What side is your appendix onAn appendix is a tiny tubular extension, about four inches long on the right side of the colon, specifically on the blind pouch of the cecum. Its diameter is between 1 to 7 mm. The appendix looks like a stubby pencil. Children have longer appendix than adults.
During surgery, the doctor pulls up the colon, locate the tinea, and run it back to clearly visualize the appendix. The appendix is medically called vermiform process. The appendix coats are the same to that of the intestines. They are the serous, mucous, submucous, and muscular. (1, 2, 3)
Appendix is attached to the gastrointestinal tract.
Parts of the appendix
- Base – The base of the appendix is attached to the posterior medial part of the cecum. The tenia part of the cecum connects to the base of the appendix. Doctors used this as a guide when locating the appendix.
- Body – The body of the appendix has a canal that leads to the cecum and guarded by a mucous fold called the valve of gerlach.
- Tip – The tip of the appendix is directed in different points. (2, 4, 5, 6)
Locating the appendix : Anatomy
Appendix is located in the right lower abdominal quadrant. (Red point in the image is - McBurney’s point)
The anatomical position of the appendix is in the right iliac fossa. The base of the appendix is at the McBurney’s point (a point one-third away from the umbilicus and the right anterior superior iliac spine). However, the appendix’s location is not isolated to a specific spot.
There are times when the appendix lies behind the cecum. There are also instances when the appendix extends down to the pelvis. The tip of the appendix can be located in different positions. Most of the time, it is located hanging down the pelvis or coiled up behind the cecum. In rare instances, the tip of the appendix projects upward on the lateral part of the cecum and either front or back of the ilium’s end.
The appendicular artery supplies blood to the appendix. The appendicular vein drains blood from the appendix. (8, 9, 10)
How can a layperson locate the appendix?For a non-medical professional to locate the appendix, the abdomen should be divided into four quadrants. The right lower quadrant is where your appendix on. It is the very same area tagged as the McBurney’s point.
The doctor uses that specific area to locate pain associated with appendicitis. (3, 5, 7)
Variation in the location of appendixThere is a slight variation in the location of the appendix. As you know, every person is unique. Some have their appendix located on the very right side corner while others have their appendix on the center part of the right lower quadrant.
A very rare condition called situs inversus wherein a person’s organs are located on the opposite side. In such condition, the appendix is located in the left lower quadrant. (4, 11, 12, 13)
Functions of the appendix
- Safehouse for white blood cells – Appendix stores lymphocytes and when the infection takes place, it releases mature lymphocytes thereby helping the body in battling infections.
- Protects probiotic colonies – The appendix plays an important role in protecting colonies of probiotics in the gastrointestinal system. (5, 8, 15)
An image of an inflamed appendix.
An inflamed appendix is called appendicitis. What could be the possible reasons for appendicitis?
- Blockage – Basing on the location of the appendix, it is an extension of the bowel, which makes it susceptible to fecal matters. Usually, the fecal matter passes into the appendix. However, there are instances when the fecal matter is stuck in the opening of the appendix. As a natural response, the appendix will do its best to remove the obstruction by stretching and squeezing hard. If the obstruction is still present despite appendix attempt to remove it, it will cause abdominal cramping around the umbilical area. Too much pressure impedes the flow of blood in the appendix. Without adequate blood flow, the appendix will be deprived of blood and oxygen. Without these essential components, it would be impossible for the appendix to survive. Death of the appendix leads to the formation of ischemic tissues. They will release chemicals causing pain and inflammation in the right lower quadrant and the surrounding structures.
- Inflammatory bowel disease – gastrointestinal-related diseases such as inflammatory bowel disease can significantly affect the appendix. If it is left untreated, it could lead to serious complications such as appendicitis.
- Trauma to the abdomen – A severe blow to the abdominal area can have serious implications in the vital organs of the abdomen including the appendix.
- Infection – A severe infection in various parts of the body, especially in the GI tract can lead to enlargement of the tissues in the appendix’s wall. (14, 16, 17, 18)
- Pain and discomfort in the abdomen (20)
- The pain is sudden and severe
- Nausea and vomiting
- Unable to pass gas (flatulence)
- Low-grade fever
- Swelling of the abdomen
- Constipation/diarrhea (19)
Locating the pain : Appendix pain Location
The location of pain in a patient with appendicitis.
Appendicitis pain usually begins near the navel area and shifts to the right lower quadrant of the abdomen as the pain intensifies. It would only take a few hours for the pain to intensify.
The pain is aggravated by movement, especially when taking deep breaths. In fact, even a simple sneezing or coughing can worsen the pain. (6, 9, 10)
Appendicitis pain in children and infantsThe location of the pain is not confined to a specific area. Most of the time, the pain is felt all over the body. Although, there are instances when the child does not feel any pain at all.
Appendicitis pain in adults and pregnant women
Appendicitis during pregnancy can be a delicate condition both for the mother and the child.
For adults and pregnant women, the pain is mild but is quite difficult to locate. For pregnant women suffering from appendicitis, the pain shifts to the right upper quadrant. The patient also complains of flank pain. (20, 21)
Characteristic and location of painThe location of appendix pain varies. It can be felt around the navel, the upper abdominal area, or all over the abdomen. The onset of the pain is gradual but within the six-hour period, the pain shifts to the right lower abdominal quadrant and gets worse.
However, the intensity and characteristics of pain are determined by the location of the appendix.
- Normally positioned appendix – The pain is felt between the umbilical area and the anterior part of the right hip bone.
- Abnormally positioned appendix – The exact location of the pain is difficult to pinpoint. As you know, there are various organs in the abdominal area. Appendix pain can be mistaken for other gastrointestinal tract problems. To accurately diagnose appendicitis, various tests need to be performed. (7, 11, 21, 22, 23)
Accessory signs of appendix pain
A Rovsing sign in a patient with acute appendicitis.
A doctor looking for obturator sign in a patient suspected of acute appendicitis
The doctor examines the patient for the presence of Psoas sign, which is one of the indicators of acute appendicitis.
A patient is asked to cough and watch out for signs of abdominal pain.
Some patients with appendicitis do have accessory signs. These include the following:
- Rovsing sign – A palpation of the left lower abdominal quadrant increases the pain in the right lower abdominal quadrant. It was named after the surgeon who discovers the procedure, Niels Thorkild Rovsing. A positive Rovsing sign confirms acute appendicitis. It is indicative of peritoneal irritation in the right lower abdominal quadrant.
- Obturator sign – A right hip is flexed and rotate internally and externally, the patient complains of pain in the right lower abdominal quadrant. It is an indicator that the appendix is inflamed and situated in the right hemipelvis.
- Psoas sign – A passive extension of the right thigh causes pain in the right lower abdominal quadrant.
- Dunphy sign – Coughing produces sharp right lower abdominal quadrant pain.
- Markle sign/jar tenderness – A patient stands on the toes to the heels with a jarring landing causes pain in the right lower abdominal quadrant. It is an indicator of localized peritonitis secondary to acute appendicitis. (17, 18, 24, 25)
Diagnostic Tests and Procedures
- Physical examination – The doctor will gently and thoroughly examine the abdominal area particularly in the right lower abdominal quadrant where the McBurney’s point is located.
- Complete blood count – The doctor will check for signs of infection as seen in the increased number of leukocytes (white blood cells).
- CT scan – it is one of the definitive tests confirming appendicitis. A CT scan result shows an inflamed appendix.
- Imaging studies – If malignancy is suspected, the doctor might order an advanced imaging study such as MRI and PET scan. (18, 19, 21, 24, 25)
Treatment for appendicitis
A comparison image between an open appendectomy and a laparoscopic appendectomy.
- Antibiotic therapy – The doctor prescribes antibiotic to treat underlying infection. However, antibiotics are only helpful in the management of symptoms. Medications alone cannot treat appendicitis. The only way to treat it is through surgery.
- Appendectomy – It is the surgical removal of the appendix. There are two ways to remove the appendix: traditional technique (open appendectomy) and laparoscopic appendectomy. (1, 6, 9, 11)