APPENDICITIS

PATHOPHYSIOLOGY

Obstruction of the appendiceal lumen is the

primary appendiceal lumen leads to distension
of the appendix due to accumulated
intraluminal fluid.
Ineffective lymphatic and venous drainage
allows bacerial invasion of the appendiceal
wall and in advanced cases, perforation and
spillage of pus into the peritoneal cavity.

WHAT IS APPENDICITIS?

APPENDICITIS IS A
PAINFUL SWELLING
AND INFECTION OF
THE APPENDIX.

WHAT IS THE APPENDIX?

The appendict is a fingerlike pouch attached to

the large intestine and located in the lower
right area of the abdomen.
The inside of the appendict is called the
appendiceal lumen.

WHAT CAUSES APPENDICITIS?

Obstruction of the appendiceal lumen

causes appendicitis. Mucus backs up in
the appendiceal lumen, causing bacteria
that normally live inside the appendix to
multiply. The appendix swells and
becomes infected. Sources of obstruction
include
Feces, parasites, or growth that clog the
appendiceal lumen

WHAT CAUSES APPENDICITIS?

Enlarged lymph tissue in the wall of the

appendix, caused by infection in the
gastrointestinal tract or elsewhere in the body.
Inflammatory bowel disease, including Crohns
disease and ulcerative colitis
Trauma to the abdomen.
An inflamed appendix will likely burst if not
removed. Bursting spreads infection throughout the
abdomen-a potentially dangerous condition called
peritonitis.

Symptoms

a)
b)
c)
d)
e)
f)

The main symptom of appendicitis is abdominal

pain. The abdominal pain usually:
Occurs suddenly, often causing a person to wake up
at night.
Occurs before other symptoms
Begins near the belly button and then moves lower
an to the right.
Is new and unlike any pain felt before
Gets worse in a matter of hours
Gets worse when moving around, taking deep
breaths, coughing or sneezing.

Other symptoms of appendicitis

a)
b)
c)
d)
e)
f)
g)
h)

Loss of appetite
Nausea
Vomiting
Constipation or diarrhea
Inability to pass gas
A low-grade fever that follows other symptoms
Abdominal swelling
The feeling that passing stool will relieve
discomfort.

Etiology and Risk Factors

A fecalith ( a fecal calculus, or stone) that

occludes the lumen of the appendix
Kinking of the appendix
Swelling of the bowel wall
Fibrous conditions in the bowel wall
External occlusion of the bowel by adhesion
Infection with Yersinia organisms has been
found in up to 30% of cases

Management of acute appendicitis

Pre-operative care
NPO, IV therapy, close monitoring
Specific pre-operative preparation
Emergency operation
Acute appendicitis appendicectomy
Perforation with peritonitis laparotomy
Post operative care

Nursing diagnosis for clients with ac.

appendicitis

Pre-operative:
Potential complication : perforation related to
inflammatory process
Anxiety related to disease process and
treatment.
Post operatives:
Altered comfort related to surgery
High risk for infection of surgical incision.

Diagnosis, Outcomes,
Interventions

Nursing diagnosis

Outcomes

Acute Pain related to inflammation

Decreased postoperative pain

Interventions

Medicate as indicated
Assess for abrupt pain changes, which
indicate perforation

Diagnosis, Outcomes,
Interventions, contd

Nursing diagnosis

Outcomes

Risk for Infection related to rupture of

appendix
Infection will not develop

Interventions

Assess vital signs

Administer antibiotic therapy
Assess and maintain drains and dressing

Diagnosis, Outcomes,
Interventions, contd

Nursing diagnosis

Outcomes

Risk for Deficient Fluid Volume related to

vomiting
Fluid and electrolyte balance

Interventions

Administer IV fluids
Careful assessment of intake and output

Symptoms vary and can mimic other

sources of abdominal pain

Intestinal obstruction
Inflammatory bowel disease
Pelvic inflammatory disease and other
gynaecological disorders
Intestinal adhesions
constipation

How is appendicitis diagnosed?

Rectal examination
Blood tests to check for signs of infection
(high white blood cell count)
Urine test to rule out a urinary tract infection.
Chest X-ray because of pneumonia in the
lower right lung can cause pain similar to
appendicitis
Ultrasound may be performed to determine if
the appendix appears to be inflamed

Physical Examination
a)

Guarding. Occurs when a person

subconsciously tenses the abdominal muscles
during an examination. Voluntary guarding
occurs the moment the doctors hand touches
the abdomen. Involuntary guarding occurs
before the doctor actually makes contact.

Physical Examination
b) Rebound tenderness. A doctor tests for

rebound tenderness by applying hand

pressure to a patients abdomen and then
letting go. Pain felt upon the release of the
pressure indicates rebound tenderness.
c) Rovsings sign. By applying hand pressure
to the lower left side of the abdomen. Pain on
the lower right side of the abdomen upon the
release of pressure on the left side indicates
the presence of Rovsings sign.

Physical Examination
d) Psoas sign. The right psoas muscle
runs over the pelvis near the
appendix. Flexing this muscle will
cause abdominal pain if the appendix
is inflamed. A doctor can check for
the psoas sign by applying resistance
to the right knee as the patient tries
to lift the right thigh while lying
down.

Physical Examination
e) Obturator sign. The right obturator muscle
alo runs near the appendix. A doctor tests
for the obturator sign by asking the patient
to lie down with the right leg bent at the
knee. Moving the bent knee left and right
requires flexing the obturator muscle and
will cause abdominal pain if the appendix
is inflamed.

McBurneys point

McBurneys point

Deep tenderness at McBurney's point, known as

McBurney's sign, is a sign of
acute appendicitis. The clinical sign of
rebound pain when pressure is applied is also
known as Aaron's sign.

Complications of acute appendicitis

Perforation
Appendicular mass
Abscess
Peritonitis
Infection of surgical wound.