Appendicitis: An Extensive Discussion
1. Definition of Appendicitis
Appendicitis is the inflammation of the vermiform appendix, a small, tube-like structure
attached to the cecum of the large intestine. It is considered a surgical emergency, as a delay
in treatment can lead to perforation (rupture), which may result in peritonitis or abscess
formation.
Appendicitis can occur at any age but is most common in adolescents and young adults
between 10 and 30 years old. If untreated, it can progress rapidly and become life-
threatening.
2. Anatomy of the Appendix
- The appendix is a narrow, finger-like pouch projecting from the cecum, which is the
beginning of the large intestine.
- It is approximately 7–10 cm long in adults and has a blind-ending lumen.
- It is located in the right lower quadrant of the abdomen, specifically at McBurney’s point.
- Though once considered a vestigial organ, it is now known to play a role in the immune
system, particularly during early life.
- It contains lymphoid tissue and contributes to gut-associated lymphoid immunity.
3. Causes / Etiology of Appendicitis
The most common cause is obstruction of the appendiceal lumen, which may be due to:
- Fecaliths (hardened stool)
- Lymphoid hyperplasia (especially in children due to infection)
- Foreign bodies (rare)
- Parasites (e.g., Enterobius vermicularis)
- Tumors (e.g., carcinoid)
- Trauma or injury
Once blocked, the appendix becomes inflamed and infected, which may lead to rupture if
untreated.
4. Signs and Symptoms
- Abdominal pain: Starts as a dull ache around the umbilicus and later localizes to the right
lower quadrant (RLQ)
- Rebound tenderness at McBurney's point
- Nausea and vomiting
- Anorexia (loss of appetite)
- Low-grade fever (may progress to high fever if ruptured)
- Constipation or diarrhea
- Abdominal rigidity or guarding
- Positive Rovsing’s sign: RLQ pain upon palpation of the LLQ
- Psoas and obturator signs: Pain on specific leg movements
- Tachycardia in severe cases
5. Pathophysiology (Brief)
1. Obstruction of the appendiceal lumen (by fecalith, lymphoid tissue, etc.)
2. Mucus secretion continues, increasing intraluminal pressure.
3. This leads to venous congestion and bacterial overgrowth.
4. Inflammation progresses and compromises blood flow, causing ischemia.
5. If untreated, necrosis develops, and the appendix may rupture, spilling infectious
contents into the abdominal cavity.
6. This can lead to localized abscess, generalized peritonitis, or sepsis.
6. Nursing and Medical Management
A. Nursing Management
Pre-operative Care:
- Monitor vital signs and observe for signs of worsening infection.
- Keep the patient NPO (nothing by mouth) in case of surgery.
- Administer IV fluids to prevent dehydration.
- Provide pain relief as prescribed.
- Avoid giving laxatives, enemas, or applying heat to the abdomen.
- Educate the patient and family about the need for surgery.
Post-operative Care:
- Monitor for complications (e.g., bleeding, infection, peritonitis).
- Assess the surgical site for signs of infection.
- Promote early ambulation.
- Maintain adequate pain control.
- Encourage deep breathing and coughing exercises.
- Monitor for return of bowel sounds and tolerance of oral intake.
- Educate on wound care and signs of infection before discharge.
B. Medical Management
Diagnosis:
- Physical examination (e.g., McBurney’s point tenderness, rebound tenderness)
- Laboratory tests: Elevated WBC count, CRP
- Imaging studies: Ultrasound, CT scan, MRI
Treatment:
- Surgical removal of the appendix (appendectomy):
- Laparoscopic appendectomy
- Open appendectomy
- Antibiotics: Pre-op and post-op (e.g., ceftriaxone, metronidazole)
- In some cases, non-operative management with antibiotics alone (selected cases)
