PENGENALAN

The appendix is a small, pouch-like sac of tissue that is located in the first part of
the colon (cecum) in the lower- right abdomen. Lymphatic tissue in the appendix aids in
immune function. The official name of the appendix is veriform appendix, which means
"worm-like appendage." The appendix sits at the junction of the small intestine and large
intestine. It’s a thin tube about four inches long.
Appendicitis is the most common cause of sudden, severe abdominal pain and
abdominal surgery in the United States. Over 5% of the population develops appendicitis at
some point. Appendicitis most commonly occurs during adolescence and in the 20s but may
occur at any age. In most cases, a blockage inside the appendix probably starts a process. The
blockage may be from a small, hard piece of stool, a foreign body, or, rarely, even worms. As
a result of the blockage, the appendix becomes inflamed and infected. If inflammation
continues without treatment, the appendix can rupture. A ruptured appendix may cause a pus-
filled pocket of infection (abscess) to form. As a result, peritonitis (inflammation and usually
infection of the abdominal cavity, which may result in a life-threatening infection) may
develop.
The human appendix averages 9 cm in length but can range from 5 to 35 cm. The
diameter of the appendix is 6 mm and more than 6 mm is considered a thickened or inflamed
appendix. William Parker, Randy Bollinger, and colleagues at Duke University proposed in
2007 that the appendix serves as a haven for useful bacteria when illness flushes the bacteria
from the rest of the intestines. This proposition is based on an understanding that emerged by
the early 2000s of how the immune system supports the growth of beneficial intestinal
bacteria,
The most common diseases of the appendix (in humans) are appendicitis and
carcinoid tumors (appendiceal carcinoid). The surgical removal of the appendix is called an
appendectomy. This removal 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.
symptoms in which pain begins in the upper abdomen or around the navel, then
nausea and vomiting develop, and then, after a few hours, the nausea passes, and the pain
shifts to the right lower portion of the abdomen. When a doctor presses on this area, it is
tender, and when the pressure is released, the pain may increase sharply (rebound
tenderness). A fever of 100° to 101° F (37.7° to 38.3° C) is common. Moving and coughing
increase the pain.
 RUJUKAN
1. https://www.msdmanuals.com/home/digestive-disorders/gastrointestinal-
emergencies/appendicitis/?network=g&matchtype=e&keyword=appendix
%20disease&creative=296219076185&device=c&devicemodel=&placement=&positi
on=&campaignid=1576431266&adgroupid=58256151583&loc_physical_ms=906648
6&loc_interest_ms=&gclid=Cj0KCQjw-
O35BRDVARIsAJU5mQXn525RniuA0uEuPX7xG3Zwjd73OGMOfevzljetRCs26rgl
eRsljaMaAv4bEALw_wcB
2. https://www.onhealth.com/content/1/appendicitis_appendectomy#:~:text=The
%20appendix%20is%20a%20small,.%22%20The%20appendix%20harbors
%20bacteria.
3. https://www.webmd.com/digestive-disorders/picture-of-the-appendix
4. https://en.wikipedia.org/wiki/Appendix_(anatomy)
5. https://hekint.org/2017/01/22/the-early-days-in-the-history-of-appendectomy/
6. https://www.msdmanuals.com/home/digestive-disorders/gastrointestinal-
emergencies/appendicitis/?network=g&matchtype=e&keyword=systems%20of
%20appendicitis&creative=296214207568&device=c&devicemodel=&placement=&
position=&campaignid=1576431263&adgroupid=58256150823&loc_physical_ms=9
066486&loc_interest_ms=&gclid=Cj0KCQjw-
O35BRDVARIsAJU5mQXy7Bx_jF6ooLkWP132wU8k03oWvnC1_fYSP-
pnHQiAXHWzmjN1Un8aAiWAEALw_wcB
 PENYATAAN MASALAH
A man of age 25 years old come told the hospital complaining about stomach pain. The
patients say that the pain since a week ago. At first the patient thought that the pain is the
normal stomach ache but since then the pain become more and more painfull and gradually
the patient come to the hospital. The pain started to be unbearable since the last 2 days. The
patient have rebound tenderness.
 PENCARIAN LITERATURE
In a 2013 paper, the appendix was found to have evolved at least 32 times (and
perhaps as many as 38 times) and to have been lost no more than six times. A more recent
study using similar methods on an updated database yielded similar, though less spectacular
results, with at least 29 gains and at the most 12 losses (all of which were ambiguous), and
this is still significantly asymmetrical. This suggests that the cecal appendix has a selective
advantage in many situations and argues strongly against its vestigial nature. This complex
evolutionary history of the appendix, along with a great heterogeneity in its evolutionary rate
in various taxa, suggests that it is a recurrent trait.
Such a function may be useful in a culture lacking modern sanitation and healthcare
practice, where diarrhea may be prevalent. Current epidemiological data on the cause of
death in developed countries collected by the World Health Organization in 2001 show that
acute diarrhea is now the fourth leading cause of disease-related death in developing
countries (data summarized by The Bill and Melinda Gates Foundation). Two of the other
leading causes of death are expected to have exerted limited or no selection pressure.
The human appendix averages 9 cm in length but can range from 5 to 35 cm. The
diameter of the appendix is 6 mm and more than 6 mm is considered a thickened or inflamed
appendix. The longest appendix ever removed was 26 cm long. The appendix is usually
located in the lower right quadrant of the abdomen, near the right hip bone. The base of the
appendix is located 2 cm beneath the ileocecal valve that separates the large intestine from
the small intestine. Its position within the abdomen corresponds to a point on the surface
known as McBurney's point. The appendix is connected to the mesentery in the lower region
of the ileum, by a short region of the mesocolon known as the mesoappendix.
William Parker, Randy Bollinger, and colleagues at Duke University proposed in
2007 that the appendix serves as a haven for useful bacteria when illness flushes the bacteria
from the rest of the intestines. This proposition is based on an understanding that emerged by
the early 2000s 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, its location just below the normal one-way flow of food and germs in the large
intestine, and its association with copious amounts of immune tissue. Research performed at
Winthrop–University Hospital showed that individuals without an appendix were four times
as likely to have a recurrence of Clostridium difficile colitis. The appendix, therefore, may
act as a "safe house" for beneficial bacteria. This reservoir of bacteria could then serve to
repopulate the gut flora in the digestive system following a bout of dysentery or cholera or to
boost it following a milder gastrointestinal illness.
The first operation for acute appendicitis was instead performed by J. Mestivier in
1759.4 Mestivier described the case of a 45-year-old patient admitted to St. Andrew Hospital
in Bordeaux for a mass localized on the right side of the umbilical area. The mass was
fluctuant and was opened. A pint of pus came out. The patient died shortly after and during
the autopsy it was found that the abscess had started from a small pin covered with salts
perforating the appendix.5 The description of symptoms, possibly attributed to the pain of
appendicitis, is found in the work of the German physician J.P. Frank, who writes of this
picture as peritonitis muscularis in 1792.

The first case in which perforation of appendix was recognized as the cause of death
was reported in 18126 by John Parkinson (1755–1824), son of the more famous James
renowned for describing Parkinson’s disease. The case presented by John Parkinson was also
the first case of appendicitis published in English. In 1813, Wegeler described7 in detail the
case of an 18-year-old patient admitted for mild abdominal spasms for 3 days, followed by an
acute and localized pain in the right lower quadrant, increasing at minimal palpation. The
abdomen was tender, patient had constipation that was preceded by mild diarrhea, nausea and
vomiting. The next day the extremities became cold and the patient died. On autopsy, there
was a generalized peritonitis and the cecum was gangrenous. Wegeler commented that “this
alteration seemed to start from the appendix that was red, enlarged and filled with stones.” In
1824 two more cases of appendix perforation with fatal peritonitis were reported8 in a classic
paper by the French physician Louyer-Villemay. Only a few years later, in 1827, the French
Francois Melier (1798–1866) was the first to describe what today is a chronic appendicitis
and suggested a surgical approach.9
The first successful operation addressing an intestinal perforation due to an abscess
of the appendix, was reported by the English surgeon Henry Hancock (1809–1880) at the
Charing Cross Hospital in London.10 This case was then followed in 1867 by the first in the
US11 authored by Willard Parker (1800–1884) from Francistown, NY. Parker advocated the
opening of appendicular abscesses at an early stage. Other cases of successful operation of
appendectomy with survival of the patients are from Richard John Hall in 188612 and Frank
Woodbury in 1887.
After 1890, the modern history of appendectomy was started with many surgeons
who refined the operation proposing different approaches. The beginning of the 20th century
corresponds also to the dawn of modern pathology, including accurate histological diagnosis
of appendicitis, such as illustrated in 190816 by the renowned German pathologist Ludwig
Aschoff.
 PERBINCANGAN
The appendix is a small, pouch-like sac of tissue that is located in the first part of
the colon (cecum) in the lower- right abdomen. Lymphatic tissue in the appendix aids in
immune function. Appendicitis is the most common cause of sudden, severe abdominal pain
and abdominal surgery in the United States. Over 5% of the population develops appendicitis
at some point. Appendicitis most commonly occurs during adolescence and in the 20s but
may occur at any age. In most cases, a blockage inside the appendix probably starts a process.
The blockage may be from a small, hard piece of stool, a foreign body, or, rarely, even
worms. As a result of the blockage, the appendix becomes inflamed and infected. If
inflammation continues without treatment, the appendix can rupture. A ruptured appendix
may cause a pus-filled pocket of infection (abscess) to form. As a result, peritonitis
(inflammation and usually infection of the abdominal cavity, which may result in a life-
threatening infection) may develop.
symptoms in which pain begins in the upper abdomen or around the navel, then
nausea and vomiting develop, and then, after a few hours, the nausea passes, and the pain
shifts to the right lower portion of the abdomen. When a doctor presses on this area, it is
tender, and when the pressure is released, the pain may increase sharply (rebound
tenderness). A fever of 100° to 101° F (37.7° to 38.3° C) is common. Moving and coughing
increase the pain.
A doctor may suspect appendicitis after reviewing the person’s symptoms and
examining the abdomen. Typically, surgery is done immediately if the doctor strongly
suspects appendicitis. If the diagnosis of appendicitis is not clear, doctors usually do an
imaging test such as computed tomography (CT) or ultrasonography. Ultrasonography is
particularly useful in children, in whom it is important to limit radiation exposure to reduce
the risk of future cancers. Surgeon can also do laparoscopy to explore the abdominal cavity
and help determine the diagnosis. A blood test often shows a moderate increase in the white
blood cell count because of the infection, but there is no definitive blood test for appendicitis.
With an early operation, the chance of death from appendicitis is very low. The
person can usually leave the hospital in 1 to 3 days, and recovery is normally quick and
complete. However, older people often take longer to recover. Without surgery or antibiotics
(as might occur in a person in a remote location without access to modern medical care),
more than 50% of people with appendicitis die. For a ruptured appendix, the prognosis is
more serious. If appendicitis is found, fluids and antibiotics are given by vein and the
appendix is removed (appendectomy). If the doctor does an operation and appendicitis is not
found, the appendix is usually removed anyway to prevent any future risk of appendicitis.
 RAWATAN
The main treatment for appendix is surgery called appendectomy. Appendectomy is
the procedure of removing the appendix. This removal 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. In
some cases, the appendicitis resolves completely; more often, an inflammatory mass forms
around the appendix. This is a relative contraindication to surgery.
If appendicitis is found, fluids and antibiotics are given by vein and the appendix is
removed (appendectomy). If the doctor does an operation and appendicitis is not found, the
appendix is usually removed anyway to prevent any future risk of appendicitis.
Appendix can be detected by using medical examination, ct scan (computer
tomography scan) and ultrasound.
 RUMUSAN
Appendix is the most common problem that people around the age of 20 often facing.
The disease is not dangerous if being treaten in the early stage but if the appendix is
perforated it’s can cause death. The treatment for appendix is the surgery that call
appendectomy. Appendectomy is the removal of appendix. Often even if the doctor don’t
found the problem when appendectomy, the appendix is still being remove in order to avoid
future appendicitis.
The symptoms of appendicitis in which pain begins in the upper abdomen or around
the navel, then nausea and vomiting develop, and then, after a few hours, the nausea passes,
and the pain shifts to the right lower portion of the abdomen. When a doctor presses on this
area, it is tender, and when the pressure is released, the pain may increase sharply (rebound
tenderness). A fever of 100° to 101° F (37.7° to 38.3° C) is common. Moving and coughing
increase the pain.