SUPPURATIVE APPENDICITIS

Inflammation of the vermiform appendix with purulent exudates in the lumen and wall of the appendix.
Has been assumed in the past to be a later stage of appendicitis, in which bacteria and inflammatory fluids
accumulated in the lumen of the appendix enter the wall of structure and subsequently cause intense pain when
the inflamed membrane rubs against the parietal peritoneum lining the abdominal cavity.
It has no age difference.
In acute suppurative appendicitis inflammation is severe and purulent. The infection begins at the bottom of the
crypts. From here it spreads in the loose sub mucosa, then to the muscularis, then along the penetrating vessels
to the serous coat.
Appendix is swollen and elongated, a bright red color with dilated subperitoneal vessels and purulent or fibrous
exudates on the surface. There may be yellow spots on the surface, indicating the beginning of abscess
formation. The tip is usually swollen and the whole process is likely to be more marked in the distal than the
proximal part. An obstructive element is usually present and is of the dangerous type.

Etiology:

 Obstruction of the appendix

 Invasion of bacteria

Risk factors:

 Decreased Dietary Fiber

 Ingestion of refined carbohydrates
 Infection
Viral epidemic
Amoebiasis outbreak
Bacterial Gastroenteritis
 Family susceptibility
This is unusual but generally accepted fact, and can be accounted for by a hereditary abnormality
in the position of the organ, which predisposes to infection. Thus the whole family may have a long
retrocaecal appendix with comparatively poor blood supply.

 Abuse of purgatives
They cause violent peristaltic waves. This results in perforation of the inflamed appendix. This
occurs particularly when castor oil is taken for stomach ache.

Signs and Symptoms

 Intense abdominal pain

 Fever
 Increased white blood cells
 Fast heart rate
 Loss of appetite
 Nausea and vomiting

Medical Management:

 NPO; parenteral fluids and electrolytes

 High fowler’s position
 Nasogastric intubation
  Antibiotics

Surgical Management:

 Appendectomy

Nursing Responsibilities:

Pre-op Management

1. Make sure patient receives nothing by mouth until the surgery is performed.
2. Administer IV fluids to prevent dehydration. Never administer cathartics or enemas because they can
rupture the appendix.
3. Don’t administer analgesics until the diagnosis is confirmed because they mask symptoms.
4. Place the patient in Fowler’s position to reduce pain.
5. Never apply heat to the right lower abdomen; this may cause the appendix to rupture.
6. Give prescribed medications. (Cefotetan 25 mg/kg IV preoperatively)

Post-op Management

1. Monitor vital signs and intake and output.

2. Give analgesics as ordered.
3. Administer IV fluids as necessary to maintain fluid and electrolyte balance.
4. Document bowel sounds, passing of flatus, or bowel movements – all signs of peristalsis. These signs in a
patient whose nausea and board-like abdomen rigidity have subsided indicate readiness to resume oral
fluids.
5. Watch closely for possible surgical complications, such as abscess or wound dehiscence.
6. Teach patient how to care for the incision. If he has a surgical dressing, demonstrate how to change it
properly. Instruct him to observe the incision daily and to report any swelling, redness, bleeding, drainage, or
warmth at the site.
7. Discuss post-op activities limitations with the patient. Tell him to follow the physician’s orders for driving,
returning to work, and resuming physical activities.