The most frequent direction of the draft-like process. Complications of acute appendicitis

One of the elements of the blind intestine is a worm-shaped process - an important organ in the immune system of the gastrointestinal tract. It has the individual features of the position of the right side of the abdominal cavity. Previously, doctors removed the process as unnecessary, but after that the deterioration of mental abilities and immunity in children was revealed and such manipulations stopped. Appendix regulates the intestinal microflora and contributes to the destruction of pathogenic organisms. When inflammation, the process diagnose appendicitis, which is accompanied by severe pain and requires immediate cutting. Self-treatment and ignoring the disease is unacceptable.

Appendix is \u200b\u200ban intestinal atavism that does not play a special role in digestion, but when inflammation is very dangerous.

What is Appendix?

Cherry prod flow of a blind intestine in the intestine - Appendix. The process of the blind intestine of the oblong shape and is located on the posterior wall of the blind intestine. The dimensions of the appendix in humans are about 7-10 cm long and 1 cm in diameter. He departs from the intestines to a small pelvis. There is an appendicitis on the right side of the side, but the location options according to the remaining organs in the body are individual. Inflammation of a worm-like process is called appendicitis. During the period of the evolution of man, the Anatomy of Appendix changed. Previously, it was a functional organ of the digestive system.

Perhaps an atypical location of a worm-like process. In this case, symptoms from inflammation may differ from the main indicators. The zone bordering the intestine, consists of folds (cells of the mucous membrane). For many years, Medicine considered the Apandix unnecessary and useless organ. Its value and the role was not established, so it was removed. Inside appendix, there are many islets of lymphoid tissue, which is a component of the body's immune system.

Where is the location options in the body?

The most common is the pelvic location of appendix

Cell-shaped process has a pelvic location. Localization location is the iliac area of \u200b\u200bthe fossa on the right side. It happens that it is located elsewhere: above or below the specified area. In the past cavity is rarely posted. Depending on the individual characteristics of the body structure, the accommodation of appendix in the patient is different. The topography of a worm-shaped process is shown in the table below.

The pelvic position is most common, it is found almost every second person. In the pathology of appendix in such a situation in women, the symptoms of the disease are confused with gynecological problems. Being in the retroperitoneal cavity, the process is hard to inspect.

Functions performed

The process of rectum is a useful body of the abdominal cavity. The main function is the help of the immune system in defense against negative microorganisms. The functions of its work associated with the digestive system and affect mental abilities in children. If in the gastrointestinal tract for some reason useful bacteria is washed - the microflora recovery function performs appendix together with a blind intestine. As a result, dysbacteriosis is prevented. Medicine diverges in the concept of which the intestine is occupied by the outflow of the intestine and why it is needed, but it is precisely established that when removing the process, the child decreases the coefficient to memorize information, perception and problems with the digestive system. This is due to the absence of the necessary microorganisms produced by a drawing process.

Diseases and their treatment

Under the inflammation of the appendix, nausea appears and the body temperature rises

1. Downwards - 40-50%.

2. Lateral - 25%.

3. Medial - 17-20%.

4. Ascending - 13%.

Classification of appendicitis (according to V.I. Kolelesov)

1. Appendicular colic

2. Simple appendicitis: superficial, catarrhal

3. Destructive (phlegmonous, gangrenous, perforated) appendicitis

4. Complicated, appendicitis: (appendicular infiltrate, appendicular abscess, purulent peritonitis, pylephlebit, sepsis, etc.).

Symptoms of acute appendicitis

1. Pain. Acute abdominal pain is the main and early manifestation of acute appendicitis. In most patients, sudden pain occurs in epigastria or near the navel (visceral pain), followed by moving to the right iliac region (the transition to a somatic) is a symptom of Kohler. In some cases, pain appears immediately in the right iliac region. The intensity of pain is usually not very high, as a rule, they do not irradiate. With the retrocekapy and retroperitoneal position of Appendix, the pain can be felt in the lumbar region, irradiating into the right thigh. With the medial arrangement of the process, the pain may occur near the navel. Sometimes pain irradiates down.

2. Disps syndrome (anorexia, nausea and vomiting)it is observed in 40-42% of cases. Vomiting is more often one-time, is reflexive and does not bring relief. Pain precedes vomiting.

3. Dynamic Ileus syndrome. In acute appendicitis, there is a latency of the stool due to the intestinal car. With a pelvic arrangement, the process can be diagrams, tenesmas.

4. Dysuric disorders. At the arrangement of Appendix near the ureter (retrocecal arrangement) of pain can be in the right lumbar region, accompanied by dysuria with microhematuria. During the basic localization of a worm-like procession, dysuric disorders may be attacked: rapid and painful urination.

5. Body temperature and pulse frequency. In most patients with acute appendicitis, moderate tachycardia is observed and an increase in body temperature to subfebrile numbers. When progressing peritonitis, the pulse frequency does not correspond to the temperature of the "symptom of scissors".

6. Objective symptoms of acute appendicitis:

Pain per palpation in the right iliac region (Mac-Burnea point);

The muscular voltage of the anterior abdominal wall indicates the involvement of the inflammatory process of parietal peritoneum. It depends on the localization of the appendix, on the degree of dissemination of the inflammatory process to the surrounding tissues, the overall state of the patients, the age, the degree of development of the muscles of the abdominal press and subcutaneous fatty fiber, etc. With a retrocecular and retroper-tonal arrangement of a heart-shaped process, you can observe the rigidity of the muscles of the lower back;

Symptom of Brush - Blumberg;

Sign of Mendel;

Symptom of rovzshchts

Sitkovsky's symptom;

Suspension symptom;

Symptom Batomier - Michelson (when palpation of the right iliac region in the position of the patient on the left side, the pain is expressed more than on the back);

Rectal symptoms (pain in the finger study of the ampoule of the rectum, the presence of painful infiltrate, the difference in rectal and skin temperature exceeds 1 ° Celsius).

7. Changes in peripheral krok: leukocytosis (moderate), neutrophilosis, shift of the leukocyte formula to the left and the appearance of immature forms of leukocytes.

8. Ultrasound If the infiltration is suspected, to eliminate cholecystitis, determining the effusion in the abdominal cavity, excluding ectopic pregnancy, etc.

Cell-shaping (Appendix Vermiformis) has all layers inherent in the intestinal wall. It is connected to the beginning of a blind intestine, being 2-4 cm from the location of the ileum in the blind. The diameter of the process of 6-8 mm, its length ranges from 3 to 9 cm, but there are processes and a length of up to 18-24 cm. In children, a worm-shaped process is relatively longer than in adults. A characteristic feature of the structure is a significant development of lymphatic tissue in the mucous membrane and the submissive layer of the process. The process has a mesentery (Mesoappendix), in which artery, vein, nerves and lymphatic vessels pass. In medical practice there is a disease of the process, so it is necessary to prevent its topography well. The position of the blind intestine is described above, and in relation to its process, several options are allocated.
1. Downward (caudal) position occurs in 40-50% of cases (Fig. 251), in children - 60%. It is characterized by the fact that the process descends into a small pelvis and comes into contact with the rectum, urinary bubble, ureter, ovary and uterus.

2. The lateral position is observed in 25% of cases. In this case, the process is directed towards the groin bond (Fig. 252).

3. The medial position is revealed at 17 - 20% of cases (Fig. 253). The process is directed to the midline and comes into contact with the loops of the subtle intestines.

4. The rear (retrocecial) position is observed in 9-13% of cases. The process is located behind the blind intestine and the top can reach the kidney or even the liver (Fig. 254).

5. Front position is rare. The process lies on the front wall of the blind intestine. With a high position of the blind intestine, the process comes into contact with the liver (Fig. 255).

6. The left-sided position of the blind intestine and a heart-shaped outflow (Fig. 256) is extremely rarely found.



The projection on the front abdominal wall of the variants of the draft-like process is shown in Fig. 257.

251. Descending position of a worm-like process. 1 - small intestine; 2 - Cell-shaped process; 3 - blind intestine.

252. The lateral position of a worm-like process. 1 - blind intestine; 2-Breaking process; 3 - Cell-shaped process.

253. Medial ascending direction of the draft-shaped process. 1 - big gland; 2 - the final department of the iliac; 3 - Cell-shaped process; 4 - blind intestine.

254. The position of a worm-shaped process behind a blind intestine. 1 - the blind intestine is assigned up; 2 - poorly developed mesenter process; 3 - Cell-shaped process.

255. High position of a blind intestine and a heart-shaped process. 1 - liver, 2 - transverse colon rims; 3 - blind intestine; 4 Breakfasts of a black-shaped process; 5 - Cell-shaped process; 6 - gallbladder; 7 - right rib arc.

256. Left-sided position of a blind intestine and a heart-shaped process. 1 - downward part of the colon; 2 - ascending part of the colon; 3 - Cell-shaped process; 4 - finite department of the iliac; 5 - blind intestine; 6 - big gland.

257. Projection of a blind intestine and a worm-like process with different positions on the front abdominal wall (diagram).

1 - navel;
2 - Cell-shaped process;
3 - blind intestine;
4 - ascending intestine;
5 - line connecting the navel with anterior upper iliac row;
6 - Place of injecting a worm-like process in the blind intestine (Mac-Burnea point).

Recognize where Appendixes is, people begin with suspected or close to his inflammation (appendicitis). Translated from Latin, this anatomical formation of the intestine is called a worm-shaped process.

The human body is very harmonious and rationally. There is nothing superfluous in it. Therefore, the opinion on the special cutting out of the intact appendix for the purpose of rehabilitation will leave the amateurants who do not want to know the anatomy and physiology of their body. Why do you need appendix we will try to understand, learning fully about its structure and opportunities.

How to find appendix?

A worm-shaped process departs from the bottom of the blind intestine by 2-3 cm below the fusion site of three longitudinal muscle beams (ribbons). Appendix looks normally like a pink shiny litigation. It has a tubular structure. The length of the appendix varies from 2 cm to 25, and the thickness is 0.4-0.8 cm.

Types of dieting from the blind intestine:

• the intestine is sick of funnel and smoothly goes to Apandix;
• the intestine narrows sharply and twisted before the transition;
• the process departs from the bowel dome, although its base is shifted back;
• departs back and down from the place of impulse of the ileum.

There are foundations, body and top of the process. In the form of the process can be:

• germinal - emphasizes the continuation of the blind intestine;
• skender - has the same thickness over the entire length;
• cone-shaped - the diameter at the base is wider than the top.

The greatest complexity of the diagnosis of appendicitis is associated with a variety of body location and the tops of the process. This feature causes diagnostic errors, makes it possible to inflaming the symptoms of other diseases of neighboring organs.

In addition to the Mac-Burnea point, there are many recommendations of different authors that surgeons can enjoy

For doctors, a point of McBurnea is a guide. It can be determined if it is mentally to spend a straight line from the navel to the top of the ileal bone on the right (or on the left with rare features - the mirror reflection of the organs). Next, the distance must be divided into 3 equal parts.

The desired point of projection of the base of the heart-shaped process can be found in the junction of the outer and middle parts. This is only a single example of the projection of appendix.

Arrangement of Appendix

The study of topographic anatomy obliges doctors to know not only which side is Appendix, but also provide for the options for its normal location.

The main provisions of the worm-like process differ 8:

• pelvic or descending (half cases at the frequency of detection) - a freely hanging end reaches the bodies of a small pelvis, women can "fall" to the right ovary, in men contact with the ureter (64%);
• ascending (tune) - it is rarely found;
• front in the iliac yam on the right - a rare phenomenon;
• middle (0.5%) - the top is drawn into the sacrum area;
• lateral (1%) - outside of a blind intestine;
• intraperitoneal or retroperitoneal - the process is located for the stop of the cecum (another name - retrocecal, is observed in 32% of cases);
• extra-breech or retroperitoneal (2%);
• intramural - the process is fused with the rear wall of the blind intestine, can be located in its layers.

So, the questions "from which side is Appendix" and "in which side to seek appendix" we will reply with a large share of probability - to the right. Because the left-sided position of the process is a big rarity.

Mobility and movement of the free end are accompanied by appendicitis with pains of different character. In 70% of applications, Appendix is \u200b\u200breleased from adhesions throughout its length. But in 30% of people, it is fixed with different battles.

Positions are determined by the deviation of the body of the process

How is Appendix arranged?

Appendix has its own mesenter in the form of a triangle between the blind and the ileum. The adhesive tissue occurs in it, vessels, nervous branches. At the base, the abroad is forms folded pockets. They are important in terms of limiting the inflammatory process.

The wall of appendix is \u200b\u200bformed by three layers or shells:

• serous - representing the continuation of a single piece of peritoneum with a iliac and blind intestine;
• subserosic - consists of adipose tissue, it lates nervous plexus;
• muscle;
• mucosa.

Muscular shell, in turn, consists of:

• from the outer layer with the longitudinal direction of the fibers;
• internal - muscles go circularly.

The submembraneous layer is formed by cruciform elastic and collagen fibers and lymphatic follicles. In an adult person, the CM 2 area accounts for up to 80 follicles with a diameter of 0.5 to 1.5 mm. The mucous membrane forms folds and growing (crypts).

In the depths are the secreted cells of the Kulchitsky, which produce serotonin. The epithelium refers to the structure to the prismatic one-row. Between it are glasswall cells that distinguish the mucus.

With the lumen of the blind intestine, Appendix communicates with his mouthpiece. Here it covers its own Gerlacha valve formed by the fold of the mucous membrane. He is well expressed only for nine-year-old child.

Features of blood supply and innervation

Appendix blood supply is possible by four options:

• the only artery that feeds only a worm-shaped process (without a neighboring section of the blind intestine), occurs in half cases;
• more than one vessel, observed in the ¼ of people;
• the process and the adjacent blind intestine receive blood together from the rear artery, found in ¼ of patients;
• the arterial branch comes with a loop - it is rare.

The practical importance of the study of blood supply can be seen on the example of imposing ligatures (seams) when removing appendix. Incorrect accounting of joint blood supply may cause necrosis of the adjacent section of the blind intestine and the inconsistency of the seams.

The photo of the remote appendix is \u200b\u200bsufficiently eloquently testifies to his inflammation.

The outflow of venous blood goes through the upper mesenteric vein in the barn. Attention should be paid to collateral connections with renal veins, ureteral, vascular network of retroperitoneal space.

The lymphatic capillaries depart from the base of the crypt and are connected to the submissible vessels. Penetrate through the muscular shell into the mesente nodes. Especially close connections are connected by vessels of a blind intestine, stomach, duodenum, right kidney. It matters in the propagation of purulent complications in the form of thrombophlebitis, abscesses, phlegmon.

Nervous fibers to a worm-like process come from the top mesenter and solar plexus. Therefore, the pain in appendicitis can be widespread.

What is needed Appendix?

The functions of appendix are sufficiently studied. In the human body, a worm-shaped process is engaged:

• the production of mucus, serotonin, some enzymes, per day in the cavity of the appendix is \u200b\u200bformed from 3 to 5 ml of an alkali secret containing bioactive substances;
• synthesis of immunoglobulins and antibodies, control over the antigenic properties of food products with reverse alarms to higher centers, takes part in the reaction of the rejection of organs with incompatible transplantation;
• the production of beneficial intestinal bacteria, delays the bacteria of rotting, destroys toxins;
• the production of lymphocytes (as much as possible from 11 to 16 years), some scientists even proposed to be called a "almond" process, and appendicitis - "angina", it equates to the reserve body, which, in extreme conditions, can take on the development of protective cells of blood;
• participation in digestion by digesting the fiber, expanding starch, the term "second salivary and pancreas" is used;
• performing an additional valve function in the iconcecular corner;
• strengthening its secret to intestinal motorcycles, coprostase warning.

Lymphocytes - killer cells in the reaction of antigen antibody

The role of a person's appendix in the formation of immunity, a protective reaction is determined. It is proved that people without appendix more often suffer from infections are more susceptible to cancer tumors.

The muscular layer helps to clean the inside of the process from stagnant content (honeystones, foreign bodies, helminths). If Appendix does not have cavities due to the overlap of the adhesion, then the cluster of the content is fraught with the suppuration and gap.

What diseases are appendix?

According to the international statistical classification, all diseases of the black-like process are attributed to the digestive bodies group and are included in the K35-K38 code.

They include:

• different forms of appendicitis - inflammation;
• hyperplasia;
• appendicular stones;
• diverticul
• fistula;
• intussusception.

Other classifications for diseases of the process still include:

• tumor education;
• infringement in hernia;
• injuries;
• cysts;
• foreign bodies;
• endometriosis.

Cell-shaped process - an example of a rudimentary organ

Appendix appendix in the human body serves as evidence of the relationship of origin with the animal world. Such organs are called rudimentary, since in humans they perform much less functions than in animals. Purbitious animals appendix is \u200b\u200bimportant to participate in digestion. For example, at the camel, it reaches longer than a meter.

In humans, such organs are laid on the embryonic stage of development of the fetus and at some point stop in development. Examples serve:

• teeth of wisdom (once they needed for stressing hard foods);
• muscles ears and even hundreds of signs.

As a result of evolution, a person did not just copy the functions of animals, but also improved them. Appendiles turned into a useful rudiment.

Table of contents of the theme "Anatomy of the Colon":

Cecum. Cell-shaped process (Apendix, Appendix). Building, walls of a worm-like process (Apendix, Appendix). Building, walls of a blind intestine.

Caecum (from Greek. Typhlon, Hence the inflammation of a blind intestine - Typhlitis), blind intestine,represents the first portion of the colon from its beginning to the place of sign in the small intestine; It has the form of a bag with a vertical size of about 6 cm and transverse - 7-7.5 cm. There is a Caecum in the right iliac yam right above the lateral half of LIG. Inguinale; Sometimes there is a higher position, right up to find the intestine under the biscuits (preservation of the germinal position). With its front surface of Caecum, he arrives directly to the front wall of the abdomen or is separated from it a large gland, behind Caecum lies m. iliopsoas. From the medial-rear surface of Caecum, 2.5 - 3.5 cm below the fountal intestine, departs cheriform process, Appendix Vermiformis. The length of a heart-shaped process and its position varies greatly; On average, the length is about 8.6 cm, but in 2% of cases it decreases to 3 cm; The absence of a worm-like process is observed very rarely. As for the position of a worm-like process, it is primarily closely associated with the position of the blind intestine. As a rule, it, like the blind intestine, lies in the right iliac yam, but may lie down and above with a high position of the blind intestine, and below, in a small pelvis, with its low position.

With a normally located blind intestine, the following four positions of a worm-like process are distinguished:

1. Downward position(most frequent, in 40 -45% of cases). If the Cell-shaped process is long, the end of it descends into the cavity of the small pelvis and sometimes hesitates with the bladder and the rectum.

2. Lateral position (about 25% of cases).

3. Medial location (17 -20% of cases).

4. Ascending position Behind the blind intestine (about 13% of cases). In this case, the worm-shaped process is located retroperly.

With all the various variants of the position of the process, the central part of it, i.e., the place of fattening the process from the blind intestine remains constant. With appendicitis, the painful point is projected onto the surface of the abdomen on the boundary of the outer and medium-sized line, connecting the navel with anterior upper iliac row (Mac-Burnea point), or, more precisely, on the line connecting both front tops at a point separating on this line right One third of the middle (point of Lanz).

The lumen of the worm-like process in the elderly can be partially or completely overgrown. Cell-shaped process opens in the cavity of the blind intestine hole, Ostium Appendicis Vermiformis. Differentiation of a blind intestine into two departments: Actually the blind intestine and a narrow part - a Cell-shaped process, except for a person, in anthropomorphic monkeys (rodents, the end of a blind intestine also reminds a worm-shaped process on its device). Appendix mucosa is relatively rich in a lymphoid cloth in the form of Folliculi Lymphatici Aggregdti Appendicis Vermiformis, and some authors see it in this functional value ("E. Almonds", which delays and destroys pathogenic microorganisms, which explains the frequency of appendicitis). The wall of the heart-shaped process consists of the same layers as the intestinal wall. According to modern data, the lymphoid formations of appendix plays an important role in lymphoposoese and immunogenesis, which served as the basis to consider it by the body of the immune system.

The blind intestine and the cumulative proceeds are covered with peritoneum on all sides. Bryzheka Drawberry Process, MesoAPPendix, Usually stretches to the very end of it. At a blind intestine, in approximately 6% of cases, the rear surface is not covered with peritoneum, and the intestine in such cases is separated from the rear abdominal wall of the interlayer of the connective tissue, and the heart-shaping process is located intraperitoneally.

At the site of the end of the small intestine in thickness inside ileo-cepny valve, Valva Ileocaecalis. It consists of two semi-short folds, at the base of which a layer of ring musculature lies, sphIncter Ileocaecdlis. Valva et SphIncter Ileocaecalisforming together adaptations that regulate the advancement of food from a small intestine, where the alkaline reaction, in a thick, where the medium is again sour, and prevent the inverse passage of the contents and neutralization of the chemical medium. The surface of Valvae IleocaCales, facing a fine intestine, is covered with vile, while the other surface of the Village has no.