Appendicitis

GROUP A
Aglibao, Rosalie G.
Aglibut, Crizza Mae B.
Arconado, Kisha Mae R.
Ayonayon, Coni Flor U.
• Appendicitis is an inflammation of
appendix that develops most
common in adolescents and young
adults.
• Appendicitis is acute
inflammation of the appendix, and
is the most common cause for
acute, severe abdominal pain.
• The abdomen is most tender at
McBurney's point - one third of the
distance from the right anterior
superior iliac spine to the
umbilicus. This corresponds to the
location of the base of the
appendix
 CAUSES
•Acute appendicitis seems to be the
end result of a primary obstruction
of the appendix. FAECOLITH
•Once this obstruction occurs, the
appendix becomes filled with
mucus and swells. This continued
production of mucus leads to
increased pressures within the
lumen and the walls of the
appendix.
•The increased pressure results in
thrombosis and occlusion of the
small vessels, and stasis of
lymphatic flow.
RISK FACTORS
• Infection, possibly stomach
infection that has traveled to the
site of appendix.
• Obstruction such as a hard piece
of stool getting trapped in the
appendix leading to infection of
the appendix.
• Low-fiber diet
• High intake of refined
carbohydrates
• Extreme of age
• Previous abdominal surgery

 PATHOPHYSIOLOGY
Obstruction of the Ulceration (lesion) of Promotes microbe
appendiceal lumen the appendix mucosal invasion
(inside the appendix) lining (ex: bacterial)

Build up of mucous Inflammation and

in the appendix ↓ oxygen delivery
swelling of the
*appendix constantly (hypoxia)
appendix
secreting mucuos

↑ appendiceal ↓ blood flow to the

lumen pressure appendix
APPENDICITIS
Types

Acute Appendicitis
• Acute appendicitis, as its name implies, develops very fast, usually in a span of several days or hours. It is easier to
detect and requires prompt medical treatment, usually surgery.
• Acute appendicitis occurs when the vermiform appendix is completely obstructed, either because of a bacterial
infection, feces or other types of blockage. Infection may also cause swelling of the lymph nodes, which then adds
pressure on the appendix, cutting off its blood supply.

Appendicitis Can Be Chronic (But It's a Rare Condition)

• Chronic appendicitis is an inflammation that can last for a long time. This is rare according to a report published in
Therapeutic Advances in Gastroenterology, it only occurs in only 1,5 percent of recorded acute appendicitis cases.
• Basically, chronic appendicitis means that the appendiceal lumen is only partially obstructed, causing inflammation.
The inflammation worsens over lime, causing internal pressure to buildup.

Stump Appendicitis: A Rare Appendectomy Side Effect

• In most instances of appendicitis, an appendectomy is the usual procedure recommended, and it works by completely
taking out the appendix to prevent it from rupturing.
• If the appendix has already ruptured, additional treatment measures are performed during an appendectomy, as the
infection needs to be prevented from spreading.
Clinical Manifestations
• Lower right quadrant pain usually accompanied by low-grade fever, nausea,
and sometimes vomiting; loss of appetite is common; constipation can occur.
• At McBurney's point (located halfway between the umbilicus and the anterior
spine of the ilium), local tenderness with pressure and some rigidity of the
lower portion of the right rectus muscle.
• Rebound tenderness may be present; location of appendix dictates amount
of tenderness, muscle spasm, and occurrence of constipation or diarrhea.
• Rovsing's sign (elicited by palpating left lower quadrant, which paradoxically
causes pain in the right lower quadrant).
• If the appendix ruptures, pain becomes more diffuse; abdominal distention
develops from paralytic ileus, and condition worsens.
 Signs
• Abdominal tenderness >95%
• Right lower quadrant tenderness >90%
• Rebound tenderness 30-70%
• Rectal tenderness 30-40%
• Cervical motion tenderness 30%
• Rigidity 10%
• Psoas sign 3-5%
• Obturator sign 5-10%
• Rovsing's sign 5%
• Palpable mass <5%
Symptoms
• Abdominal pain >95%
• Anorexia >70%
• Constipation 4-16%
• Diarrhea 4-16%
• Fever 10-20%
• Migration of pain to right
lower quadrant 50-60%
• Nausea Vomiting >65%

Assessment
and
Diagnostic
Findings
• Roving's sign: Palpating in the left
lower quadrant causes pain in the
right lower quadrant.

• Obturator's sign: Internal rotation

of the hip causes pain, suggesting
the possibility of an inflamed
appendix located in the pelvis.


• Dunphy's sign: Increased pain in

the right lower quadrant with
coughing.

• lliopsoas sign: Extending the right

hip causes pain along
posterolateral back and hip,
suggesting Retrocecal appendicitis.

• Sitkovskiy (Rosenstein)'s sign:

Increased pain in the right iliac
region as the person is being
examined lies on his/her left side.

 DIAGNOSIS
Diagnosis is based on results of a complete physical
examination and on laboratory and x-ray findings.

The complete blood cell count demonstrates an

elevated white blood cell count.

The leukocyte count may exceed 10,000 cells/mm3,

and the neutrophil count may exceed 75%.

 ALVARADO SCORE

The Alvarado score is the most

widely used scoring system.
A score below 5 suggests against a
diagnosis of appendicitis,
whereas a score of 7 or more is
predictive of acute appendicitis.
MANAGEMENT
Surgery is indicated it appendicitis is
diagnosed.
To correct or prevent fluid and electrolvte
imbalance and dehydration, antibiotics
and intravenous fluids are administered
until surgery is performed.
Analgesics can be administered after the
diagnosis is made. (Morphine Sulphate 10
mg/ml)

ANTIBIOTICS
Colotaxime 250mg, 500mg
Levofloxacin 500 mg
Metronidazole 500mg/100ml, 400 mg tablet
 Appendectomy
(ie, surgical removal of
the appendix)
is performed as soon as
possible to decrease the
risk of perforation.
It may be performed
under a general or
spinal anesthetic with a
low abdominal incision
or by laparoscopy.
NURSING MANAGEMENT

• Goals include relieving pain, preventing fluid volume deficit, reducing

anxiety, eliminating infection from the potential or actual disruption of
the Gl tract, maintaining skin integrity, and attaining optimal nutrition.

• The nurse prepares the patient for surgery, which includes an

intravenous infusion to replace fluid loss and promote adequate renal
function and antibiotic therapv to prevent infection.
 Pre-Operative Care
Assessment History taking physical examinations,
Regarding pain, nausea vomiting, abdominal
rebound tenderness, Anorexia
Monitor vital signs B.P, Temperature for baseline
data
NPO and 1.V. Fluids be started
Naso-gastric aspiration
Monitor for signs of ruptured appendix and
peritonitis
Position right-side lying or low to semi fowler
position to promote comfort
Auscultate Bowel Sounds
Administer antibiotics as prescribed
Preparation for surgery i.e. physically &
psychologically
Alley anxiety & fears
Written consent for surger
Prepare and send the patient for surgery without
delay
OT clothes and pre medications to be aiven 45
minutes before operation
Post Operative Care
Clear airwav
Proper breathing and adequate tissue perfusion
by IVF
Naso-gastric suction to be done regularly to
relieve tension on sutures
Provide safety & effective care environment to the
patient
Care of all drainage tubes
Care of surgical wounds. Watch for
soapage/bleeding
Nutritional status maintained by IV. fluids
Observe for return of bowel sounds,
Intake and outout maintained
Monitor vital signs & fluid, electrolytes balance
Encourage early ambulation to prevent post
operation complications
Medication as per prescription to be given by
using 6 rt of Nursing standards of medication
After surgery, the nurse places the patient in a
semi-Fowler position. This position reduces the
tension on the incision and abdominal organs,
helping to reduce pain.
NURSING DIAGNOSIS
Acute Pain - May be related to, Distension of intestinal tissues by
inflammation, Presence of surgical incision

Risk for Fluid Volume Deficit - Risk factors may include, Preoperative
vomiting, postoperative restrictions (e.g., NPO). Hypermetabolic state (e.g.,
fever, healing process) Inflammation of peritoneum with sequestration of
fluid

Risk for Infection - Risk factors may include, Inadequate primary defenses;
perforation/rupture of the appendix peritonitis: abscess formation. Invasive
procedures, surgical incision

Deficient Knowledge - May be related to Lack of exposure recall;

information misinterpretation. Unfamiliarity with information resources
 Discharge and Home Healthcare Guidelines

MEDICATIONS. Be sure the patient understands any pain medication

prescribed, including doses, route, action, and side effects.

INCISION. Sutures are generally removed in the physician's office in 5 to

7 days.

COMPLICATIONS. Instruct the patient that a possible complication of

appendicitis is peritonitis.

NUTRITION. Instruct the patient that diet can be advanced to her or his
normal food pattern as long as no gastrointestinal distress is
experienced.