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Incidence
Acute appendicitis is one of the most common acute surgical abdominal emergencies.
More than 34,600 cases were treated in UK hospitals in 2006 to 2007. Most cases were
in male subjects (30,120) and occurred predominantly in the 15 to 59 year age group. A
large majority presented (29,576) as medical emergencies. More than 250,000
appendectomies are performed each year in the US; however, the incidence is lower in
populations where a high-fibre diet is consumed. The overall lifetime risk of developing
acute appendicitis is 8.6% for males and 6.7% for females; lifetime risk of
appendectomy is around 12% in males and 23% in females. The rate of appendectomy
is around 10 per 10,000 cases per year in the US. This condition is most commonly
seen in patients aged between early teens and late 40s.
Causes:
-trauma
-obstructing fecalith
-lymphadenitis
-intestinal worm
Manifestations
1.Pain
-Caused initially by the distention of the wal of the appendix
-Later due to the grossly inflamed appendix rubbing on the overlying inner
wall of the abdomen
-then with the spillage of the content of the appendix into the general
abdominal cavity
2. Fever
-due to the release of toxic materials (endogenous pyrogens) following the
necrosis of the appendiceal wall, and later by pus formation
3. Guarding
-occur when the abdominal wall becomes rigid during examination.
Classic symptom- pain in the right lower quadrant (Mc Burneys Point)
4 signs
1. rovsings sign
deep palpation of the left iliac fossa may cause pain in the right iliac fossa
Description
Pressure over the descending colon causes pain in the right lower quadrant of the
abdomen
2. psoas sign
occasionally, an inflamed appendix lies on the poas muscle and the patient will lie with
the right hip flexed for the pain relief
Description
It is elicited by passively extending the thigh of the patient lying on their side with the
knees extended, or asking the patient to actively flex their thigh at the hip
Positive abdominal pain--- positive psoas sign
3. obturator sign
Description
If an inflamed appendix is in contact with the obturator internus, spasm of the muscle
can be demonstrated by flexing and internally rotating the hip----cause pain in the
hypogastrium
4. blumber sign
- rebound tenderness
Description
Deep palpation of the viscera over the suspected inflamed appendix followed by the
sudden release of the pressure causes the severe pain on the site indicating positive
blumber sign
Diagnostic tests
Urinalysis
Urinalysis is a microscopic examination of the urine that detects red blood cells, white
blood cells and bacteria in the urine. Urinalysis usually is abnormal when there is
inflammation or stones in the kidneys or bladder. The urinalysis also may be abnormal
with appendicitis because the appendix lies near the ureter and bladder. If the
inflammation of appendicitis is great enough, it can spread to the ureter and bladder
leading to an abnormal urinalysis. Most patients with appendicitis, however, have a
normal urinalysis. Therefore, a normal urinalysis suggests appendicitis more than a
urinary tract problem
Abdominal X-ray
An abdominal x-ray may detect the fecalith (the hardened and calcified, pea-sized piece
of stool that blocks the appendiceal opening) that may be the cause of appendicitis.
This is especially true in children.
Ultrasound
An ultrasound is a painless procedure that uses sound waves to provide images to
identify organs within the body. Ultrasound can identify an enlarged appendix or an
abscess. Nevertheless, during appendicitis, the appendix can be seen in only 50% of
patients. Therefore, not seeing the appendix during an ultrasound does not exclude
appendicitis. Ultrasound also is helpful in women because it can exclude the presence
of conditions involving the ovaries, Fallopian tubes and uterus that can mimic
appendicitis.
Barium enema
A barium enema is an X-ray test in which liquid barium is inserted into the colon from
the anus to fill the colon. This test can, at times, show an impression on the colon in the
area of the appendix where the inflammation from the adjacent inflammation impinges
on the colon. Barium enema also can exclude other intestinal problems that mimic
appendicitis, for example Crohn's disease.
Nursing management
PRE-OP
1. Inform consent
2. NPO post midnight before surgery (except in case of STAT surgery)
3. Start IVF and IVTT meds antibiotic, pain relievers (morphine: only if diagnosis is
confirmed) and sedative
POST-OP
1. Monitor VS
2. Monitor signs of bleeding and infection
3. Clear liquids to solid foods once tolerated