APPENDICITIS
Appendicitis is inflammation of the vermiform appendix.
Causes
Obstruction from infection, stricture faecal mass/foreign body of tumor
About 7% of the population will have appendicitis. Males are affected more than females and teenagers more than adults.
Most common between the ages of 10 and 30 yr
More prevalent in countries in which people consume a diet low in fibre and high in refined carbohydrates.
Pathophysiology
Etiological factors
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Kinking or occlusion of appendix.
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Appendix becomes inflamed and edematous.
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Increased intraluminal pressure.
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Severe generalized or upper abdominal pain which, becomes localized in the right lower quadrant of the abdomen.
Clinical Manifestations
1. Generalized or localized abdominal pain in the epigastric or periumbilical areas and upper right abdomen. Within 2-12 hours the pain localizes in the right lower quadrant and intensity increases,
2. Anorexia, moderate malaise, mild fever, nausea and vomiting.
3. Usually constipation occurs, occasionally diarrhoea
4. Rebound tenderness, involuntary guarding, generalized abdominal rigidity.
At McBurney's point located ½ way between the umbilicus and the anterior superior iliac. spine, lobal tenderness is noted when pressure is applied and there is some rigidity of the lower portion of the right rectus muscle.
5. Rovsing's sign occurs when pain is felt in the right lower quadrant after the left lower quadrant has been palpated.
If the patient coughs or the anterior abdominal wall is percussed, pain is enhanced.
Diagnostic Evaluation
1. Physical Examination findings include slight muscular rigidity, normal bowel sounds and local and rebound tenderness, tenderness at McBurney's point Rovsing's sign and position psoas sign (A posture of right hip flexion is a protective manoeuvre used by the patient, suggesting irritation of the psoas muscle by the inflamed appendix).
2. White blood cell count reveals moderate leucocytosis-
3. Abdominal x-ray (may visualize shadow consistent with fecalith in appendix; perforation will reveal free air).
4. Abdominal ultrasound or CT scan can visualize appendix and rule out other conditions such as diverticulitis and Crohn's disease.
Complications
Perforation Hole (or) break in the containing organ.
Peritonitis
Abscess formation collection of pus in the cavity
Medical Management
1. Bed rest
2. NPO Status
3. IV hydration - Parenteral electrolyte and amino acid solutions
4. Possible antibiotic prophylaxis.
5. Analgesia. As long as the question of operation is undecided, a narcotic analgesic is withheld even in the face of moderate pain, because it may mask the patient's symptoms.
Surgical Management
Appendectomy is indicated.
a. Simple appendectomy or laparoscopic appendectomy in absence of rupture or peritonitis.
b. An incisional dram may be placed if an abscess or rupture occurs.
Nursing Interventions
1. Monitor-pain level/including location, intensity and pattern.
2.Assist patient to comfortable positions, such as semi-Fowler's and knees up.
3. Restrict activity that may aggravate pain, such as coughing and ambulation.
4. Give analgesics only as ordered.
5. Avoid indiscriminate palpation of the abdomen to avoid increasing the patient's discomfort.
6. Monitor (frequently) for signs & symptoms of worsening condition indicating perforation, abscess or peritonitis, increasing severity of pain, tenderness, rigidity, distention, ileus, fever, malaise tachycardia.
7. Administer antibiotics as ordered intestinal obstruction 8. Promptly prepare patient for surgery
