Appendicitis

Amante M. Valencia Jr.

 Definition
• Appendicitis is an inflammation of the appendix, a
finger-shaped pouch that projects from your colon
on the lower right side of your abdomen.
• Appendicitis causes pain in your lower right
abdomen. However, in most people, pain begins
around the navel and then moves. As inflammation
worsens, appendicitis pain typically increases and
eventually becomes severe.
• Although anyone can develop appendicitis, most
often it occurs in people between the ages of 10
and 30. Standard treatment is surgical removal of
the appendix.
 Pathophysiology
• Appendicitis occurs when the appendix
becomes acutely inflamed. It’s not entirely
known why appendicitis occurs however it is
thought to be due to the lumen of the appendix
becoming blocked by a faecolith, normal faecal
matter or lymphoid hyperplasia due to a viral
infection.
Pathophysiology
 Pathophysiology
• Obstruction. The appendix becomes inflamed
and edematous as a result of becoming kinked or
occluded by a fecalith, tumor, or foreign body.
• Inflammation. The inflammatory process
increases intraluminal pressure, initiating a
progressively severe, generalized, or
periumbilical pain.
• Pain. The pain becomes localized to the right
lower quadrant of the abdomen within a few
hours.
• Pus formation. Eventually, the inflamed
appendix fills with pus.
Pathophysiology
 Clinical Manifestations
Symptoms:
• 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 and vomiting
 Clinical Manifestations
• Loss of appetite
• Low-grade fever that may worsen as the
illness progresses
• Constipation or diarrhea
• Abdominal bloating
• Flatulence
 Clinical Manifestations
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.
Clinical Manifestations
 Clinical Manifestations
Cause:
A blockage in the lining of the appendix that
results in infection is the likely cause of
appendicitis. The bacteria multiply rapidly, causing
the appendix to become inflamed, swollen and filled
with pus. If not treated promptly, the appendix can
rupture.
 Clinical Manifestations
Complications:
Appendicitis can cause serious
complications, such as:

• A ruptured appendix. A rupture spreads

infection throughout your abdomen
(peritonitis). Possibly life-threatening, this
condition requires immediate surgery to
remove the appendix and clean your
abdominal cavity.
 Clinical Manifestations
• A pocket of pus that forms in the
abdomen. If your appendix bursts, you may
develop a pocket of infection (abscess). In most
cases, a surgeon drains the abscess by placing a
tube through your abdominal wall into the
abscess. The tube is left in place for about two
weeks, and you're given antibiotics to clear the
infection.
Once the infection is clear, you'll have surgery to
remove the appendix. In some cases, the abscess is
drained, and the appendix is removed immediately.
 Assessment and Diagnostic
Findings
• Diagnosis is based on the results of a complete
physical examination and on laboratory findings
and imaging studies.
• CBC count. A complete blood cell count shows
an elevated WBC count, with an elevation of
the neutrophils.
• Imaging studies. Abdominal x-ray films,
ultrasound studies, and CT scans may reveal a
right lower quadrant density or localized
distention of the bowel.
 Assessment and Diagnostic
Findings
• Pregnancy test. A pregnancy test may be
performed for women of childbearing age to
rule out ectopic pregnancy and before x-
rays are obtained.
• Laparoscopy. A diagnostic laparoscopy may
be used to rule out acute appendicitis in
equivocal cases.
• C-reactive protein. Protein produced by the
liver when bacterial infections occur and
rapidly increases within the first 12 hours.
 Assessment and Diagnostic
Findings
Diagnosis:
To help diagnose appendicitis, your doctor will
likely take a history of your signs and symptoms
and examine your abdomen.
Tests and procedures used to diagnose
appendicitis include:
• Physical exam to assess your pain. Your
doctor may apply gentle pressure on the painful
area. When the pressure is suddenly released,
appendicitis pain will often feel worse, signaling
that the adjacent peritoneum is inflamed.
 Assessment and Diagnostic
Findings
• Your doctor may also look for abdominal
rigidity and a tendency for you to stiffen your
abdominal muscles in response to pressure
over the inflamed appendix (guarding).
• Your doctor may use a lubricated, gloved
finger to examine your lower rectum (digital
rectal exam). Women of childbearing age may
be given a pelvic exam to check for possible
gynecological problems that could be causing
the pain.
 Assessment and Diagnostic
Findings
• Blood test. This allows your doctor to check for a
high white blood cell count, which may indicate
an infection.
• Urine test. Your doctor may want you to have a
urinalysis to make sure that a urinary tract
infection or a kidney stone isn't causing your
pain.
• Imaging tests. Your doctor may also
recommend an abdominal X-ray, an abdominal
ultrasound, computerized tomography (CT) scan
or magnetic resonance imaging (MRI) to help
confirm appendicitis or find other causes for your
pain.
Medical Management/Surgical

Initial Management:
Suspected appendicitis in children
needs immediate hospital admission as it is
a medical emergency. There is a low threshold
for admitting children and infants with
suspected appendicitis. Research shows that
young children with appendicitis have increased
mortality due to delayed presentation and
often have atypical signs and symptoms.
 Medical Management/Surgical
Acute management of patients with suspected
appendicitis:
• IV access
• Fluid resuscitation
• Contact surgical team to discuss IV antibiotics, whether
to make the child NBM and if surgical intervention is
needed*.

*if there is an appendix mass, conservative management

is opted for (IV antibiotics and monitoring). If there is an
improvement then an interval appendectomy is considered
after at least 6 weeks. However, if during the monitoring
the patient begins to deteriorate then surgical intervention
will be considered sooner.
Medical Management/Surgical
Surgical Management:

Appendicitis is treated by surgical removal of the

infected appendix. The surgery may be done
by laparoscopy which is gold standard or by open
incision at McBurney’s point (two thirds between the
umbilicus and the anterior superior iliac spine). Many
studies suggest a laparoscopic approach leads to shorter
hospital stays and a quicker return to baseline
function. Pre-operative antibiotics may be given as they
are associated with a reduction in surgical site infections.
 Medical Management/Surgical
Peri-op Care
• In uncomplicated cases, the patient is usually discharged after 24-36
hours.
• Post operatively ensure:
• The patient is apyrexial
• Sufficient oral intake
• Adequate pain control
• The wound has no signs of inflammation/infection.
In patients where perforation has occurred, a longer hospital stay
is needed for IV antibiotics. The WCC should be monitored during this
time and should be within the normal range and the child should be
apyrexial when considering discharge.
 Nursing Management

A focus of the nurses’ management is the

preparation of the patient for surgery.
Nursing Assessment:
Assessment of a patient with appendicitis
may be both objective and subjective.
• Assess the level of pain.
• Assess relevant laboratory findings.
• Assess patient’s vital signs in preparation for
surgery.
 Nursing Management

Diagnosis:
• Based on the assessment data, the most
appropriate diagnoses for a patient with
appendicitis are:
• Acute pain related to obstructed appendix.
• Risk for deficient fluid volume related to
preoperative vomiting, postoperative
restrictions.
• Risk for infection related to ruptured
appendix.
 Nursing Management

Planning & Goals:

• Goals for a patient with appendicitis include:
• Relieving pain.
• Preventing fluid volume deficit.
• Reducing anxiety.
• Eliminating infection due to the potential or
actual disruption of the GI tract.
• Maintaining skin integrity.
• Attaining optimal nutrition.
 Nursing Management
Nursing Interventions:
• The nurse prepares the patient for surgery.
• IV infusion. An IV infusion is made to replace fluid
loss and promote adequate renal functioning.
• Antibiotic therapy. Antibiotic therapy is given to
prevent infection.
• Positioning. After the surgery, the nurse places the
patient on a High-fowler’s position to reduce the
tension on the incision and abdominal organs,
thereby reducing pain.
• Oral fluids. When tolerated, oral fluids could be
administered.
 Nursing Management

Evaluation:
• Relieved pain.
• Prevented fluid volume deficit.
• Reduced anxiety.
• Eliminated infection due to the potential or
actual disruption of the GI tract.
• Maintained skin integrity.
• Attained optimal nutrition.
 Nursing Management
Discharge and Home Care Guidelines:
• Discharge teaching for patient and family is imperative.
• Removal of sutures. The nurse instructs the patient to
make an appointment with the surgeon to remove the
sutures between the 5th and 7th days after surgery.
• Activities. Heavy lifting is to be avoided
postoperatively; however, normal activity can be
resumed within 2 to 4 weeks.
• Home care. A home care nurse may be needed to
assist with incision care and to monitor the patient for
complications and wound healing.