Appendicitis

Appendicitis is characterized by inflammation of the appendix. it is most common abdominal emergency encountered in children. most common symptom is pain., vomiting and low - grade fever. Here, nurses play an important role in managing the problem before the doctor arrives. so read this out and it will help you in the future.

1. APPENDICITIS
PIYUSH PARASHAR
BSC(HONS.) NURSING

2. INTRODUCTION
•The appendix is a small, fingerlike appendage about 10cm long that is
attached to the cecum just below the ileocecal valve.
•The appendix fills with food and empties regularly into the cecum.
•Because it empties insufficiently and its lumen is small, the appendix
is prone to the obstruction and is particularly vulnerable to infection.
•Appendicitis, the most common cause of the acute surgical abdomen
in US, is most common reason for emergency abdominal surgery.

4. DEFINITION
•Appendicitis is characterized by inflammation of the
appendix. It is most common abdominal emergency
encountered in children.

5. PATHOPHYSIOLOGY OF APPENDICITIS
•The appendix becomes inflamed and edematous as a result of
becoming kinked or occluded by a fecalith, tumor, lymphoid
hyperplasia or foreign body.
•The inflammatory process increases intraluminal pressure, initiating a
progressively severe, generalized or periumbilical pain that becomes
localized to the right lower quadrant of the abdomen within few
hours.
•Eventually, the inflamed appendix fills with pus.
•Once obstructed the appendix becomes ischemic, bacterial
overgrowth occurs, and eventually gangrene occurs.

7. CLINICAL MANIFESTATIONS
•Vague epigastric or periumbilical pain-dull, poorly localized,
progresses to right lower quadrant.
•Low grade fever
•Nausea
•Vomiting
•Loss of appetite-common
•Local tenderness –elicited at McBurney’spoint when pressure is
applied
•Rebound tenderness –production or intensification of pain when
pressure is released.

9. •Rigidity of the lower portion of the right rectus muscle .
•Rovsing’ssign-elicited by palpating the left lower quadrant. This
paradoxically causes pain to be felt in the right lower quadrant.
•Psoas sign: Pain that occurs upon slow extension of the right thigh
with the patient lying on left side.
•Obturator’s sign: pain that occurs with passive internal rotation of the
flexed right thigh with the patient supine.
•constipation

12. CLINICAL FEATURES IN CHILDREN
•The pain classically starts around the umbilicus and then localizes at
the McBurney’spoint in the right iliac fossa.
•The child may develop anorexia.
•Vomiting is common and follows pain.
•A low grade fever
•High grade fever suggest perforation of appendix, peritonitis or
abscess formation.

13. ASSESSMENT AND DIAGNOSTIC FINDINGS
•Complete history taking
•Physical examination
•Laboratory findings
•Imaging studies
•CBC-elevated WBC count, elevated neutrophils
•Abdominal x-ray films
•Ultrasound studies
•CT scan

14. •A pregnancy test may be ordered for women of childbearing age to
rule out ectopic pregnancy
•Radiological studies.
•A urinalysis is usually obtained to rule out urinary tract infections.
•A diagnostic laparoscopy may be used to rule out acute appendicitis
in equivocal cases.
NOTE: CT scanning is particularly helpful when the diagnosis is
uncertain, especially if non-surgical diagnoses are under consideration.

15. EXAMINATION IN CHILDREN
•The child shows signs of discomfort and pain.
•There is tenderness and rebound tenderness in the right iliac fossa.
•There can be hyperaesthesiain the right lower abdomen.
•The child is febrile.
•In cases with delayed presentation, an appendicular lump may have
formed.
•Rectal examination may show tenderness or abscess.

16. COMPLICATIONS
•Perforation of appendix
•Peritonitis
•Abscess formation
•Portal pylephlebitis-It is septic thrombosis of the portal vein caused
by vegetative emboli that arise from septic intestines.
•Wound infections
•Ileus and post-operative adhesions.

18. TREATMENT
•Immediate surgery is typically indicated if appendicitis is diagnosed.
•Treatment of acute appendicitis is appendectomy ( surgical removal of
the appendix).
•The child or person is put nil orally .
•Administer intravenous fluids.
•Antibiotics are prescribed.
•If a lump is formed, the patient is put on conservative treatment with bed
rest.
•Ryles’stube aspiration, intravenous fluids
•Monitor vital signs.
Laparoscopic appendectomy is now the procedure of choice.

20. NURSING CARE
•Monitor vital signs
•Relieve pain
•Prevent fluid volume deficit
•Eliminate infection due to potential or actual disruption of the GI
tract.
•Maintain skin integrity
•Help patient to attain optimal nutrition.
•Promote adequate renal function
•Administer antibiotics as prescribed.

21. •Administer IV fluids to replace fluid loss.
AFTER SURGERY:
•After surgery, place the patient in high Fowler’s position. This position reduces the tension
on the incision and abdominal organs, helping to reduce pain.
•When tolerated, oral fluids are administered.
•Food is provided as desired and tolerated on the day of surgery when normal bowel sounds
are present.
DISCHARGE
•Instruct the patient to make the appointment to have the surgeon to remove the sutures
and inspect the wound between the fifth and seventh day after surgery.
•Tell the method of incision care
•Discuss activity guidelines with patient and family members
•Instruct the patient not to lift heavy objects immediately after operation.
•Instruct the patient to monitor signs of complications.

22. INTUSSUSCEPTION
•A part of the intestine invaginates into the immediately adjoining
part.
•Portion of the bowel that invaginates is called intussusceptum, while
the adjoining part of the bowel receiving the intussusceptum is
known as intussuscipiens.
•Most cases of the intussusception are idiopathic.
•Most common site of intussusception is ileocolic though ileoilealand
colo-colic varieties also occur.

24. VOLVULUS
•It is another emergency surgical condition in which
the bowel loop may get twisted around its own axis.
•Twisted intestinal loop can further cut off the blood
supply leaving the segment die.

26. MALROTATION
•Intestinal malrotationis a condition that is congenital
and occurs as a result of a problem in the normal
formation of the fetal intestines.