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Appendectomy Appendicectomy (or appendectomy) is the surgical removal of the vermiform appendix.

This procedure 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; it is now recognized that many cases will resolve when treated non-operatively. In some cases the appendicitis resolved completely; more often, an inflammatory mass forms around the appendix. Appendicectomy may be performed laparoscopically or as an open operation. Laparoscopy is often used if the diagnosis is in doubt, or if it is desirable to hide the scars in the umbilicus or in the pubic hair line. Recovery may be a little quicker with laparoscopic surgery; the procedure is more expensive and resource-intensive than open surgery and generally takes a little longer, with the (low in most patients) additional risks associated with pneumoperitoneum (inflating the abdomen with gas). Advanced pelvic sepsis occasionally requires a lover midline laparotomy.

Anatomy and Physiology

The appendix (or vermiform appendix; also cecal (or cecal) appendix; also vermix) is a blind-ended tube connected to the cecum (or caecum), from which it develops embryologically. The cecum is a pouchlike structure of the colon. The appendix is located near the junction of the small intestine and the large intestine. The term vermiform comes from latin and means worm-shaped Size and location

The appendix averages 10cm in length, but can range from 2 to 20cm. the diameter of the appendix is usually between 7 and 8 mm. The longest appendix ever removed measured 26cm in Zagreb, Croatia. The appendix is located in the lower quadrant of the abdomen, or more specifically, the right iliac fossa. Its position within the abdomen corresponds to a point on the surface known as McBurneys point. While the base of the appendix is at a fairly constant location, 2cm below the ileocaecal valve, the location of the tip of the appendix can vary from being retrocaecal (74%) to being the pelvis o being extraperitoneal. In rare individuals with situs in versus, the appendix may be located in the lower left side.

Maintaining gut flora Although it was long accepted that the immune tissue, called gut associated lymphoid tissue, surrounding the appendix and elsewhere in the gut carries out a number of important functions, explanations were lacking for the distinctive shape of the appendix and its apparent lack of importance as judged by an absence of side-effects following appendectomy. William Parker, Randy Bollinger, and colleagues at Duke University proposed that the appendix serves as a haven for useful bacteria when illness flushes those bacteria from the rest of the intestines. This proposal is based on a new understanding of how the immune system supports the growth of beneficial intestinal bacteria, in combination with many well-known features of the appendix, including its architecture and its association with copious amounts of immune tissue. Such a function is expected to be useful in a culture lacking modern sanitation and health care practice, where diarrhea may be prevalent.

Mouth (Oral cavity/ Bucal Cavity, includes tongue, teeth, salivary glands and mucosa) The mouth is the first of the digestive tract. It is the opening through which takes food. It is lined by stratified squamous non-cornified epithelium, except the hard palate, gingival and filiform papillae of tongue which are cornified. It is bound infront by the lips, above by the hard and soft palate, below by the floor of the mouth including the tongue and behind by faucial isthmus. Pharynx The pharynx is the part of the digestive system which connects the mouth with esophagus. It is where the digestive tract and the respiratory tract cross, commonly called the throat. The human pharynx is bent at a sharper angle. Esophagus (Gullet/Oesophagus) The esophagus is a muscular tube, lined with moist stratified squamous epithelium that extends from the pharynx to the stomach. It is about 25cms. Long and lies anterior to the vertebrae and posterior to the trachea within the mediasternum. It passes through the diaphragm and ends at the stomach. It transports food from the pharynx to the stomach. Stomach The stomach is an enlarged segment of the digestive tract in the left superior part of the abdomen. It is an alimentary canal used to store and digest food. Its primary function is a storage and mixing chamber for the stomach include Ventriculuc and Gasti, many medical terms realted to the stomach part in gastro or gastric. In humans the stomach is a highly acidic environment (maintain by the hydrochloric acid secretion) wit peptidase digestive enzymes. In ruminants, the stomach is a large multichambered organ that hostssymbiotiv bacteria which produced enzymes required for the digestion of cellulose from plant matter. The partially digestive plant matter passes through each of the stomachs chamber in sequence, being regurgitated and rechewed at least once in the process. Bowel/Intestine

Small Intestine Small intestine is the portion of the alimentary tract between the stomach and the large intestines whose main function is for absorption. It is about 6 meters long and consists of 3 parts: duodenum; jejunum and ileum.

Duodenum Duodenum is a hollow jointed tube that connects the stomach to the jejunum, it is the shortest, the widest and most fixed part of the small intestine and is largely retro-peritoneal closely attached to the dorsal wall. Jejunum Jejunum is about 2.5 meters long and makes up 2/5 of the total length of the small intestine. Ileum The ileum joins with the cecum at ileocal junction. It is about 3.5 meters long and it makes up 3/5 of the small intestine. Large Intestine The large intestine extends from the ileocal junction up to the anal opening in the peritoneum. It is about 5-6 feet long. It is subdivided into: cecum and appendix, colon, rectum and anal canal. Cecum and Appendix Cecum is the proximal end of the large intestine and is where the large and the small intestine meet at the ileocal junction. It is located in the right lower quadrant of the abdomen near the iliac fossa. It is a sac thar extends inferiorly about 6 cms. Past ileocal junction. Attached to the cecum is a tube about 9 cms. Long called appendix. Colon The colon is about 1.5-1.8 meters long and consists of four parts: Ascending Colon Transverse Colon Descending Colon and Sigmoid Colon Ascending Colon

The ascending colon extends superiorly from the ceccum to the right colic flexure near the liver, where it turns left. Transverse Colon The transverse colon extends from the right colic flexure to the left colic flexure near the spleen, where the colon turns inferiorly.

Descending Colon and Sigmoid Colon The descending colon extends from the left colic flexure to the pelvis, where it becomes the sigmoid colon. The sigmoid colon foms an s-shaped tube that extends medically and the inferiorly into the pelvic cavity and ends at the rectum. Rectum The rectum is a straight muscular tube that begins at the termination of the sigmoid colon and ends at the anal canal. Anal Canal The anal canal represents the terminal portion of the large intestines and it is about 2-3 cms. Long.

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