UMAR BIN KHADDABI COLLEGE OF NURSING SCIENCES

KAURA NAMODA ZAMFARA STATE

SEMINAR PRESENTATION

ON

APPENDICITIS

PREPARED BY

ALHERI ADAMU
GN2021B/122

SUPERVISOR NAME
ZAHRA'U LABARAN
RM RN BNSc PGDE

November, 2023
 TABLE OF CONTENT

Introduction - - - - - - - - - --
Summary - - - - - - - - - -
Review of Anatomy and Physiology Digestive System - - - -
Definition of Appendicitis - - - - - - - -
Types of Appendicitis - - - - - - - -
Stages of appendicitis - - - - - - - -
Causes of appendicitis - - - - - - - -
Sign and symptoms of Appendicitis - - - - - - -
Pathophysiology - - - - - - - - -
Diagnosis Investigation - - - - - - - -
Medical Management - - - - - - - -
Nursing Management - - - - - - - -
Surgical Management - - - - - - - -
Appendicitis Treatment - - - - - - - -
Nursing Care Plan - - - - - - - - -
Complication - - - - - - - - - -
Prevention - - - - - - - - - -
Conclusion - - - - - - - - - -
Reference
 CHAPTER ONE

INTRODUCTION

The appendix is a fingerlike pouch attached to the large intestine in the lower right area of the

abdomen, the area between the chest and hips. The large intestine is part of the body ’s

gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting

tube from the mouth to the anus. The movement of muscles in the GI tract, along with the

release of hormones and enzymes, helps digest food. The appendix does not appear to have a

specific function in the body, and removing it does not seem to affect a person ’s health. The

inside of the appendix is called the appendicular lumen. Normally, mucus created by the

appendix travels through the appendicular lumen and empties into the large intestine. The

large intestine absorbs water from stool and changes it from a liquid to a solid form.

Although being one of the most common abdominal emergencies with a lifetime risk of about

8%, the pathogenesis of appendicitis is still not fully understood. It is thought to be

multifactorial, with mechanical, infectious and genetic circumstances leading to inflammation

of the appendix.

Appendicitis can present as simple or uncomplicated, with inflammation of the appendix with

or without phlegmonous imbibition of its surroundings, or as complicated appendicitis, with

inflammation having led to gangrene or perforation, with or without building of an abscess.

Perforation is found in 13-20% of patients who present with acute appendicitis [2]. Although

it has been assumed for a long time that uncomplicated appendicitis will eventually lead to a

complicated form, recent data have led to speculations that different biologic forms of

appendicitis might exist. Although the overall rates of appendicitis are decreasing, the rate of

patients presenting with perforated appendicitis and with only a short period of time since

onset of symptoms did not For over a century, open appendectomy was the only standard
treatment for appendicitis. Recently published European trials have suggested that it is

feasible to treat uncomplicated appendicitis non-operatively with antibiotics alone. With

regard to these data, we want to analyze the evidence for non-operative management (NOM)

of acute appendicitis and to eventually suggest a clinical pathway for the management of this

disease.

SUMMARY

Appendicitis occurs when the appendix becomes inflamed and filled with pus. Appendicitis is

an inflammation of the appendix. The appendix is a finger-shaped pouch that sticks out from

the colon on the lower right side of the belly, also called the abdomen. Appendicitis causes

pain in the lower right abdomen.

REVIEW OF ANATOMY AND PHYSIOLOGY OF DIGESTIVE SYSTEM

FUNCTIONS OF DIGESTIVE SYSTEM

The function of the digestive system is to digest and absorb food and then excrete the waste

products with the help of the liver, gallbladder, pancreas, small intestine, large intestine, and

rectum. Each of these organs plays a specific role in the digestive system. The oral cavity has

four main functions.

1. Ingestion. Food must be placed into the mouth before it can be acted on; this is an

active, voluntary process called ingestion.

2. Propulsion. If foods are to be processed by more than one digestive organ, they must

be propelled from one organ to the next; swallowing is one example of food

movement that depends largely on the propulsive process

called peristalsis (involuntary, alternating waves of contraction and relaxation of the

muscles in the organ wall).

3. Food breakdown: mechanical digestion. Mechanical digestion prepares food for

further degradation by enzymes by physically fragmenting the foods into smaller

pieces, and examples of mechanical digestion are the mixing of food in the mouth by

the tongue, churning of food in the stomach, and segmentation in the small intestine.

VERMIFORM APPENDIX

This is a fine finger like tube of about 7to 12cm long and about 0.5cm wide.it is attached to
the medial aspect of the caecum about 2.5cm below the ileo-colic junction.it is called
vermiform appendix because it looks like a worm. It also called the tonsils of the abdomen.

The base of the appendix is attached to the caecum while its apex is free. Appendix is
relatively long in children but shorter in later life. The lumen may be obliterated commencing
at the tip and spreading to the base.it lies within the right iliac fossa
Arterial blood supply: Superior mesenteric arteries

Venous drainage: Superior mesenteric veins

Nerve supply: Sympathetic and para sympathetic nerves

APPENDICITIS

Definition:

Appendicitis is an inflammation of the appendix. The appendix is a finger-shaped pouch that

sticks out from the colon on the lower right side of the abdomen.

Appendicitis causes pain in the lower right abdomen. However, in most people, pain begins

around the abdomen button and then moves. As inflammation worsens, appendicitis pain

typically increases and eventually becomes serious.

CAUSES

 Infection due to presence of hard stool in the rectum

 Intestinal worms

 Tumors

 Traumatic injury

SIGN AND SYMPTOMS

 Abdominal pain

 Vomiting

 Fever

 Constipation
  Anxiety

 Loss of appetite

PATHOPYSIOLOGY

Appendicitis is an inflammation of the vermiform appendix, it usually occurs when the

foreign body or the facility containing microorganisms inflamed the mucosa of the appendix

causing appendicitis.

This will result to increase blood supply (hyperemia) containing more white blood cells

(leukocytosis) to the appendix to arrest the situation.

The increased blood supply coupled with the inflammatory exudates and the already

accumulated materials within the appendix lead to its swelling.

The redness as a sign of inflammation due to hyperemia appears at this initial stage.

The accumulated and irritating materials exerts pressure on the intraluminal nerve endings

both in the mucosa and sub mucosa layers of the appendix causing sudden colicky abdominal

pain, which radiates from the umbilicus to the right iliac fossa.

The accumulation of the inflammatory exudates makes the appendix tender on palpation, and

also makes the muscular wall of the appendix rigid around the right iliac fossa. The victim

finds it difficult to extend the right thigh at the hip joint, since active movement of this thigh

initiates the pain in the right iliac fossa.

Therefore, the victim prefers to walk slowly and gently. In mild cases, and where the body

resistance is high, the inflammation subsides and healing of the inflamed appendix takes

place.

In severe cases where the body resistance is low and the virulence microorganisms are high,

this leads to suppuration and abscess formation and further congestion. The appendix then

appears light yellowish at this stage.

Also in severe cases of appendicitis, increased congestion within the appendix or exerts

pressure on intraluminal vessels causing ischemia.

Appendix then becomes gangrenous appearing greenish or black in color and later perforates

or ruptures.

The infected materials then escape in to the peritoneum causing peritonitis, and also to the

blood stream causing septicemia with all their manifestations like rigor, tachycardia,

vomiting E.T.C.

Occasionally there may be diarrhea where the inflamed appendix lies in the pelvic region and

irritating the rectum.

The victim may present with dysuria where the tip of the inflamed appendix lies very close to

the urinary bladder or commencement of the urethra

DIAGNOSIS INVESTIGATION

Physical exam checks for pain in the lower right side of your abdomen where your appendix

is typically located.

Blood and urine tests identify an infection or inflammation and rule out other conditions that

can mimic an appendicitis presentation, like a urinary tract infection.

CT scan images of your abdomen are the most accurate way to diagnose appendicitis. If

you’re of childbearing age, you’ll have a pregnancy test before the CT scan to avoid

unnecessary radiation if possible. A pregnancy test and an ultrasound can rule out an ectopic

pregnancy, which can also be the cause of abdominal or pelvic pain similar to that of

appendicitis.

Ultrasound creates pictures of the abdominal contents using sound waves instead of radiation.

It’s less accurate than a CT scan for diagnosing appendicitis but healthcare providers use
abdominal ultrasound instead of CT to diagnose appendicitis in infants, children, young

adults and pregnant people.

MEDICAL MANAGEMENT

1. Appendectomy

An appendectomy is a surgical procedure in which the appendix is removed. The

appendix is a small, tube-like structure attached to the cecum, the beginning of the
large intestine. Appendectomies are most commonly performed as an emergency
surgery to treat appendicitis, which is the inflammation of the appendix. However, in
some cases, an appendectomy may be done as a preventive measure or during other
abdominal surgeries for unrelated conditions.

Procedure

Diagnosis: Appendicitis is typically diagnosed based on symptoms, physical

examination, and sometimes imaging tests like ultrasound or CT scan.

Emergency Appendectomy:

In cases of acute appendicitis, surgery is often performed as an emergency to prevent

the appendix from rupturing. A ruptured appendix can lead to serious complications,
such as the spread of infection within the abdomen.

Laparoscopic Appendectomy:

The most common approach for appendectomy is laparoscopic surgery. In this

minimally invasive procedure, small incisions are made in the abdomen, and a tiny
camera (laparoscope) and specialized instruments are used to remove the appendix.

Open Appendectomy:

In some cases, an open appendectomy may be necessary. This involves a larger

incision in the lower right side of the abdomen to access and remove the inflamed
appendix directly. Open appendectomies are usually reserved for complicated cases or
when laparoscopic surgery is not feasible.
 Recovery

Hospital Stay: Laparoscopic appendectomy often allows for a shorter hospital stay
compared to open surgery. Patients may be able to go home the same day or within a
day or two.

Pain Management: Pain and discomfort are common after surgery, and pain
medications are prescribed to manage this. Laparoscopic procedures generally result
in less pain and a quicker recovery.

Resuming Activities: Patients are usually advised to avoid strenuous activities for a
few weeks and gradually resume normal activities as tolerated.

Diet: A temporary modification in diet may be recommended initially, with a gradual

return to a normal diet as the digestive system recovers.Risks and Complications

Infection: As with any surgery, there is a risk of infection. Antibiotics are often
prescribed to reduce this risk.

Bleeding: Though rare, excessive bleeding can occur during or after the surgery,
requiring additional medical attention.

Injury to Surrounding Organs: There is a slight risk of damage to nearby structures

during the surgical procedure.

Complications from Anesthesia: Anesthesia always carries some risk, and

complications can occur.

2. Antibiotics

Commonly used antibiotics for appendicitis include:

Cefoxitin or Cefotetan: These are second-generation cephalosporins commonly used

for surgical prophylaxis in appendicitis.

Cefazolin: A first-generation cephalosporin that may be used as an alternative for

surgical prophylaxis.

Metronidazole: Often used in combination with a cephalosporin to provide broad-

spectrum coverage against both aerobic and anaerobic bacteria.
 Ampicillin-Sulbactam or Amoxicillin-Clavulanate: These are combination antibiotics
that include a penicillin derivative along with a beta-lactamase inhibitor. They provide
coverage against a broad range of bacteria.

Gentamicin: An aminoglycoside antibiotic that may be used in combination with

other antibiotics for additional coverage.

3. Percutaneous drainage

Percutaneous drainage is a medical procedure that involves the insertion of a thin

needle or catheter through the skin into a targeted area to drain fluid or pus.

Here's an overview of how percutaneous drainage might be used in the context of

complicated appendicitis:

Abscess Formation: In some cases of appendicitis, particularly when there is a delay

in seeking medical attention, an abscess (a collection of pus) can form around the
inflamed appendix.

Imaging Guidance: Before percutaneous drainage, imaging studies like ultrasound or

CT scans are often used to locate and assess the size of the abscess.

Percutaneous Drainage Procedure: During the procedure, a radiologist or

interventional physician will use imaging guidance to insert a needle or catheter
through the skin and into the abscess cavity.

Drainage and Fluid Removal: The needle or catheter is used to drain the fluid or pus
from the abscess, helping to alleviate symptoms and reduce the risk of systemic
infection.

NURSING MANAGEMENT

 Admit patient in a medical ward

 Assessing and relieving pain.

 Provide bed rest

 Input and output chart should be maintaining
 Provide physical care to the patient and establish good relationship with the patient
 Proper wound dressing
  Encourage exercises
 Recognizes infection for prompt treatment
 Monitor patient nutritional diet
 Educate patient about the condition.
 Support patient psychologically
 Administer prescribe drugs and chart
 Reassure the patient and give psychological support
 Ensure bed rest
 Antibiotics and analgesics should be given
 Encourage fluid intake
 Appendectomy should be done if severe.
 If surgery should be performed, then pre and post-operative nursing care should be
done.

NOTE: do not apply heat to the appendicitis patient's abdomen as this could lead to rupture.

SURGICAL MANAGEMENT

The surgical procedure for the removal of the appendix is called an appendectomy.

Appendectomy can be performed through open or laparoscopic surgery. Laparoscopic

appendectomy has several advantages over open appendectomy as an intervention for acute

appendicitis.

NURSING CARE PLAN

 Acute Pain related to inflammation as evidence by patient complain

 Ineffective Tissue Perfusion related to appendix obstruction evidence by patient
discomfort

 Risk for Infection related to Surgical incision infection following appendectomy

COMPLICATION
  Painful inflammation of the inner lining of the abdominal wall
 Small bowel obstruction
 Intra-abdominal abscess formation
 Infections
 Severe dehydration

PREVENSION
Healthy Diet: Include a high-fiber diet with plenty of fruits, vegetables, and whole
grains.Fiber helps maintain regular bowel movements, reducing the risk of fecal matter
becoming trapped in the appendix.

Hydration: Drink an adequate amount of water to keep the digestive system functioning
properly.

Regular Exercise: Engage in regular physical activity to promote overall health and a healthy
digestive system.

Good Hygiene: Practice good hygiene to prevent infections that could lead to inflammation
of the appendix.Wash hands thoroughly, especially before eating and after using the
bathroom.

Prompt Treatment of Gastrointestinal Issues: Address any gastrointestinal issues promptly to

prevent the spread of infection to the appendix.

Avoid Smoking: Smoking has been associated with an increased risk of appendicitis, so
quitting smoking may be beneficial.

CONCLUSION
Appendicitis is an inflammation of the appendix that may lead to an abscess, ileus,

peritonitis, or death if untreated. Appendicitis is the most common abdominal surgical

emergency.
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Appendicitis involves the inflammation of the appendix, often initiated by obstruction,
commonly due to fecal material. The obstruction leads to increased pressure
 within the appendix, compromising blood supply and facilitating bacterial
overgrowth. This bacterial invasion triggers an inflammatory response,
causing swelling, redness, and the potential formation of an abscess. Without
timely intervention through surgical removal (appendectomy), there is a risk
of appendix rupture, releasing infectious material into the abdominal cavity
and causing peritonitis, a serious and potentially life-threatening condition.
Systemic effects, including fever and increased heart rate, may result from the
release of inflammatory mediators. Appendicitis is a medical emergency, and
surgical intervention is the standard treatment, with antibiotics sometimes used
to manage infection. Understanding this pathophysiology is vital for
recognizing symptoms, seeking immediate medical attention, and preventing
complications.

The diagnosis of appendicitis typically involves a combination of clinical evaluation,

medical history assessment, and diagnostic tests. Here's a detailed overview of
the diagnostic investigations commonly used for appendicitis:

1. Medical History and Physical Examination:

Clinical Assessment: The healthcare provider will review the patient's medical history,
paying attention to symptoms such as abdominal pain, nausea, vomiting, and
fever.Physical Examination: A thorough physical examination, including
assessment of abdominal tenderness, rebound tenderness, and pain
localization, is crucial.
2. Blood Tests:
Complete Blood Count (CBC): Elevated white blood cell count (leukocytosis) is a
common finding in appendicitis, indicating an inflammatory response.
C-reactive Protein (CRP): Increased levels may suggest inflammation.
3. Urinalysis:Urinary Tract Infection (UTI) Exclusion: Since the symptoms of
appendicitis can overlap with UTIs, a urinalysis may be performed to rule out
urinary tract involvement.
4. Imaging Studies:Ultrasound: Particularly useful in children and pregnant women,
ultrasound imaging can visualize the appendix and detect signs of
inflammation, such as increased diameter and fluid accumulation.Computed
Tomography (CT) Scan: A CT scan of the abdomen and pelvis is highly
sensitive and specific for diagnosing appendicitis. It provides detailed images
to visualize the appendix, surrounding structures, and signs of inflammation or
abscess formation.Magnetic Resonance Imaging (MRI): MRI can be used
when radiation exposure needs to be minimized, such as in pregnant women.
5. Diagnostic Laparoscopy:Direct Visualization: In some cases, a diagnostic laparoscopy
may be performed, allowing direct visualization of the appendix. If
 appendicitis is confirmed, an appendectomy can be performed during the same
procedure.
6. Pregnancy Testing:Pregnant Women: Due to the risks associated with radiation
exposure in pregnant women, special considerations may be taken, and
alternative imaging methods or serial clinical assessments may be employed.
7. Clinical Scoring Systems:Alvarado Score: This scoring system combines clinical
signs, symptoms, and laboratory findings to assess the likelihood of
appendicitis.Appendicitis Inflammatory Response (AIR) Score: Another
scoring system that considers clinical and laboratory parameters.
8. Rectal Examination:Digital Rectal Examination (DRE): Performed in some cases to
assess tenderness and detect rectal masses.
9. Observation and Reassessment:Serial Observation: In cases where the diagnosis is
uncertain, a period of observation with repeated clinical assessments and
imaging studies may be employed.
10. Differential Diagnosis:Exclusion of Other Conditions: It is essential to rule out other
conditions that may mimic appendicitis, such as pelvic inflammatory disease,
diverticulitis, or ovarian cyst rupture.

The diagnosis of appendicitis involves a comprehensive approach, considering clinical

presentation, laboratory results, and imaging studies. The choice of diagnostic
tests may vary based on factors such as the patient's age, gender, and
pregnancy status. Rapid and accurate diagnosis is crucial for timely
intervention and the prevention of complications associated with appendicitis.