Appendicitis

Appendicitis inflammation of the appendix, the narrow, finger-shaped

organ that branches off the first part of the large intestine on the right
side of the abdomen. Although the appendix is a vestigial organ with
no known function, it can become diseased. In fact, acute appendicitis
is the most common reason for abdominal surgery in the world. If it is
not treated promptly, there is the chance that the inflamed appendix
will burst, spilling fecal material into the abdominal cavity. The usual
result is a potentially life-threatening infection (peritonitis), but the
infection may become sealed off and form an abscess.
Appendicitis is uncommon among older people, and symptoms are
generally mild, so that diagnosis of the acute episode is often not
made. Members of this age group are thus at greater risk for rupture
with peritonitis or abscess formation.

Signs and Symptoms:

In very young children or people over age 65, symptoms of acute

appendicitis may be deceptively mild. Otherwise, symptoms can vary
widely and may include the following:
Vague discomfort or tenderness near the navel (early in an attack),
migrating to the right lower quadrant of the abdomen
Sharp, localized, persistent pain within a few hours
Pain that worsens with movement, deep breathing, coughing, sneezing,
walking or being touched
Constipation and inability to pass gas, possibly alternating with
diarrhea
Low fever (below 102F). A high fever (possibly accompanied by chills)
may indicate an abscessed appendix
Rapid heartbeat
Abdominal swelling (in late stages)
Abrupt cessation of abdominal pain after other symptoms occur,
indicating the appendix has burstan emergency
Nausea and vomiting (in some cases)
Loss of appetite
Coated tongue and bad breath
Painful and/or frequent urination
Blood in the urine
Abdominal swelling or bloating, especially in infants

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Risk factors

Risk factors for Acute Appendicitis are factors that do not seem to be a
direct cause of the disease, but seem to be associated in some way.
Having a risk factor for Acute Appendicitis makes the chances of
getting the condition higher but does not always lead to Acute
Appendicitis.
Age: Appendicitis can occur in all age groups but it is more common
between the ages of 11 and 20.
Gender: A male preponderance exists, with a male to female ratio (1.4:
1) and the overall lifetime risk is 8.6% for males and 6.7% for females.
A male child suffering from cystic fibrosis is at a higher risk for
developing appendicitis.
Diet: People whose diet is low in fiber and rich in refined carbohydrates
have an increased risk of getting appendicitis.
Hereditary: A particular position of the appendix, which predisposes it
to infection, runs in certain families. Having a family history of
appendicitis may increase a child's risk for the illness.
Seasonal variation: Most cases of appendicitis occur in the winter
months - between the months of October and May.
Infections: Gastrointestinal infections such as Amebiasis, Bacterial
Gastroenteritis, Mumps, Coxsackievirus B and Adenovirus can
predispose an individual to Appendicitis

Tests and diagnosis:

Physical exam to assess pain. The doctor may apply gentle pressure on
the painful area. When the pressure is suddenly released, appendicitis
pain will often feel worse, signalling that the adjacent peritoneum is
inflamed.
The doctor also may look for abdominal rigidity and a tendency for you
to stiffen your abdominal muscles in response to pressure over the
inflamed appendix (guarding).
The 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.
Blood test. This allows the doctor to check for a high white blood cell
count, which may indicate an infection.
Urine test. The 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.

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 Imaging tests. The doctor may also recommend an abdominal X-ray, an
abdominal ultrasound or a computerized tomography (CT) scan to help
confirm appendicitis or find other causes for your pain.

Treatments and drugs

Surgery to remove the appendix (appendectomy)

o Appendectomy can be performed as open surgery using one
abdominal incision about 2 to 4 inches (5 to 10 centimeters) long
(laparotomy). Or the surgery can be done through a few small
abdominal incisions (laparoscopic surgery). During a laparoscopic
appendectomy, the surgeon inserts special surgical tools and a
video camera into your abdomen to remove your appendix.
o In general, laparoscopic surgery allows you to recover faster and
heal with less pain and scarring. It may be better for people who
are elderly or obese. But laparoscopic surgery isn't appropriate
for everyone. If your appendix has ruptured and infection has
spread beyond the appendix or you have an abscess, you may
need an open appendectomy, which allows your surgeon to clean
the abdominal cavity.
o Expect to spend one or two days in the hospital after your
appendectomy.
Draining an abscess before appendix surgery
o If your appendix has burst and an abscess has formed around it,
the abscess may be drained by placing a tube through your skin
into the abscess. Appendectomy can be performed several
weeks later after controlling the infection.

Medications:

Antibiotic: The goals of therapy are to eradicate the infection and to

prevent complications. Thus, antibiotics have an important role in the
treatment of appendicitis, and all such. Agents under consideration
must offer full aerobic and anaerobic coverage. The duration of the
administration is closely related to the stage of appendicitis at the time
of the diagnosis.
Penicillins: The penicillins are bactericidal antibiotics that work
against sensitive organisms at adequate concentrations and inhibit the
biosynthesis of cell wall mucopeptide.
Cephalosporins: Cephalosporins are structurally and
pharmacologically related to penicillins. They inhibit bacterial cell wall
synthesis, resulting in bactericidal activity.
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 Aminoglycosides: Aminoglycosides have concentration-dependent
bactericidal activity. These agents work by binding to the 30S
ribosome, inhibiting bacterial protein synthesis.
Anti-infective Agents: Anti-infectives such as metronidazole and
tigecycline are effective against many types of bacteria that have
become resistant to other antibiotics.
Analgesics: These agents can be used to relieve acute undifferentiated
abdominal pain.

Medical management

Surgery (conventional or laparoscopic) is indicated if appendicitis is

diagnosed and should be performed as soon as possible to decrease
risk of perforation.
Administer antibiotics and IV fluids until surgery is performed.
Analgesic agents can be given after diagnosis is made. These are not
given before a suspected case of appendicitis to determine whether
the patient has a ruptured appendix or not.

Nursing Management

1. Nursing goals 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, and attaining
optimal nutrition.
2. Preoperatively, prepare patient for surgery, start IV line, administer
antibiotic, and insert nasogastric tube (if evidence of paralytic ileus).
Do not administer an enema or laxative (could cause perforation).
3. Postoperatively, place patient in high Fowlers position, give narcotic
analgesic as ordered, administer oral fluids when tolerated, give food
as desired on day of surgery (if tolerated). If dehydrated before
surgery, administer IV fluids.
4. If a drain is left in place at the area of the incision, monitor carefully for
signs of intestinal obstruction, secondary hemorrhage, or secondary
abscesses (eg, fever, tachycardia, and increased leukocyte count).

Anatomy & Physiology

The appendix is a small, finger-shaped protrusion of the colon. It is found in

the lower right quadrant of the abdomen. Its purpose is unknown.

Pathophysiology

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 The obstructed appendix becomes inflamed and edematous and
eventually fills with pus. It is the most common cause of acute
inflammation in the right lower quadrant of the abdominal cavity and
the most common cause of emergency abdominal surgery. Although it
can occur at any age, it more commonly occurs between the ages of
10 and 30 years.

By: Mary Josephine M. Briones BSN III