Vermiform appendix

Infobox Anatomy
Name = Vermiform Appendix
Latin = appendix vermiformis
GraySubject = 249
GrayPage = 1178


Caption = Arteries of cecum and vermiform appendix. (Appendix visible at lower right, labeled as "vermiform process").


Caption2 = Normal location of the appendix relative to other organs of the digestive system (frontal view).
Precursor = Midgut
System = Digestive
Artery = appendicular artery
Vein = appendicular vein
MeshName = Appendix
MeshNumber = A03.556.124.526.209.290
DorlandsPre = a_54
DorlandsSuf = 12147735
In human anatomy, the appendix (or vermiform appendix; also cecal (or caecal) appendix; also vermix) is a blind ended tube connected to the cecum (or caecum), from which it develops embryologically. The cecum is a pouch-like structure of the colon. The appendix is near the junction of the small intestine and the large intestine.

The term "vermiform" comes from Latin and means "worm-like in appearance".

ize and location

The appendix averages 10 cm in length, but can range from 2 to 20 cm. The diameter of the appendix is usually between 7 and 8 mm. The longest appendix ever removed measured 26 cm in Zagreb, Croatia. [http://www.guinnessworldrecords.com/records/human_body/body_parts/largest_appendix_removed.aspx Guinness world record for longest appendix removed.] ] The appendix is located in the lower right quadrant of the abdomen, or more specifically, the right iliac fossa.Paterson-Brown S. The acute abdomen and intestinal obstruction. Chapter 15 in Garden O.J., Bradbury A.W., Forsythe J.L.R., Parks R.W. (2007) Principles and Practise of Surgery, Fifth Edition, Churchill Livingstone Elsevier.] Its position within the abdomen corresponds to a point on the surface known as McBurney's point (see below). While the base of the appendix is at a fairly constant location, 2 cm below the ileocaecal valve , the location of the tip of the appendix can vary from being retrocaecal (74% ) to being in the pelvis to being extraperitoneal. In rare individuals with situs inversus, the appendix may be located in the lower left side.

Function

Given the appendix's propensity to cause death via infection, and the general good health of people who have had their appendix removed, the purpose of the appendix has mystified scientists for some time. There have been cases of people who have been found, usually on laparoscopy or laparotomy, to have a congenital absence of an appendix. There have been no reports of impaired immune or gastrointestinal function in these people.

Vestigiality

The most common explanation is that the appendix is a vestigial structure which now has no purpose. In " [http://onlinebooks.library.upenn.edu/webbin/gutbook/lookup?num=1043 The Story of Evolution] ", Joseph McCabe argued thus:

The vermiform appendage—in which some recent medical writers have vainly endeavoured to find a utility—is the shrunken remainder of a large and normal intestine of a remote ancestor. This interpretation of it would stand even if it were found to have a certain use in the human body. Vestigial organs are sometimes pressed into a secondary use when their original function has been lost.

One potential ancestral purpose put forth by DarwinDarwin, Charles (1871) "Jim's Jesus". "The Descent of Man, and Selection in Relation to Sex". John Murray: London.] was that the appendix was used for digesting leaves as primates. Over time, we have eaten fewer vegetables and have evolved, over thousands of years, for this organ to be smaller to make room for our stomach. It may be a vestigial organ of ancient man that has degraded down to nearly nothing over the course of evolution. Evidence can be seen in herbivorous animals such as the Koala. The cecum of the koala is attached to the juncture of the small and large intestines and is very long, enabling it to host bacteria specific for cellulose breakdown. Early man’s ancestor must have also relied upon this system and lived on a diet rich in foliage. As man began to eat more easily digested foods, they became less reliant on cellulose-rich plants for energy. The cecum became less necessary for digestion and mutations that previously had been deleterious were no longer selected against. These alleles became more frequent and the cecum continued to shrink. After thousands of years, the once-necessary cecum has degraded to what we see today; the appendix.

Evolutionary theorists have suggested that natural selection selects for larger appendices because smaller and thinner appendices would be more susceptible to inflammation and disease [cite news|title=The old curiosity shop|work=New Scientist|date=2008-05-17|url=http://www.newscientist.com/channel/being-human/mg19826562.100-vestigial-organs-remnants-of-evolution.html] .

Immune Use

Loren G. Martin, a professor of physiology at Oklahoma State University, argues that the appendix has a function in fetuses and adults. [cite news|url=http://www.sciam.com/article.cfm?id=what-is-the-function-of-t|title=What is the function of the human appendix? Did it once have a purpose that has since been lost?|work=Scientific American|date=1999-10-21|accessdate=2008-07-01] Endocrine cells have been found in the appendix of 11 week old fetuses that contribute to "biological control (homeostatic) mechanisms." In adults, Martin argues that the appendix acts as a lymphatic organ. The appendix is experimentally verified as being rich in infection-fighting lymphoid cells, suggesting that it might play a role in the immune system. Zahid [Zahid, A. (2004) "The vermiform appendix: not a useless organ." J Coll Physicians Surg Pak. 14:256-258. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15228837&dopt=Abstract PubMed] ] suggests that it plays a role in both manufacturing hormones in fetal development as well as functioning to 'train' the immune system, exposing the body to antigens in order that it can produce antibodies. He notes that doctors in the last decade have stopped removing the appendix during other surgical procedures as a routine precaution, because it can be successfully transplanted into the urinary tract to rebuild a sphincter muscle and reconstruct a functional bladder.

Latest Interpretation: 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. Robbins Pathologic Basis of Disease, 4th edition, 1989, pages 902-903 ] 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. [cite news|url=http://www.msnbc.msn.com/id/21153898/|title=Scientists may have found appendix’s purpose: Seemingly useless organ may produce, protect good germs for your gut|date=2007-10-05|accessdate=2008-07-01|work=MSNBC] Bollinger, R.R., Barbas, A.S., Bush, E.L., Lin, S.S. & Parker. W. (2007) Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J. Theoretical Biology. doi:10.1016/j.jtbi.2007.08.032.] This proposal is based on a new understanding of how the immune system supports the growth of beneficial intestinal bacteria [ Sonnenburg JL, LT Angenent, JI Gordon. Getting a grip on things: how do communities of bacterial symbionts become established in our intestine? Nature Immunology. 2004;5:569-73 ] [ Everett ML, D Palestrant, SE Miller, RR Bollinger, W Parker. Immune exclusion and immune inclusion: a new model of host-bacterial interactions in the gut. Clinical and Applied Immunology Reviews. 2004;5:321-332. ] , 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 healthcare practice, where diarrhea may be prevalent. Current epidemiological data [ Statistics on the cause of death in developed countries collected by the World Health Organization in 2001 show that acute diarrhea is not the fourth leading cause of disease-related death in developing countries (data summarized by The Bill and Melinda Gates Foundation).Fact|date=December 2007 Two of the other leading causes of death are expected to have exerted limited or no selection pressure on humans in the distant past because one (HIV-AIDS) only very recently emerged and another (ischaemic heart disease) primarily affects people in their post-reproductive years. Thus, acute diarrhea may have been one of the primary disease-related selection pressures on the human population in the past. (Lower respiratory tract infection (pneumonia) is the remaining of the top four leading causes of disease-related death in third world countries.) ] show that diarrhea is one of the leading causes of death in developing countries, indicating that a role of the appendix as an aid in recovering beneficial bacteria following diarrhea may be extremely important in the absence of modern health and sanitation practices.

Diseases

The most common diseases of the appendix (in humans) are appendicitis and carcinoid tumors.
Appendix cancer accounts for about 1 in 200 of all gastrointestinal malignancies. Adenomas also (rarely) present.

Appendicitis (or epityphlitis) is a condition characterized by inflammation of the appendix. Pain often begins in the center of the abdomen, corresponding to the appendix's development as part of the embryonic midgut. This pain is typically a dull, poorly localised, visceral pain.

As the inflammation progresses, the pain begins to localise more clearly to the right lower quadrant, as the peritoneum becomes inflamed. This peritoneal inflammation, or peritonitis, results in rebound tenderness (pain upon "removal" of pressure rather than "application" of pressure). In particular, it presents at McBurney's point, 1/3 of the way along a line drawn from the Anterior Superior Iliac Spine to the Umbilicus. Typically, point (skin) pain is not present until the parietal peritoneum is inflamed as well. Fever and an immune system response are also characteristic of appendicitis.

Many cases of appendicitis require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, the appendix may rupture, leading to peritonitis, followed by shock, and, if still untreated, death.

The surgical removal of the vermiform appendix is called an appendicectomy (or appendectomy). 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 resolves completely; more often, an inflammatory mass forms around the appendix. This is a relative contraindication to surgery.

Use as efferent urinary conduit

The appendix is used for the construction of an efferent urinary conduit, in an operation known as the Mitrofanoff procedure,cite journal |author=Mingin GC, Baskin LS |title=Surgical management of the neurogenic bladder and bowel |journal=Int Braz J Urol |volume=29 |issue=1 |pages=53–61 |year=2003 |pmid=15745470 |doi= |url=http://www.brazjurol.com.br/january_february_2003/Baskin_ing_53_61.htm] in people with a neurogenic bladder.

=Additional

ee also

* Homology (biology)
* McBurney's point
* Noncoding DNA

References

External links

* [http://www.talkorigins.org/faqs/vestiges/appendix.html "The vestigiality of the human vermiform appendix: A Modern Reappraisal"] -- evolutionary biology argument that the appendix is vestigial
* [http://www.cnn.com/2007/HEALTH/10/05/appendix.purpose.ap/index.html Purpose of appendix believed found] CNN article
* [http://www.webmd.com/digestive-disorders/news/20071012/appendix-may-have-purpose Appendix May Actually Have a Purpose] WebMD article

* - "Abdominal Cavity: The Cecum and the Vermiform Appendix"