Appendix

Dr.Kumar has more than 29 years of experience in treating patients with appendicitis and performing APPENDICULAR SURGERY,especially LAPAROSCOPIC APPENDECTOMY.

He is an expert in the field of LAPAROSCOPIC APPENDICECTOMY and even in patients with complicated appendicitis,he has successfully perform laparoscopic appendicectomy in hundreds of patients.

With his experience and expertise Dr.KUMAR can be considered as the best doctor for appendicitis and best doctor for laparoscopic appendicectomy.

WHAT IS APPENDIX?

The human body’s appendix also known as the vermiform appendix is a muscular and tubular organ that is joined to the large intestine near its junction with small intestine and it is usually present in the right lower abdomen.Its term vermiform which means worm shaped comes from the latin word for a small tube that resembles a worm.The appendix protudes from the cecum a pouch like structure in the large intestine at its lower end near its junction with the small intestine.

The appendix typically has a diameter of 7to 8mm and a length of 2 to 20cm with an average length of 9cm.

WHAT ARE THE FUNCTIONS OF APPENDIX ?

The appendix is rudimentary, it has lost its purpose and its now redundant and almost has no function.According to scientists and to some studies the appendix maybe a source of lymphoid cells,which aid in the body’s ability to fight infections.As a result,it may play a part in the immune system,but function is not clear.

WHAT IS APPENDICITIS?

Appendicitis is infection of the appendix and is a painful condition in which the appendix becomes inflamed and filled with pus, a fluid made up of dead cells and inflammatory tissue that often results from an infection.The appendix becomes large and enlarged and the infection may spread to the surrounding tissues and the appendix may become rotten and several times it may burst causing peritonitis.

WHAT ARE THE CAUSES OF APPENDICITIS ?

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.Constipation can lead to an appendicolith in the appendix,which can lead to appendicitis.Intestinal infection can spread to appendix leading to appendicitis.

WHAT ARE THE SYMPTOMS OF APPENDICITIS?

  • Sudden pain that begins on the right side of the lower abdomen.
  • Sudden pain that begins around your navel and often shifts to your lower right abdomen.
  • Pain that worsens if you cough,walk or make other jarring movements.
  • Nausea and vomiting
  • Loss of appetite
  • Low grade fever that may worsen as the illness progresses.
  • Constipation or diarrhea.
  • Abdominal bloating
  • Flatulence

    • The site of pain may vary,depending on your age and position of your appendix and the severity of appendicitis,but most of the time the pain is in the right lower abdomen.

    WHAT ARE THE COMPLICATION OF APPENDICITIS ?

    If your appendix ruptures can cause serious complications like fecal matter spill and spill of bacteria into your abdominal cavity.A ruptured appendix can lead to painful and potentially life threatening infections including,

    • Peritonitis
    • Rupture
    • Perforation
    • Gangerous
    • Abscesses
    • Sepsis

    PERITONITIS– If appendix bursts,the lining of your abdomen (peritoneum) will become infected with bacteria.This is called peritonitis.Internal organs can also be damaged.

    APPENDICULAR ABSCESSES

    Abscess forms around a burst appendix.This is a painful collection of pus that forms when the body tries to fight the infection and appendix is surrounded by pus and it is an emergency situation which needs to be operated urgently.

    APPENDICULAR MASS

    Sometimes the surroundings intestines adhere to the appendix forming a mass.This is a late presentation of improperly treated appendicitis and many times may have to be conservatively treated with medicines and planned for interval appendicectomy later.Most of the time the appendicular mass can be diagnosed on CT scan.

    WHAT ARE THE INVESTIGATION TO DIAGNOSE APPENDICiTIS

    Most of the times the doctors examining the patient may clinically diagnose the appendicitis however the diagnosis of appendicitis can be confirmed by doing CT scan of the abdomen/ultrasound of the abdomen /biochemical blood investigations.Most of the time the surgeon needs to have a high degree of suspicious so that diagnosis of appendicitis is not missed.

    TREATMENT

    Treatment usually involves surgery to remove the inflamed appendix.Before surgery a dose of antibiotics given to treat infection.

    APPENDECTOMY

  • Removal of the appendix is carried out under general anaesthetic using two methods
  • Laparoscopic Appendicectomy
  • Open Appendicectomy

    • LAPAROSCOPIC APPENDICECTOMY

    Laparoscopic surgery (key hole surgery)entails making small incision in the abdomen and inserting a miniaturized camera and laparoscopic surgical instruments.Usually three holes may be made.The surgeon then removes the appendix with the laparoscopic instruments,eliminating the need for a big incision in the belly.The camera displays a magnified view of the region onto a monitor assisting surgeons in removing the appendix.Most of the time laparoscopic surgery is done to remove the appendix.Dr.Kumar has a large experience and he is an expert in laparoscopic appendicectomy procedure.Laparoscopy has distinct advantage of lesser pain, faster recovery, early discharge and early return to work.

    OPEN APPENDECTOMY

    Even though most of the times laparoscopic is done to remove the appendix very rarely sometimes open surgery maybe required to remove the appendix.

    In open surgery a single larger cut is made in the lower right side of abdomen /lower midline to remove the appendix.

    Open surgery is recommended when the appendix has already burst and formed a lump and complicated situation arises ,when there is widespread infection of the inner lining of the abdomen its sometimes necessary to operate through a cut along the middle of the abdomen.

    Most of the time Dr.Kumar removes the appendix by laparoscopic even in most complicated cases and only rare cases open surgery is performed.

    RECOVERY AFTER APPENDIX SURGERY

    Usually hospitalization after surgery is around two days and patient may need to take rest for approximately five days to a week before returning to excecutive work.In a month time patient can get back to almost all types of work.Sometimes after open appendectomy the recovery period maybe longer .

    DIET AFTER APPENDECTOMY

    Usually after appendectomy we gradually start liquid diet and the gradually shift to soft bland diet and after a month absolutely normal diet.Advised to avoid constipation.Advised to drink lot of water and high fibre food.

    TYPES OF APPENDICITIS

  • SUBACUTE APPENDICITIS-Many times the infection with appendix is mild and the symptoms may not be severe and it is called subacute appendicitis.
  • ACUTE APPENDICITIS-When the infection and the pain is sudden onset it is acute appendicitis.
  • RECURRENT APPENDICITIS-Sometimes the appendicular infection comes mildly and then disappears and becomes alright and then pain recurs later.This is called Recurrent appendicitis.
  • PERFORATED APPENDIX-It is one of the complication of acute appendicitis.When appendicitis is left untreated, necrosis of the appendiceal wall can occur and progress to a focal rupture.
  • GANGRENOUS APPENDICITIS-Pain in appendix with necrosis of the wall of the appendix and most commonly developing in obstructive appendicitis.And the appendix becomes gangrenous.
  • APPENDICULAR MASS- sometimes the appendix becomes infected and forms a mass with the surrounding intestine,which is called appendicular mass.
  • APPENDICULAR ABSCESS- sometimes the appendix get infected leading to pus formation and forms appendicular abscess.

    • WHAT IS APPENDICOLITH?

    A calcified deposit found inside the appendix is called an appendicolith.They can be an incidental finding on an abdominal radiograph or CT and are found in many children with acute appendicitis.Patients who have a retrocecal appendix may have an increase in incidence.

    Mineral deposists and hard thick stool and constipation combine to produce the appendicolith.Appendiceal calculi,Appendiceal enterolith or Appendicular lithiasis are the other names for it.Young people and pediatric groups frequently have appendicoliths.Mens are more likely to have them found.

    WHAT IS MUCOCELE OF APPENDIX

    It is an obstructive dilatation of the appendix caused by intraluminal accumulation of mucoid material.

    It is a fluid filled growth that develops on the mucosal membrane of the appendix.

    Mucocele of appendix are caused by excessive mucous production and surgery is necessary to remove the appendix.

    WHAT IS STUMP APPENDICITIS

    Stump appendicitis is the inflammation of the residual appendiceal tissue after an appendectomy (removal of appendix).

    This is due to reinflammation of the residual part of the appendix due to incomplete appendectomy.

    APPENDICULAR CARCINOMA

    Appendicular carcinoma is a type of cancer that grows from cells that made up of appendix. There are two main types of appendiceal cancer;epithelial appendiceal cancer and neuroendocrine appendiceal cancer.

    Epithelial appendiceal cancer grows from cells that made up the lining of the appendix.It may also be called adenocarcinoma.These cells help make a jelly-like substance called mucin.

    Neuroendocrine appendiceal cancer -Enterochromaffin cells (ECs) are the source of growth in neuroendocrine tumors of appendix.ECs produce substance that aids in digestion and bowel motion,This is the most typical form of appendiceal cancer.They are also called carcinoid tumors.

    Directly from the appendix,appendiceal cancer can spread to other areas of the abdomen.Generally when it ruptures.Appendiceal carcinoma can ready spread outside of the abdomen through lymph nodes.

    APPENDICITIS IN PREGNANCY

    The symptoms of appendicitis may be mistaken for routine discomfort from pregnancy.Pregnancy can also cause your appendix to shift upwards in abdomen,which can affect the location of appendicitis-related pain.This can make it harder to diagnose.

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