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Ruptured appendix

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 

Appendicitis is inflammation of the appendix.

It is classified as a medical emergency and in many cases in the past, has resulted in the removal of the inflamed appendix. 

Given  the role the appendix has in replenishing the intestinal flora, there is every reason, however,  to try to save it whenever possible.

Our intestinal flora is somewhat like an extension to the immune system.  It both processes food and extracts nutrients, but also protects us from pathogens. It does a stirling job trying to prevent pathogens from entering the blood stream or lymph system. The appendix is then an extension to this:

This review assesses the current state of knowledge regarding the cecal appendix, its apparent function, and its evolution. The association of the cecal appendix with substantial amounts of immune tissue has long been taken as an indicator that the appendix may have some immune function.

Recently, an improved understanding of the interactions between the normal gut flora and the immune system has led to the identification of the appendix as an apparent safe-house for normal gut bacteria.

Further, a variety of observations related to the evolution and morphology of the appendix, including the identification of the structure as a "recurrent trait" in some clades, the presence of appendix-like structures in monotremes and some non-mammalian species, and consistent features of the cecal appendix such as its narrow diameter, provide direct support for an important function of the appendix.

 

This bacterial safe-house, which is likely important in the event of diarrheal illness, is presumably of minimal importance to humans living with abundant nutritional resources, modern medicine and modern hygiene practices that include clean drinking water. Consistent with this idea, epidemiologic studies demonstrate that diarrheal illness is indeed a major source of selection pressure in developing countries but not in developed countries, whereas appendicitis shows the opposite trend, being associated with modern hygiene and medicine. The cecal appendix may thus be viewed as a part of the immune system that, like those immune compartments that cause allergy, is vital to life in a "natural" environment, but which is poorly suited to post-industrialized societies.  PMID:  21370495

This last section is vitally important.  Appendicitis and its increasing prevalence is part and parcel of our western way of life.  So called developing countries don't know of it as an illness.   One of the reasons it is " poorly suited to post-industrialized societies" is because it cannot keep up with demand.    Every time we have antibiotics we disrupt the intestinal flora :

The human gastrointestinal lumen is inhabited by a wide variety of microbiota. Our understanding of the intestinal microbiota and its full consequences on gastrointestinal health is still evolving. However, it is well accepted that altered colonic flora drives the pathogenesis of many disorders and diseases as seen in antibiotic-associated diarrhea and Clostridium difficile infection. PMID:  23037903

 

Thus the appendix with its store of emergency microbiota is somewhat key.   And those who demand antibiotics at the drop of a hat for every small [often viral] infection are putting a great strain on the appendix and its ability to supply the demand.

It may be inflamed for a very good reason.

Symptoms

There are a number of well recognised symptoms of appendicitis :

  • Pain – Appendicitis is accompanied by acute pain near the umbilicus.  Coughing causes point tenderness in the same area. Coughing can also produce pain in the right lower quadrant.  If the abdomen when pressed is also involuntarily rigid, this is also a symptom 
  • Vomiting - anorexia, nausea or vomiting 
  • Fever – which is a major contributor to producing the spiritual experience

Pain starts mid abdomen in the region of the umbilicus, and moves to the right in a few hours. The abdominal wall becomes very sensitive to gentle pressure and severe pain results from putting stronger pressure on the lower abdomen.  Heavy pressure on the left near the intestines may cause pain on the right, by pushing bowel contents towards the appendix. A digital rectal examination may also  cause pain or tenderness.  Thus severe pain on an ongoing basis is one feature of appendicitis. 

If the appendix ruptures, the pain becomes excruciating. Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock. 

 Causes

Obstruction - Acute appendicitis can be the end result of a primary obstruction of the inside of the appendix  and its tubular structure.  The obstructions can include foreign bodies, intestinal worms, viruses, bacteria, and calcified fecal deposits.  The latter seem to be linked with those who have a significantly lower number of bowel movements per week and is found in people having low fibre diets. 

Once the obstruction occurs, the appendix subsequently becomes filled with mucus and swells, increasing pressure on the walls of the appendix and the blood vessels get blocked and cells die.  As bacteria begin to leak out through the dying walls, pus forms within and around the appendix.

The end result of this is appendiceal rupture  - a 'burst appendix'  . 

Pharmaceuticals

 

The explanation above, does not explain how all these foreign bodies were allowed to get there in the first place, and again we go back to the disruption of the intestinal flora. 

Although a number of man made pharmaceuticals [anti-virals, anti-fungals, etc] are implicated in causing microbiota destruction and damage, antibiotics seem to stand out as one of the biggest culprits:

The healthy human intestine is colonized by as many as 1014 bacteria belonging to more than 500 different species forming a microbial ecosystem of unsurpassed diversity, termed the microbiota. The microbiota's various bacterial members engage in a physiological network of cooperation and competition within several layers of complexity…………
An increasing number of human disease conditions, such as inflammatory bowel diseases (IBD), type 2 diabetes, obesity, allergies and colorectal cancer are linked with altered microbiota composition. ……………
A general feature of a normal, healthy gut microbiota can generate conditions in the gut that disfavor colonization of enteric pathogens. This is termed colonization-resistance (CR). Upon disturbance of the microbiota, CR can be transiently disrupted, and pathogens can gain the opportunity to grow to high levels. This disruption can be caused by

  • exposure to antibiotics,
  • changes in diet,
  • application of probiotics and drugs, and
  • a variety of diseases.

Breakdown of CR can boost colonization by intrinsic pathogens or increase susceptibility to infections. One consequence of pathogen expansion is the triggering of inflammatory host responses and pathogen-mediated disease.
Interestingly, human enteric pathogens are part of a small group of bacterial families that belong to the Proteobacteria: the Enterobacteriaceae (E. coli, Yersinia spp., Salmonella spp., Shigella spp.), the Vibrionaceae (Vibrio cholerae) and the Campylobacteriaceae (Campylobacter spp.). …… proteobacterial "blooms" are a characteristic trait of an abnormal microbiota such as in the course of antibiotic therapy……PMID:  26185088

Nutritional deprivation

 

There is a common assumption that when one mentions the phrase 'nutritional deprivation', one is talking about starvation, but nutritional deprivation actually means either an overdose or a deficiency of the main vitamins, minerals, amino acids, proteins, sugars, fats and so on needed to sustain life.

What we tend to forget too, is that this ‘life’ includes the microbiota. 

Early depletion in gut Bifidobacterium longum, a typical maternal probiotic, known to inhibit pathogens, represents the first step in gut microbiota alteration associated with severe acute malnutrition (SAM). Later, the absence of the Healthy Mature Anaerobic Gut Microbiota (HMAGM) leads to deficient energy harvest, vitamin biosynthesis and immune protection, and is associated with diarrhea, malabsorption and systemic invasion by microbial pathogens.   PMID:  26853753

There is gradually emerging evidence that our microbiota live on some very strange things - trace elements, tiny tiny homeopathically small doses of things like arsenic and cyanide!

Prevention

 

The most obvious preventative measure is to stop taking all the pharmaceuticals we do.  If we spent as much time boosting the immune system as we do popping pills we would not become ill  in the first place.

And there is an obvious role for a balanced diet, not too much not too little of all the things we know we need to sustain our lives.

But of course the million dollar question is then, how do we feed our microbiota?  There are papers that say probiotics help, but equally there are papers that say probiotics are as much of a problem as a help.

Until we get a much better handle on what is in our microbiota, we will not know how to feed it.  Meanwhile the answer simply seems to be variety, balance and moderation.

The modification of microbiota composition to a 'beneficial' one is a promising approach for improving intestinal as well as overall health. Natural fibres and phytochemicals that reach the proximal colon, such as those present in various nuts, provide substrates for the maintenance of healthy and diverse microbiota. The effects of increased consumption of specific nuts, which are rich in fibre as well as various phytonutrients, on human gut microbiota composition have not been investigated to date. The objective of the present study was to determine the effects of almond and pistachio consumption on human gut microbiota composition. We characterised microbiota in faecal samples collected from volunteers in two separate randomised, controlled, cross-over feeding studies (n 18 for the almond feeding study and n 16 for the pistachio feeding study) with 0, 1·5 or 3 servings/d of the respective nuts for 18 d. Gut microbiota composition was analysed using a 16S rRNA-based approach for bacteria and an internal transcribed spacer region sequencing approach for fungi. The 16S rRNA sequence analysis of 528 028 sequence reads, retained after removing low-quality and short-length reads, revealed various operational taxonomic units that appeared to be affected by nut consumption. The effect of pistachio consumption on gut microbiota composition was much stronger than that of almond consumption and included an increase in the number of potentially beneficial butyrate-producing bacteria. Although the numbers of bifidobacteria were not affected by the consumption of either nut, pistachio consumption appeared to decrease the number of lactic acid bacteria (P< 0·05). Increasing the consumption of almonds or pistachios appears to be an effective means of modifying gut microbiota composition.  PMID:  24642201

How it works

Why do people get hallucinations, out of body experiences, near death experiences and so on from a ruptured appendix, or even just appendicitis?

The answer is partly the Fever and hyperthermia that results, but principally the Extreme pain.

If the appendix ruptures, the complication rate  rises to almost 59%. The most usual complications that can occur are pneumonia, hernia of the incision, thrombophlebitis, bleeding or adhesions, peritonitis -  which may lead to septicemia.

All of these latter complications may also thus be causes in producing spiritual experience especially any bleeding or pneumonia, both of which lead to hypoxia.

References and further reading

Anat Rec (Hoboken). 2011 Apr;294(4):567-79. doi: 10.1002/ar.21357. Epub 2011 Mar 2.  The cecal appendix: one more immune component with a function disturbed by post-industrial culture.  Laurin M1, Everett ML, Parker W.  1UMR 7207, CNRS/MNHN/UPMC, Centre de Recherches sur la Paléobiodiversité et les Paléoenvironnements, Muséum National d'Histoire Naturelle, Paris, France.

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