is the inflammation of the vermiform appendix and was first described as a pathologic condition by Reginald Fitz in 1886; it is caused

by an obstruction attributed to infection, stricture, fecal mass, foreign body or tumor. Appendicitis can affect either gender at any age, but is most common in male ages 10-30. Appendicitis is the most common disease requiring surgery and one of the most commonly misdiagnosed diseases. Appendectomy, removal of the appendix, is the standard treatment for acute appendicitis, it is important to immediately remove the appendix after the diagnosis to prevent the occurrence of the life-threatening complication of appendix. The most frequent complication of appendicitis is perforation. Perforation of the appendix can lead to a periappendiceal abscess (a collection of infected pus) or diffuse peritonitis (infection of the entire lining of the abdomen and the pelvis). The major reason for appendiceal perforation is delay in diagnosis and treatment. In general, the longer the delay between diagnosis and surgery, the more likely is perforation. The risk of perforation 36 hours after the onset of symptoms is at least 15%. Therefore, once appendicitis is diagnosed, surgery should be done without unnecessary delay.

Risk Factors Age: Appendicitis can occur in all age groups but it is more common between the ages of 11 and 20. Gender: A male preponderance exists, with a male to female ratio (1.4: 1) and the overall lifetime risk is 8.6% for males and 6.7% for females. A male child suffering from cystic fibrosis is at a higher risk for developing appendicitis Diet: People whose diet is low in fiber and rich in refined carbohydrates have an increased risk of getting appendicitis. Hereditary: A particular position of the appendix, which predisposes it to infection, runs in certain families. Having a family history of appendicitis may increase a child's risk for the illness. Seasonal variation: Most cases of appendicitis occur in the winter months between the months of October and May. Infections: Gastrointestinal infections such as Amoebiasis, Bacterial Gastroenteritis, Mumps, Coxsackievirus B and Adenovirus can predispose an individual to appendicitis. Causes The cause of appendicitis isn't always clear. Sometimes appendicitis can occur as a result of:

An obstruction. Food waste or a hard piece of stool (fecal stone) can block the opening of the cavity that runs the length of your appendix. An infection. Appendicitis may also follow an infection, such as a gastrointestinal viral infection, or it may result from other types of inflammation. In both cases, bacteria inside the appendix multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. Signs and Symptoms Aching pain that begins around your navel and often shifts to your lower right abdomen Pain that becomes sharper over several hours Tenderness that occurs when you apply pressure to your lower right abdomen Sharp pain in your lower right abdomen that occurs when the area is pressed on and then the pressure is quickly released (rebound tenderness) Pain that worsens if you cough, walk or make other jarring movements Nausea Vomiting Loss of appetite Low-grade fever Constipation

Inability to pass gas Diarrhea

Abdominal swelling

The location of your pain may vary, depending on your age and the position of your appendix. Young children or pregnant women, especially, may have appendicitis pain in different places.

Pathophysiology
Obstruction of the appendix (by fecalith, lymph node, tumour, foreign objects)

Inflammation

Increase intraluminal pressure

Distention of the Appendix (causes pain)

Decrease venous drainage

Blood flow and oxygen restriction to the appendix

Bacterial Invasion of the Blood wall (causes fever)

Necrosis of the appendix

Diagnostic Procedure Urinalysis White Blood Cell Count Abdominal X-ray Ultrasound The Alvarado Score for Acute Appendicitis A popular mnemonic used to remember the Alvarado score factors is MANTRELS: Migration to the right iliac fossa Anorexia, Nausea/Vomiting Tenderness in the right iliac fossa Rebound pain Elevated temperature (fever) Leukocytosis Shift of leukocytes to the left Medical Management Surgery is indicated if appendicitis is diagnosed and should be performed as soon as possible to decrease risk of perforation. Administer antibiotics and intravenous fluids until surgery is performed. Barium enema Computerized (CT) Scan Laparoscopy Tomography

Analgesic agents can be given after diagnosis is made. Surgical Management Surgery is the only treatment for acute appendicitis. The appendix may be removed in two ways: First is the open method or through appendectomy. During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall over the area of the appendix. The surgeon enters the abdomen and looks for the appendix which usually is in the right lower abdomen. After examining the area around the appendix to be certain that no additional problem is present, the appendix is removed. This is done by freeing the appendix from its mesenteric attachment to the abdomen and colon, cutting the appendix from the colon, and sewing over the hole in the colon. If an abscess is present, the pus can be drained with drains that pass from the abscess and out through the skin. The abdominal incision then is closed. Second is Laparoscopic Method. Laparoscopy is a new technique for removing the appendix which involves the use of the laparoscope. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds. The benefits of the laparoscopic technique include less post-operative pain

(since much of the post-surgery pain comes from incisions) and a speedier return to normal activities. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in which the diagnosis of appendicitis is in doubt. For example, laparoscopy is especially helpful in menstruating women in whom a rupture of an ovarian cyst may mimic appendicitis. Nursing Management Nursing goals include relieving pain, preventing fluid volume deficit, reducing anxiety, eliminating infection due to potential or actual disruption of the gastrointestinal tract, maintaining skin integrity, and attaining optimum nutrition. Preoperatively, prepare patient for surgery, start intravenous line, administer antibiotic, and insert nasogastric tube (if evidence of paralytic ileus). Do not administer an enema or laxative (could cause perforation). Postoperatively, place patient in semi-fowlers position, give narcotic analgesic as ordered, administer oral fluids when tolerated, give food as desired on day of surgery (if tolerated). If dehydrated before surgery, administer intravenous fluids. If a drain is left in place at the area of the incision, monitor carefully for signs of intestinal obstruction, secondary hemorrhage, or secondary abscesses (eg. fever, tachycardia, and increased leukocyte count)

Also known as Gallstones, Gallbladder attack, Gallstone attack, Biliary Calculus and Biliary Colic. Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine. Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time. Gallstones are common in the United States. People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don't cause any signs and symptoms typically don't need treatment. Risk Factors Being female Being age 60 or older Being an American Indian Being a Mexican-American

Being overweight or obese Being pregnant Eating a high-fat diet Eating a high-cholesterol diet Eating a low-fiber diet Having a family history of gallstones Having diabetes Causes

Losing weight very quickly Taking some cholesterollowering medications Taking medications that contain estrogen, such as hormone therapy drugs

It's not clear what causes gallstones to form. Doctors think gallstones may result when: Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones. Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract

infections and certain blood disorders. The excess bilirubin contributes to gallstone formation. Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated and this contributes to the formation of gallstones.

Signs and Symptoms Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as: Sudden and rapidly intensifying pain in the upper right portion of your abdomen Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone Back pain between your shoulder blades Pain in your right shoulder Gallstone pain may last several minutes to a few hours. Seek immediate care if you develop signs and symptoms of a serious gallstone complication, such as: Abdominal pain so intense that you can't sit still or find a comfortable position

Yellowing of your skin and the whites of your eyes Clay-colored stools High fever with chills

Pathophysiology Diagnostic Procedures Abdominal ultrasound Abdominal CT scan Endoscopic retrograde cholangiopancreatography (ERCP) Gallbladder radionuclide scan Endoscopic ultrasound Magnetic resonance cholangiopancreatography (MRCP) Percutaneous transhepatic cholangiogram (PTCA) Bilirubin Liver function tests Pancreatic enzymes

Medical Management Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given in pill form to dissolve cholesterol gallstones. However, they may take 2 years or longer to work, and the stones may return after treatment ends. Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is not used very often, because it is difficult to perform, the chemicals can be toxic, and the gallstones may return. LITHOTRIPSY Electrohydraulic shock wave lithotripsy (ESWL) of the gallbladder has also been used for certain patients who cannot have surgery. Because gallstones often come back in many patients, this treatment is not used very often anymore. Surgical Management A technique called laparoscopic cholecystectomy is most commonly used now. This procedure uses smaller surgical cuts, which allow for a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning. In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. However, this is done less often now.

Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to find or treatgallstones in the common bile duct. Nursing Management