

The appendix contains a lot of lymphatic tissue and produces immunoglobulins, which are a group of proteins that function like antibodies. They help regulate the good bacteria in your intestines.

The location and shape of the appendix make it a perfect place to store good bacteria. For instance, after an episode of diarrhea, the appendix can quickly replenish your large bowel with good bacteria. 

Many people who have had their appendix removed after appendicitis live a healthy life. However, several clinical reports propose that having your appendix removed may be linked to more inflammatory disorders such as heart disease, inflammatory bowel disease, and Parkinson’s disease.

Your appendix also works with your digestive system to eliminate waste.

Appendicitis is when your appendix becomes inflamed.

Some of the symptoms and signs of appendicitis are:

  • Sudden pain starting in the right lower abdomen 
  • Sudden pain starting around the navel and then shifting to the right lower abdomen
  • Pain that becomes worse when you’re coughing, walking, or making other types of jarring movements
  • Vomiting and nausea
  • Reduced appetite
  • Fever (low-grade) that may get worse 
  • Diarrhea or constipation
  • Flatulence (gas)
  • Bloating

Because the location of your appendix may be different than other people’s, the location of the pain due to appendicitis may also differ. For most people, the pain starts around the belly button and shifts gradually. Appendicitis usually becomes more painful and severe as the inflammation increases.

During pregnancy, pain from appendicitis may come from the upper abdomen because the appendix is higher during pregnancy.

Inflammation of the appendix is usually caused by a blockage in the appendiceal lining, resulting in an infection. Some of the things that can cause a blockage like this include:

  • Inflammation
  • Viruses
  • Bacteria
  • Parasites
  • Hard stool
  • Ulcers
  • Enlarged tissues
  • Abdominal tearing

The bacteria can multiply quickly, causing the appendix to swell, become inflamed, and form pus. Your appendix can rupture if you don’t get prompt treatment.

If you develop pain that spreads over your abdomen and gets worse gradually, or if the pain gets better temporarily and then worse again, seek immediate medical help.

To treat appendicitis, the doctor usually performs laparoscopic surgery to remove the appendix, called an appendectomy. You may have to take antibiotics before surgery to treat the infection. It usually takes a few weeks to recover completely from an appendectomy.

Malignant tumors on the appendix can occur along with acute appendicitis. If there are tumors, the doctor will diagnose them when they assess the inflamed appendix after removing it.

Appendix cancer might not produce any symptoms. The doctor may find it during a routine colonoscopy, surgery, or imaging studies for other issues, including suspected ovarian cancer.

If appendix cancer produces symptoms, then the disease is often in an advanced stage. Advanced appendix cancer may cause the abdomen to become distended. It may also cause pain if the cancer spreads to the membrane that lines the abdominal cavity and covers the abdominal organs (peritoneum).

There are three kinds of tumors that can occur in the appendix:

  • Carcinoid tumor (also commonly called a neuroendocrine tumor) — This is a rare kind of cancer that grows very slowly. About 50 percent of all appendix cancers are of this type.
  • Mucinous neoplasms — These tumors are usually benign and include appendix mucocele (an accumulation of mucus in the appendix) and appendiceal low-grade mucinous neoplasms (tumors that have the potential to become malignant).
  • Appendix adenocarcinoma — This kind of appendix cancer starts as cells lining the inside cavity of the appendix. Its treatment is similar to the treatment of cancer of the colon and rectum.
  • Goblet cell carcinoma/adenocarcinoid — This kind of tumor has characteristics of both carcinoid and adenocarcinoma tumors. It is more aggressive than a carcinoid tumor.

Some of the symptoms of appendix cancer include:

  • Pain in the pelvis or stomach
  • Bloating
  • Accumulation of fluid in your abdomen 

When making a diagnosis of appendix cancer, your doctor will consider your age, symptoms, medical history, and the type of tumor they suspect. They may also order tests to check for appendix cancer, including:

  • Ultrasound
  • Biopsy
  • Computed tomography scan
  • Magnetic resonance imaging

Treatment for appendix cancer depends on the extent of the cancer and its subtype. Surgery is one of the most common treatments for appendix cancer.

To treat appendix cancer, the surgeon may perform one of the following kinds of surgeries:

  • An appendectomy is the removal of your appendix.
  • In a hemicolectomy, the surgeon removes part of your colon next to the appendix. This type of surgery is usually done for a carcinoid tumor that is larger than two centimeters.
  • A cytoreductive surgery is often done for tumors that have spread (non-carcinoid tumors). The surgeon will remove the tumor along with the surrounding fluid.
  • A peritonectomy is often done when the appendix cancer has spread beyond the large intestine. The surgeon may also remove the peritoneum.
  • In hyperthermic intraperitoneal chemotherapy, the doctor fills the abdominal cavity with heated chemotherapy drugs.
  • Chemotherapy involves strong chemicals that help kill off fast-growing cells.

Some factors that may increase your risk of developing appendix cancer include:

  • Smoking — The risk of developing appendix cancer is higher in smokers than in nonsmokers.
  • Medical history — Having a history of medical conditions that affect your stomach’s ability to produce acids (such as pernicious anemia or atrophic gastritis) increases your risk.
  • Family history — Having a family history of multiple endocrine neoplasia type 1 syndrome or appendix cancer increases your risk.
  • Age — Your risk of developing appendix cancer increases with age.
  • Sex — Women are at a higher risk of developing carcinoid tumors than men.

The appendix helps supply helpful bacteria to your gut and helps your intestines eliminate waste. It is a narrow pouch-like structure at the bottom of the place where your small intestines meet your large intestines. It used to be thought of as a primitive organ with very little function. But according to recent research, the appendix stores beneficial intestinal flora.

https://www.ncbi.nlm.nih.gov/books/NBK459205/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011360/

https://pubmed.ncbi.nlm.nih.gov/29503124-the-immunological-functions-of-the-appendix-an-example-of-redundancy/

https://pubmed.ncbi.nlm.nih.gov/15228837-the-vermiform-appendix-not-a-useless-organ/

https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543

https://www.nhs.uk/conditions/appendicitis/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655112/

https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendix-cancer

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