APPENDICIT

IS

APPENDICITIS

An inflammation of the
vermiform appendix

ETIOLOGY / CAUSES

Obstruction of the appendix lumen

Fecolith (composed of inspissated fecal material, calcium
phosphates, bacteria, epithelial debris, rarely a foreign
body)
Tumor (carcinoma of cecum)
Intestinal parasites (Oxyuris/Enterobius vermicularis
pinworm)

Genetics

Genetic variant that predisposes a person to obstruction of the appendiceal lumen

RISK FACTORS

Age- children and young adults are more

likely to experience appendicitis, with the
risk factor highest in those who are aged
between 10-30. The reason for this is not
known
Infection- a recent infection, especially if it
occurs in the gastrointestinal system is a
known risk factor for increasing likelihood of
infection of the appendix and subsequent
appendicitis

Trauma to the appendix- if the appendix has been

injured in some way (through an accident of some sort
that causes internal injuries), this can also increase
risk for appendicitis where the appendix becomes very
inflamed and swollen and risk for rupture also
increases

Low fibre diet- a lowfiberdiet is linked to many

digestive disorders that can increase risk of
appendicitis. A low fiber diet especially increases risk
for constipation and this can cause some of the fecal
matter to become lodged in the appendix and cause
appendicitis

APPENDIX

its function are not certain, but some biologists believe

that the appendix serve as a sort of breeding ground for
intestinal bacteria.

Often called simply the intestinal flora, a community of

various bacterial populations normally inhibits the colon.

The predominance of nonpathogenic bacteria under normal

conditions is thought to help prevent disease. Some of the
non pathogenic bacteria are also thought to aid in the
digestion or absorption of essential nutrients.

Also, it bind extension ofposteromedial cecum. It contains

many lymphoid nodules and serves as bacterial reservoir of
sorts.

Obstruction + infection lead

to distention with pus hence
increase intraluminal
pressure lead to venous
occlusion, edema, arterial
occlusion, gangrene and
perforation follows rapidly
localized by defense
mechanism (greater
omentum and coils of
bowel).Appendix mass is
formed, can undergo
suppuration to produce an

Signs and symptoms of appendicitis

may include:
Sudden

pain that begins on the right side of the

lower abdomen

Sudden

pain that begins around your navel and

often shifts to your lower right abdomen

Pain

that worsens if you cough, walk or make

other jarring movements

Nausea
Loss

and vomiting

of appetite

Low-grade

fever that may worsen as the

illness progresses
Constipation or diarrhea
Abdominal bloating
The site of your pain may vary, depending
on your age and the position of your
appendix. When you're pregnant, the pain
may seem to come from your upper
abdomen because your appendix is higher
during pregnancy.

Signs to elicit

Pointing sign (patient is asked to point where the

pain began and where it moved)
Rovsings sign (deep palpation of the left iliac fossa
may cause pain in the right iliac fossa)
Psoas sign (patient will lie with the right hip flexed
for pain relief)
Obturator sign (the hip is flexed and internally
rotated. If an inflamed appendix is in contact with
the obturator internus, this maneuver will cause
pain in the hypogastrium)

DIAGNOSTIC PROCEDURE

IMAGING TEST

CT scan (computed tomography): A CT scanner uses

X-rays and a computer to create detailed images. In
appendicitis, CT scans can show the inflamed
appendix, and whether it has ruptured.

may be used when symptoms are recurrent or

prolonged.
Check allergies and renal function if contrast dye is
used

Ultrasound: An ultrasound uses sound waves to detect

signs of appendicitis, such as a swollen appendix.

LABORATORY TEST

Complete blood count (CBC): An increased number of

white blood cells -- a sign of infection and
inflammation -- are often seen on blood tests during
appendicitis.
Mild to moderate elevation 10,000-18,000 mm3 with
shift is consistent with appendicitis

left

Diagnostic Scoring

Diagnosis is essentially clinical;

HOWEVER a decision to operate based
on clinical suspicion only can lead to
the removal of a normal appendix.
A number of clinical and laboratorybased scoring systems have been
devised to assist diagnosis.
The most widely used isAlvarado
score.

The Alvarado (MANTRELS)

Score

< 5 is strongly against a diagnosis of appendicitis

7 or more is strongly predictive of acute appendicitis
In patients with an equivocal score of 5 or 6, abdominal USG or

CT Scan images of
Appendicitis:
1. enlarged appendix

CT findings of appendicitis fall into 3 categories

1. appendiceal changes
2. cecal apical changes
3. inflammatory changes in the right lower
quadrant

2. appendicle wall thickening

CT Scan images of Appendicitis

3. appendicolith

4.periappendiceal fat
stranding

PHARMACOLOGIC
Antibiotics and other treatment

If symptoms have a nonsurgical or medically treatable

cause

IV antibiotics and IV fluids

Draining the abscess and leaving the drain in the

abscess cavity

Appendectomy may be scheduled after the abscess is

drained

SURGERY
Appendectomy
Conventional Appendectomy
Laparoscopic Appendectomy

Conventional Appendectomy

1/3

2/3

Gridiron incision : right

angles to a line joining
the ASIS to the
umbilicus. Centred on
McBurneys point

2 cm

Lanz incision : 2 cm
below the umbilicus
centred on the midclavicular-midinguinal
line

Laparoscopic appendectomy

NURSING INTERVENTION
Pre

Operative

NPO status upon admission

Administer IV fluids as prescribed

Semi-Fowlers position to contain abdominal drainage in the lower abdomen

Avoid laxatives/enemas or application of heat that could cause perforation

Post

Operative

Administer opioid analgesia (morphine sulfate)

Administer IV antibiotics as ordered (surgical prophylaxis, perforation)

For peritonitis, monitor NG tube drainage

For perforation or abscess, monitor surgical drains.