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1. APPENDICITIS

2. DEFINITION
• Appendicitis is an inflammation of appendix that develops
most common in adolescents and young adults.
• Appendicitis is acute inflammation of the appendix, and is the
most common cause for acute, severe abdominal pain.
• The abdomen is most tender at McBurney’s point – one third of
the distance from the right anterior superior iliac spine to the
umbilicus. This corresponds to the location of the base of the
appendix

4. RISK FACTORS
• Infection, possibly stomach infection that has
traveled to the site of appendix.
• Obstruction such as a hard piece of stool getting
trapped in the appendix leading to infection of the
appendix.
• Extreme of age
• Previous abdominal surgery

5. CAUSES
• Acute appendicitis seems to be the end result of a primary
obstruction of the appendix. FAECOLITH
• Once this obstruction occurs, the appendix becomes filled with
mucus and swells. This continued production of mucus leads to
increased pressures within the lumen and the walls of the appendix.
• The increased pressure results in thrombosis and occlusion of the
small vessels, and stasis of lymphatic flow.

6. Common Causes
1. Fecal impaction and/or a fecality
• A layered buildup of calcium salts and fecal debris around a
piece of fecal material within the appendix
2. Lymphoid Hyperplasia
• The appendix contains lymphoid (immune system) tissue that
can become inflamed as a result of infection or inflammatory
bowel disease (IBD)
3. Parasites
• Examples: Schistosomes species, pinworms, Strongyloides,
stercoralis

7. Uncommon Causes:
1. Tumors
2. Foreign Material
• A wide variety of foreign objects can become lodged in the
appendix. Some of these include: shotgun pellets, intrauterine
devices, tongue studs, and activated charcoal
• Trauma, intestinal worms, lymphadenitis

9. TYPES
Acute Appendicitis:
• Acute appendicitis, as its name implies, develops very fast, usually in a
span of several days or hours. It is easier to detect and requires prompt
medical treatment, usually surgery.
• Acute appendicitis occurs when the vermiform appendix is completely
obstructed, either because of a bacterial infection, feces or other types of
blockage. Infection may also cause swelling of the lymph nodes, which
then adds pressure on the appendix, cutting off its blood supply.

10. Cont..
Appendicitis Can Be Chronic (But It's a Rare Condition)
• Chronic appendicitis is an inflammation that can last for a long time. This is
rare according to a report published in Therapeutic Advances in
Gastroenterology, it only occurs in only 1.5 percent of recorded acute
appendicitis cases.
• Basically, chronic appendicitis means that the appendiceal lumen is only
partially obstructed, causing inflammation. The inflammation worsens over
time, causing internal pressure to buildup.

11. Cont..
Stump Appendicitis: A Rare Appendectomy SideEffect
• In most instances of appendicitis, an appendectomy is the usual
procedure recommended, and it works by completely taking out the
appendix to prevent it from rupturing.
• If the appendix has already ruptured, additional treatment measures
are performed during an appendectomy, as the infection needs to be
prevented from spreading.

12. CLINICAL MANIFESTATIONS
• Local tenderness is elicited at McBurney’s point when pressure
is applied. Rebound tenderness (ie, production or intensification
of pain when pressure is released) may be present.
Symptoms
• Abdominal pain >95%
• Anorexia >70%
• Constipation 4-16%
• Diarrhea 4-16%

13. Cont...
• Fever 10-20%
• Migration of pain to right lower quadrant 50-60%
• Nausea Vomiting >65%

14. Signs
• Abdominal tenderness >95%
• Right lower quadrant tenderness >90%
• Rebound tenderness 30-70%
• Rectal tenderness 30-40%
• Cervical motion tenderness 30%
• Rigidity 10%

15. Cont…
• Psoas sign 3-5%
• Obturator sign 5-10%
• Rovsing's sign 5%
• Palpable mass <5%

16. ASSESSMENT AND DIAGNOSTIC FINDINGS

17. Cont..
• Rovsing’s sign: Palpating in the
left lower quadrant causes pain in
the right lower quadrant
• Obturator’s sign: Internal rotation
of the hip causes pain, suggesting
the possibility of an inflamed
appendix located in the pelvis

18. • Dunphy's sign: Increased pain in the right lower quadrant with
coughing.
• Iliopsoas sign: Extending the right hip causes pain along
posterolateral back and hip, suggesting Retrocecal appendicitis.

19. • Sitkovskiy (Rosenstein)'s sign: Increased pain in the right
iliac region as the person is being examined lies on his/her left
side.

20. Diagnosis
• Diagnosis is based on results of a complete physical
examination and on laboratory and x-ray findings.
• The complete blood cell count demonstrates an elevated white
blood cell count.
• The leukocyte count may exceed 10,000 cells/mm3, and the
neutrophil count may exceed 75%.

21. ALVARADO SCORE
• The Alvarado score is the most widely used scoring system. A
score below 5 suggests against a diagnosis of appendicitis,
whereas a score of 7 or more is predictive of acute appendicitis

22. Abdominal x-ray films

23. Ultrasound studies
• Aperistaltic, non-
compressible, dilated
appendix (>6 mm outer
diameter)
• Distinct appendiceal wall
layers
• Periappendiceal fluid
collection/enlargement

24. CT scans
• Dilated appendix with
distended lumen ( >6
mm diameter)
• Thickened and
enhancing wall
• Thickening of the caecal
apex (up to 80%)

25. MANAGEMENT
• Surgery is indicated if appendicitis is diagnosed.
• To correct or prevent fluid and electrolyte imbalance and dehydration,
antibiotics and intravenous fluids are administered until surgery is
performed.
• Analgesics can be administered after the diagnosis is made. (Morphine
sulphate 10 mg/ml)
Antibiotics
• Cefotaxime 250mg, 500mg
• Levofloxacin 500 mg
• Metronidazole 500mg/100ml, 400 mg tablet

26. • Appendectomy (ie, surgical removal of the appendix) is
performed as soon as possible to decrease the risk of
perforation. It may be performed under a general or spinal
anesthetic with a low abdominal incision or by laparoscopy.

28. Open Appendectomy

29. NURSING MANAGEMENT
• Goals include relieving pain, preventing fluid volume deficit, reducing
anxiety, eliminating infection from the potential or actual disruption of
the GI tract, maintaining skin integrity, and attaining optimal nutrition.
• The nurse prepares the patient for surgery, which includes an
intravenous infusion to replace fluid loss and promote adequate
renal function and antibiotic therapy to prevent infection.

30. Pre-Operative care:
• Assessment History taking physical examinations, Regarding pain,
nausea vomiting, abdominal rebound tenderness,Anorexia
• Monitor vital signs B.P., Temperature for baseline data
• NPO and I.V. Fluids be started
• Naso-gastric aspiration
• Monitor for signs of ruptured appendix and peritonitis
• Position right-side lying or low to semi fowler position to promote
comfort.

31. Cont..
• Auscultate Bowel Sounds
• Administer antibiotics as prescribed
• Preparation for surgery i.e. physically & psychologically
• Alley anxiety & fears
• Written consent for surgery
• Prepare and send the patient for surgery without delay
• OT clothes and pre medications to be given 45 minutes before operation

32. Post-Operative Nursing care:
• Clear airway
• Proper breathing and adequate tissue perfusion by IVF
• Naso-gastric suction to be done regularly to relieve tension on sutures
• Provide safety & effective care environment to the patient
• Care of all drainage tubes
• Care of surgical wounds. Watch for soapage/bleeding
• Daily A.S. dressing and watch for signs of infections
• Nutritional status maintained by I.V. fluids

33. • Observe for return of bowel sounds,
• Intake and output maintained
• Monitor vital signs & fluid, electrolytes balance
• Encourage early ambulation to prevent post operation complications.
• Maintain NPO till bowel sounds return then start clear fluids orally
• Medication as per prescription to be given by using 6 rt of Nursing standards
of medication
• Drugs – Antibiotics, analgesic & Anticholenergies i.e. Injection Aciloc as per
prescription
• After surgery, the nurse places the patient in a semi-Fowler position. This
position reduces the tension on the incision and abdominal organs, helping to
reduce pain.

34. NURSING DIAGNOSIS
• Acute Pain May be related to, Distension of intestinal tissues by inflammation,
Presence of surgical incision
• Risk for Fluid Volume Deficit, Risk factors may include, Preoperative vomiting,
postoperative restrictions (e.g., NPO), Hypermetabolic state (e.g., fever, healing
process) Inflammation of peritoneum with sequestration of fluid
• Risk for Infection, Risk factors may include, Inadequate primary defenses;
perforation/rupture of the appendix; peritonitis; abscess formation, Invasive
procedures, surgical incision
• Deficient Knowledge May be related to Lack of exposure/recall; information
misinterpretation, Unfamiliarity with information resources

36. Discharge and Home Healthcare
Guidelines
• MEDICATIONS. Be sure the patient understands any pain medication
prescribed, including doses, route, action, and side effects.
• INCISION. Sutures are generally removed in the physician’s office in 5 to 7
days.
• COMPLICATIONS. Instruct the patient that a possible complication of
appendicitis is peritonitis.
• NUTRITION. Instruct the patient that diet can be advanced to her or his
normal food pattern as long as no gastrointestinal distress is experienced.

37. Thank You!