Appendicitis
Under Supervision:
D / Shaimaa Abdelhamid
Group: A2
Medical Surgical Nursing Department
Faculty of Nursing- Fayoum University
1st semester, 2021-2022
Appendicitis
Outlines:
Introduction
Anatomy of GIT
Definition
Pathophysiology
Causes
Clinical picture
Diagnosis
Surgical Management
Medical Management
Complications
Nursing Management
Nursing Intervention for Appendectomy
Prevention according to level of prevention
Reference
Objectives:
By the end of this Seminar, each student will be able to:
Review the anatomy of GIT
Review the pathophysiology of appendicitis
Discuss the diagnosis of appendicitis
Identify clinical picture for appendicitis
Identify treatment options for appendicitis
Identify complication of appendicitis
Discuss how to prevent appendicitis
Introduction
Appendicitis happens when the appendix becomes inflamed. It can be acute or
chronic. In the United States, appendicitis is the most common Trusted
Source cause of abdominal pain resulting in surgery. Over 5 percent Trusted
Source of Americans experiences it at some point in their lives. If left untreated,
appendicitis can cause your appendix to burst. This can cause bacteria to spill
into the abdominal cavity, which can be serious and sometimes fatal.
Definition
Appendicitis (also known as epityphlitis) is the inflammation of
the appendix which is a small finger-like appendage attached to the cecum.
The appendix is a small, finger-like appendage attached to the cecum just
below the ileocecal valve.
Because the appendix empties into the colon inefficiently and its lumen is
small, it is prone to becoming obstructed and is vulnerable to
infection (appendicitis).
Anatomy of gastrointestinal tract:
The gastrointestinal tract (GIT) consists of a hollow muscular tube starting
from the oral cavity, where food enters the mouth, continuing through the
pharynx, oesophagus, stomach and intestines to the rectum and anus, where food
is expelled. There are various accessory organs that assist the tract by secreting
enzymes to help break down food into its component nutrients. Thus the salivary
glands, liver, pancreas and gall bladder have important functions in the digestive
system. Food is propelled along the length of the GIT by peristaltic movements
of the muscular walls.
The primary purpose of the gastrointestinal tract is to break food down into
nutrients, which can be absorbed into the body to provide energy. First food must
be ingested into the mouth to be mechanically processed and moistened.
Secondly, digestion occurs mainly in the stomach and small intestine where
proteins, fats and carbohydrates are chemically broken down into their basic
building blocks. Smaller molecules are then absorbed across the epithelium of
the small intestine and subsequently enter the circulation. The large intestine
plays a key role in reabsorbing excess water. Finally, undigested material and
secreted waste products are excreted from the body via defecation (passing of
faeces).
In the case of gastrointestinal disease or disorders, these functions of the
gastrointestinal tract are not achieved successfully. Patients may develop
symptoms of nausea, vomiting, diarrhoea, malabsorption, constipation or
obstruction. Gastrointestinal problems are very common and most people will
have experienced some of the above symptoms several times throughout their
lives.
Pathophysiology
The simple pathophysiology of appendicitis follows the typical pathophysiology
of infection.
Obstruction. The appendix becomes inflamed and edematous as a result of
becoming kinked or occluded by a fecalith, tumor, or foreign body.
Inflammation. The inflammatory process increases intraluminal pressure,
initiating progressively severe, generalized, or periumbilical pain.
Pain. The pain becomes localized to the right lower quadrant of the abdomen
within a few hours.
Pus formation. Eventually, the inflamed appendix fills with pus.
Statistics and Epidemiology
Appendicitis is actually a common disorder in the United States.
Appendicitis is the most common cause of acute surgical abdomen in the
United States.
It is the most common reason for emergency abdominal surgery in the
United States.
Appendicitis commonly occurs between the ages 10 and 30 years.
Causes
In many cases, the exact cause of appendicitis is unknown. Experts believe it
develops when part of the appendix becomes obstructed, or blocked.
Many things can potentially block your appendix, including:
a buildup of hardened stool
enlarged lymphoid follicles
intestinal worms
traumatic injury
tumors
When your appendix becomes blocked, bacteria can multiply inside it. This can
lead to the formation of pus and swelling, which can cause painful pressure in
your abdomen.
Clinical Picture:
Signs and symptoms of appendicitis are listed below.
Pain. Vague epigastric or periumbilical pain progresses to right lower
quadrant pain usually accompanied by low-grade fever, nausea,and
sometimes vomiting.
Tenderness. In 50% of presenting cases, local tenderness is elicited
at McBurney’s point when pressure is applied.
Rebound tenderness. Rebound tenderness or the production or intensification
of pain when pressure is released.
Rovsing’s sign. Rovsing’s sign may be elicited by palpating the left lower
quadrant; this paradoxically causes pain to be felt at the right lower quadrant.
Assessment and Diagnostic Findings
Diagnosis is based on the results of a complete physical examination and on
laboratory findings and imaging studies.
o CBC count. A complete blood cell count shows an elevated WBC count,
with an elevation of the neutrophils.
o Imaging studies. Abdominal x-ray films, ultrasound studies, and CT scans
may reveal a right lower quadrant density or localized distention of the
bowel.
o Pregnancy test. A pregnancy test may be performed for women of
childbearing age to rule out ectopic pregnancy and before x-rays are
obtained.
o Laparoscopy. A diagnostic laparoscopy may be used to rule out acute
appendicitis in equivocal cases.
o C-reactive protein. Protein produced by the liver when bacterial infections
occur and rapidly increases within the first 12 hours.
Surgical Management
Immediate surgery is typically indicated if appendicitis is diagnosed.
1. Appendectomy. Appendectomy or the surgical removal of the appendix is
performed as soon as it is possible to decrease the risk of perforation.
2. Laparotomy and laparoscopy. Both of these procedures are safe and effective
in the treatment of appendicitis with perforation.
Medical Management
Medical management should be performed carefully to avoid altering the
presenting symptoms.
IV fluids. To correct fluid and electrolyte imbalance and dehydration, IV
fluids are administered prior to surgery.
Antibiotic therapy. To prevent sepsis, antibiotics are administered until the
surgery is performed.
Drainage. When perforation of the appendix occurs, an abscess may form
and the patient is initially treated with antibiotics and the surgeon may place
a drain in the abscess.
Complications
Appendicitis can cause serious complications, such as:
A ruptured appendix. A rupture spreads infection throughout your
abdomen (peritonitis). Possibly life-threatening, this condition requires
immediate surgery to remove the appendix and clean your abdominal
cavity.
A pocket of pus that forms in the abdomen. If your appendix bursts, you
may develop a pocket of infection (abscess). In most cases, a surgeon
drains the abscess by placing a tube through your abdominal wall into the
abscess. The tube is left in place for about two weeks, and you're given
antibiotics to clear the infection.
Once the infection is clear, you'll have surgery to remove the appendix. In some
cases, the abscess is drained, and the appendix is removed immediately.
Nursing Interventions
The nurse prepares the patient for surgery.
IV infusion. An IV infusion is made to replace fluid loss and promote
adequate renal functioning.
Antibiotic therapy. Antibiotic therapy is given to prevent infection.
Positioning. After the surgery, the nurse places the patient on a High-
fowler’s position to reduce the tension on the incision and abdominal
organs, thereby reducing pain.
Oral fluids. When tolerated, oral fluids could be administered.
Nursing Intervention
Preoperative interventions
Maintain NPO status.
Administer fluids intravenously to prevent dehydration.
Monitor for changes in level of pain.
Monitor for signs of ruptured appendix and peritonitis
Position right-side lying or low to semi fowler position to promote comfort.
Monitor bowel sounds.
Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
Administer antibiotics as prescribed
Avoid the application of heat in the abdomen.
Avoid laxatives or enema.
Postoperative interventions
Monitor temperature for signs of infection.
Assess incision for signs of infection such as redness, swelling and pain.
Maintain NPO status until bowel function has returned.
Advance diet gradually or as tolerated or as prescribed when bowel sound
return.
If ruptured of appendix occurred, expect a Penros drain to be inserted, or the
incision maybe left to heal inside out.
Expect that drainage from the Penros drain maybe profuse for the first 2
hours.
Documentation Guidelines
Location, intensity, frequency, and duration of pain
Response to pain medication, ice applications, and position changes
Patient’s ability to ambulate and tolerate food
Appearance of abdominal incision (color, temperature, intactness, drainage)
Discharge and Home Healthcare Guidelines
MEDICATIONS. Be sure the patient understands any pain medication
prescribed, including doses, route, action, and side effects. Make certain the
patient understands that he or she should avoid operating a motor vehicle or
heavy machinery while taking such medication.
INCISION. Sutures are generally removed in the physician’s office in 5 to 7
days. Explain the need to keep the surgical wound clean and dry. Teach the
patient to observe the wound and report to the physician any increased
swelling, redness, drainage, odor, or separation of the wound edges. Also
instruct the patient to notify the doctor if a fever develops. The patient needs
to know these may be symptoms of wound infection. Explain that the patient
should avoid heavy lifting and should question the physician about when
lifting can be resumed.
COMPLICATIONS. Instruct the patient that a possible complication of
appendicitis is peritonitis. Discuss with the patient symptoms that indicate
peritonitis, including sharp abdominal pains, fever, nausea and vomiting, and
increased pulse and respiration. The patient must know to seek medical
attention immediately should these symptoms occur.
NUTRITION. Instruct the patient that diet can be advanced to her or his
normal food pattern as long as no gastrointestinal distress is experienced.
Preventing appendicitis
There’s no sure way to prevent appendicitis. But you might be able to lower your
risk of developing it by eating a fiber-rich diet. Although more research is
needed on the potential role of diet, appendicitis is less common in countries
where people eat high-fiber diets. Foods that are high in fiber include:
fruits
vegetables
lentils, split peas, beans, and other legumes
oatmeal, brown rice, whole wheat, and other whole grains
fiber supplement like:
o sprinkling oat bran or wheat germ over breakfast cereals, yogurt, and
salads
o cooking or baking with whole-wheat flour whenever possible
o swapping white rice for brown rice
o adding kidney beans or other legumes to salads
o eating fresh fruit for dessert
Reference
https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-
causes/syc-20369543
https://healthengine.com.au/info/gastrointestinal-system
https://nurseslabs.com/appendicitis/#nursing_management
https://www.medicinenet.com/appendicitis/
article.htm#what_is_appendicitis_what_causes_it
