APPENDICITIS

APPENDICITIS – Etiology, Signs and Symptoms, Diagnostic Evaluation and Management

Appendicitis is an inflammation of the appendix. The inflamed appendix becomes infected with bacteria from the intestine. The inflamed appendix gradually swells and fills with pus. Appendicitis is a medical emergency that requires prompt surgery to remove the appendix. Left untreated, an inflamed appendix will eventually burst, or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis.

ETIOLOGY

• An obstruction: food waste or a hard piece of stool (fecal stone) can block the opening of the cavity that runs the length of appendix
• An infection: appendicitis may also follow an infection, such as gastrointestinal viral infection, or it may result from other types of inflammation

SIGNS AND SYMPTOMS

• Aching pain that begins around the navel and often shifts to lower right abdomen (pain usually occurs at McBurney’s point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus).
• Pain that becomes sharper over several hours
• Tenderness
• Sharp pain in lower right abdomen that occurs when the area is pressed on and then the pressure is quickly released (Aure-Rozanova sign).
• Pain that worsens during coughing (Dunphy’s sign)
• Nausea
• Vomiting
• Loss of appetite
• Low-grade fever
• Constipation
• Inability to pass gas
• Diarrhea
• Abdominal swelling

DIAGNOSTIC EVALUATION

• Physical examination: a 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
• Blood test: high white blood cell count, which may indicate an infection
• Urine test: urinalysis to make sure that a urinary tract infection or a kidney stone is not causing pain
• Imaging tests: an abdominal X-ray, an ultrasound scan or a computerized tomography (CT) scan to help confirm appendicitis

COMPLICATIONS

• Ruptured appendix: if appendix ruptures, the contents of intestines and infectious organisms can leak into abdominal cavity. This can cause peritonitis

MANAGEMENT

Appendectomy

Appendectomy can be performed as open surgery using one abdominal incision that is about 2 to 4 inches long. Or appendicitis surgery can be done as a laparoscopic operation, which involves a few small abdominal incisions. During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into the abdomen to remove appendix

Life style and Home Remedies

• Avoid strenuous activity
• Support abdomen when coughing
• Don’t wear tight clothes, like tight belt, etc

NURSING MANAGEMENT

Presurgery

• Installation of nasogastric tube to decompress
• Catheters to control urine production
• Rehydration
• Giving antibiotics with broad-spectrum, high doses given intravenously
• Medicines for fever
• If fever, must be lowered before anesthesia

Post surgery

• Observation of vital signs
• Lift the nasogastric tube; if the patient had been aware of that, aspiration of gastric fluid can be prevented
• Put the patient in a semi-Fowler’s position
• Patients are said to be good when in the last 12 hours without any disturbance, while the patient fasted
• When the surgery is greater, for example, on perforation, fasting was continued until bowel function returned to normal
• Give the drink starting at 15 ml/h for 4-5 hours and then raise it to 30 ml/hour
• One day after surgery patients are encouraged to sit up in bed
• On the second day, the patient can stand and sit outside the room