BACKGROUND

Acute appendicitis is a common medical condition that is characterized by inflammation of the

appendix. The appendix is a small, thin tube that is attached to the large intestine and located
in the lower right side of the abdomen. Despite being a small organ in the human body, the
appendix can cause severe pain and discomfort when it becomes inflamed. The cause of acute
appendicitis is still not clear, but the condition is often linked to blockage of the appendix. The
blockage can be due to the buildup of mucus in the appendix or by the presence of a foreign
object, such as fecal matter or a small piece of hard stool. The blockage leads to the
accumulation of bacteria, which multiply and cause an infection, which often leads to
inflammation. The inflammation causes pain and swelling, making the condition noticeable and
urgent.
RISK FACTORS
 Aged 10-30 years- this is due to changes in the lymphoid tissue and the microbiome
of the appendix during this phase of life.
 Gender- with males being more susceptible than females. This may be because the
male appendix is longer and narrower, making it more prone to obstruction.
 Dietary factors- for example, a diet high in refined carbohydrates and low in fiber has
been associated with a greater risk of this condition.
 Family history of acute appendicitis- may increase an individual's risk of developing
the condition.
 Infectious agents- such as viruses and bacteria
 Use of oral contraceptives- may increase the risk of this condition by altering the
hormonal balance in the body.

EPIDEMIOLOGY

Appendicitis is one of the more common surgical emergencies, and it is one of the most
common causes of abdominal pain. In the United States, 250,000 cases of appendicitis are
reported annually, representing 1 million patient-days of admission. The incidence of acute
appendicitis has been declining steadily since the late 1940s, and the current annual incidence
is 10 cases per 100,000 population. Appendicitis occurs in 7% of the US population, with an
incidence of 1.1 cases per 1000 people per year. Some familial predisposition exists.
In Asian and African countries, the incidence of acute appendicitis is probably lower
because of the dietary habits of the inhabitants of these geographic areas. The incidence of
appendicitis is lower in cultures with a higher intake of dietary fiber. Dietary fiber is thought to
decrease the viscosity of feces, decrease bowel transit time, and discourage formation of
fecaliths, which predispose individuals to obstructions of the appendiceal lumen. In the last few
years, a decrease in frequency of appendicitis in Western countries has been reported, which
may be related to changes in dietary fiber intake. In fact, the higher incidence of appendicitis is
believed to be related to poor fiber intake in such countries. There is a slight male
preponderance of 3:2 in teenagers and young adults; in adults, the incidence of appendicitis is
approximately 1.4 times greater in men than in women. The incidence of primary
appendectomy is approximately equal in both sexes.

The incidence of appendicitis gradually rises from birth, peaks in the late teen years, and
gradually declines in the geriatric years. The mean age when appendicitis occurs in the pediatric
population is 6-10 years. Lymphoid hyperplasia is observed more often among infants and
adults and is responsible for the increased incidence of appendicitis in these age groups.
Younger children have a higher rate of perforation, with reported rates of 50-85%. The median
age at appendectomy is 22 years. Although rare, neonatal and even prenatal appendicitis have
been reported. Clinicians must maintain a high index of suspicion in all age groups.

CLINICAL MANIFESTATION
 Vague periumbilical pain (visceral pain that is dull and poorly localized) - with
anorexia progresses to right lower quadrant pain (parietal pain that is sharp, discrete,
and well localized) and nausea in approximately 50% of patient with appendicitis.
 Low Grade fever- fever may be present and local tenderness may be elicited at
McBurney’s point when pressure is applied (Aaron’s sign).
 Rebound tenderness - (production or intensification of pain when pressure is
released) may be present (Blumberg’s sign).
 Cough tenderness- Differentiates from right sided uretic colic.
 Cope’s obturator Sign- flexion and medial rotation at hip produce pain due to
irritation of obturator muscle in pelvic appendicitis. Cope’s Psoas - pain in attempt to
extend the hip flexed due to irritation of psoas major in retrocecal appendicitis.
 Rovsing’s sign-may be elicited by palpating the left lower quadrant; this paradoxically
causes pain to be felt in the right lower quadrant.
 Constipation - can also occur with appendicitis laxatives given in this instance may
result perforation of the inflamed appendix. In general, a laxative or cathartic should not
be given when a person has fever, nausea, and abdominal pain.
 Ten Horn Sign- pain caused by gentle traction of right testicle.
COMPLICATIONS
 Rupture (Perforation) generalized peritonitis, increased risk in infants (thin omentum
without much fat) and elderly (atherosclerosis of appendicular artery which is an end-
artery).
 Appendicular mass: cecum, terminal ileum and appendix sealed by greater omentum.
 Appendicular abcess others: Adhesion, portal pyaemia, abdominal actinomycosis.
DIAGNOSTICS AND LABORATORY EXAMINATION
 White blood cell (WBC)- count is useful when determining diagnosis; between 80%
and 85% of adults with appendicitis will have a WBC count >10,500/mm3; 78% of
patient have neutrophilia, where neutrophils comprise >75% of WBC. C- reactive protein
levels are typically elevated, especially within the 12 hours of symptoms, but may return
to normal in patients who are symptomatic longer than 24 hours.
 Urinalysis, several WBC and RBCs- may be found in appendicitis secondary to
bladder irritation from inflamed appendix.
 Abdominal x-ray- may reveal fecolith to rule out perforation.
 Abdominal USG +ve if > 6mm noncompressible appendix to rule out gynecology
pathology. Laparoscopy, to rule out ovarian pathology in females.
 Abdominal CT scan
MEDICAL AND SURGICAL MANAGEMENT
 Appendectomy- often involves going into surgery immediately to remove the inflamed
appendix and prevent the risk of rupture, which can be life-threatening. The surgery to
remove the appendix. It is performed as soon as possible to decrease the risk of
perforation.
 Laparotomy- performed under the general anesthesia with an open technique via
transverse incision in the right lower.
  Antibiotics and IV fluids- to correct or prevent electrolyte imbalance, dehydration
and sepsis, are given until surgery is performed . For complicated appendicitis with
gangrene and perforation the patient is typically treated with a 3 to 5 days of
antibiotics postoperatively.
NURSING MANAGEMENT
Goals
 relieving pain
 preventing fluid volume deficit
 reducing anxiety or
 preventing treating surgical site infection
 preventing atelectasis
 maintaining skin integrity
 attaining optimal nutrition.
 Nurse prepares the patient surgery, which include IV infusion to replace fluid loss and
promote adequate renal function, antibiotic therapy to prevent infection and
administration analgesic agents for pain.
 Enema is not given because it can lead to perforation.
 Place patient to high fowler’s position
 Auscultate for the return of bowel sounds and queries the patient for passing flatus.
 Urine output is also monitored to ensure that the patient is not hampered by
postoperative urinary retention and to ensure that hydration is adequate.
PREVENTION
 Lifestyle measures can help decrease the risk of developing the condition.
 High-fiber diet and regular exercise can help decrease the buildup of mucus in the
appendix.
 Drinking plenty of fluids can also help pass stool smoothly, preventing blockages.
 Avoiding smoking and a sedentary lifestyle can also reduce the risk of developing
appendicitis.
In conclusion, acute appendicitis is a common inflammation of the appendix that can cause
severe pain and discomfort. The condition is often linked to blockage of the appendix, which
can be caused by the buildup of mucus or foreign objects. The symptoms of the condition
include abdominal pain, fever, nausea, and vomiting. Once suspected, doctors use different
diagnostic tests to confirm the diagnosis. The treatment involves surgery to remove the
inflamed appendix, and prevention measures include lifestyle measures that encourage proper
bowel movements.