APPENDICITIS
BY
ASMA SHAIKH
ANATOMY AND PHYSIOLOGY
The appendix sits at the junction of the small intestine and large intestine.
It's a thin tube about four inches long. Normally, the appendix sits in the lower right
abdomen.
INTRODUCTION
Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from
colon on the lower right side of abdomen. Appendicitis causes pain in lower right abdomen.
However, in most people, pain begins around the navel and then moves. As inflammation
worsens, appendicitis pain typically increases and eventually becomes severe. Although
anyone can develop appendicitis, most often it occurs in people between the ages of 10
and 30..
DEFINITION
Appendicitis is an inflammation of the vermiform appendix that develops most commonly
in adolescents and young adults. (Joyce M Black)
Appendicitis is an acute inflammation of the appendix .(B.T Basuvanthapa)
INCIDENCE
Appendicitis is the most common acute surgical condition of the abdomen.
Approximately 7% of the population will have appendicitis in their lifetime,
with the peak incidence occurring between the ages of 10 and 30 years.
ETIOLOGY
Obstructive causes
Fecalith (a fecal calculus or stone) that occlude lumen of the appendix.DEFINITION
Kinking of the appendix (Twisting or curling)
Swelling of bowel wall
No obstructive causes
Haematogenous spread of infection
Vascular occlusion
Trauma
Diet lacking fibres
PATHOPHYSIOLOGY
Dual etiological factors
Obstruction of appendix (due to Fecalith tumor)
Ischemic injury
Bacterial proliferation (tissue become infected by bacteria in the digestive track)
Puss accumulation
Impairment is blood supply
Rupture of appendix
Digestive contents enters Into the abdominal cavity
Peritonites ( inflammation of peritonites
CLINICAL FEATURES (SYMPTOMS)
Pain: severe colicky type initially felt in the umbilical region & it is due to the distension of
appendix
ROVSING'S SON
Vomiting
Anorexia
Fever (100° F)
Haematuria (uncommon)
Constipation
CARDINAL SIGNS
The 5 important cardinal science of appendicitis are
PSOA'S SIGN
ROVSING'S SIGN
OBTURATOR'S SIGN
BLOOMBERG'S SIGN
MCBURNEY'S SIGN
ROVSING’S SING
The Rovsing's sign is positive when pressure over the patient's left lower quadrant causes
pain in the right lower quadrant
PSOA’S SIGN
Psoas sign is right lower-quadrant pain that is produced with the patient extending the hip
due to inflammation of the peritoneum. Straightening out the leg causes the pain because
it stretches the muscles.
OBTURATORS SIGN
Pain on passive internal rotation of the flexed thigh. Examiner moves lower leg laterally
while applying resistance to the lateral side of the knee resulting in internal rotation of the
femur
BLOOMBERG SIGN
BLOOMBERG'S SIGN Also referred as rebound tenderness.
Deep palpation of the viscera over the suspected inflamed appendix followed by sudden
release of the pressure causes the severe pain on the site.
This indicates positive Blumberg's sign peritonitis.
CONTINUE…….
Assessment of the abdomen rebound tenderness
Apply firm pressure for several seconds to the abdomen with hand at right angles and
fingers extended
Quickly release the pressure
Test away from site where pain is initially determined
MCBURNEYS SIGN
• Mc Burney's Point is two third away from umbilicus to Anterior superior iliac spine
To elicit Mcburney's sign patient should be in supine position with his knees slightly flexed
and his abdominal muscles relaxed.
Palpate deeply and slowly in the right lower quadrant over McBurney's point, located
about 2" from the Rt. Ant. Sup. Iliac Spine, On a line between the spine and umbilicus.
pain and tenderness is a positive sign and indicates appendicitis.
CLINICAL STAGES
The stages of appendicitis can be divided into early, suppurative, gangrenous.
Early stage appendicitisTIC MEASURES
In the early stage of appendicitis, obstruction of the appendiceal lumen leads to
Mucosal edema,
mucosal ulceration,
bacterial diapedesis
appendiceal distention due to accumulated fluid, and increasing intraluminal pressure.
The visceral afferent nerve fibers are stimulated, and the patient perceives mild visceral
periumbilical or epigastric pain, which usually lasts four to six hoursGangrenous
appendicitisIntramural venous and arterial thrombosis, resulting in gangrenous
appendicitis.
SUPPURATIVE APPENDICITIS
Increasing intraluminal pressures eventually exceed capillary perfusion pressure.ment
Transmural spread of bacteria causes acute suppurative appendicitis.HermaGROUP 4Fanny
Naga J Camilia Munirah Aishwaeriyo
When the inflamed serosa of the appendix comes in contact with the parietal peritoneum,
patients typically experience the classic shift of pain from the periumbilicus to the right
lower abdominal quadrant (RLQ), which is continuous and more severe than the early
visceral pain.
DIAGNOSTIC MEASURES
History collection
Physical examination
White cell count (WCC) – usually mildly elevated, around 11-14,000ement
C reactive protein (CRP) - elevated.
Urinalysis
Complete blood count
CT – Scan
Ultrasound - visualise tubular structures & cysts
USG is not accurate as CT sometimes difficult to see appendix
Magnetic resonance imagingagement
x-ray
MANAGEMENT
Medical management
Surgical management
Nursing management
MEDICAL MANAGEMENT
Goal of medical management includesReco
To treat infections
To prevent further complications
Medication therapy includes
Antibiotic therapy examples cephalosporin
Analgesics
Fluid therapy.
SURGICAL MANAGEMENT
The surgical procedure for the removal of the appendix is called an appendectomy.
Appendectomy can be performed through open or laparoscopic surgery.
Laparoscopic appendectomy has several advantages over open appendectomy as an
intervention for acute appendicitis.
NURSING ASSESSMENT
History collection
Medical history
complaints of pain in postoperative wound appendectomy,
nausea, vomiting, increased body temperature, increased leukocytes.
Past medical history
Physical Examination
Cardiovascular System
To determine vital signs, presence or absence of jugular venous distension, pallor, edema,
and abnormal heart sounds
Hematologic System
To determine whether there is an increase in leukocytes (sign of infection and bleeding)
Urogenital System
Assess Whether or not the tension of the bladder and lower back pain complaints.
Musculoskeletal System
To determine whether there is difficulty in movement, pain in bones, joints and there is a
fracture or not.
The immune system
To determine whether there is lymph node enlargement
INVESTIGATIONS
Routine blood tests
To determine an increase in leukocytes is a sign of infection.
Abdominal examination
To know the existence of post-surgical complications.
COMPLICATIONS
Appendicitis can cause serious complications, such as
A ruptured appendix.
A rupture spreads infection throughout abdomen (peritonitis).
life-threatening.
This condition requires immediate surgery to remove the appendix and clean your abdominal cavity
A pocket of pus that forms in the abdomen.
If appendix bursts, Patient may develop a pocket of infection (abscess).
In most cases, a surgeon drains the abscess by placing a tube through abdominal wall into the
abscess site
The tube is left in place for two weeks,
Antibiotics are given to clear the infection
THANK YOU
