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3. Presented by:
K.AJAI KUMAR,
B.SC(N) III YEAR,
TEXCITY COLLEGE OF
NURSING
COIMBATORE
APPENDICITIS

4. CHILD PROFILE
NAME OF CHILD : Master. Akash
AGE/SEX : 14 years , 5 months / male
CLASSIFICATION : Adolescent
CHIEF COMPLIANTS : Abdominal pain since 2 days, loose stool,
vomiting, poor intake since 1 day.
DIAGNOSIS : ACUTE GANGREONUS APPENDICITIS
PERFORATION
WITH MASS FORMATION.

5. INTRODUCTION
 Appendicitis is the most common acute
abdominal inflammatory problem
in childhood .
 It is also the most common disease process
requiring surgery in childhood.
 Perforated appendicitis is more common
in children than in adults, and is associated
with increased morbidity.

6. DEFINITION
 A serious medical condition in which
the appendix becomes inflamed and
painful.

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8. CAUSES
 There is no clear cause of appendicitis.
 Fecal material is thought to be one possible cause of
obstruction of the appendix . Blockage of the
opening inside the appendix
 Enlarged tissue in the wall of your appendix, caused
by infection in the gastrointestinal (GI) tract or
elsewhere in your body
 Inflammatory bowel disease
 Stool, parasites, or growths that can clog your
appendiceal lumen
 Trauma to your abdomen

9. ANATOMY OF APPENDIX
The appendix is
usually located in the
lower right quadrant of
the abdomen, near the
right hip bone. The base
of the appendix is
located 2 cm beneath
the ileocecal valve that
separates the large
intestine from the small
intestine.

10. POSITION

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13. SIGNS AND SYMPTOMS
 Nausea
 Vomiting
 Pain in the lower right side of the
abdomen
 Loss of appetite
 Constipation or diarrhea
 low-grade fever and chills
 A temperature between 99° and 102°
Fahrenheit
 stomach swelling
 Tenderness in the right iliac fossa

14. Dunphy's sign is a
medical sign characteriz
ed by increased
abdominal pain with
coughing. It may be an
indicator of appendicitis.
DUNPHY SIGN

15. Deep tenderness
at McBurney's
point, known
as McBurney's
sign, is a sign of
acute appendicitis
.
MCBURNEY'S SIGN

16. . PSOAS SIGN
Psoas sign is
elicited by having
the patient lie on
his or her left side
while the right
thigh is flexed
backward. Pain
may indicate an
inflamed appendix
overlying
the psoas muscle.
.

17. A positive
obturator sign is
pain that is
elicited in a
supine position
by internally and
externally
rotating the
flexed right hip.
OBTURATOR SIGN

18. Rovsing's sign is
a sign of appendicitis.
If palpation of the left
lower quadrant of a
person abdomen
increases the pain felt
in the right lower
quadrant
ROVSING'S SIGN

19. DIAGNOSTIC EVALUATION
 Physical examination
 Blood test. .
 Urine test.
 Imaging tests.
abdominal X-ray,
an abdominal ultrasound,
computerized tomography (CT)
magnetic resonance imaging (MRI)

20. ABDOMINAL X-RAY

21. ABDOMINAL ULTRASOUND

22. COMPUTERIZED TOMOGRAPHY (CT)

23. APPENDICITIS SCORE

24. MEDICAL
MANAGEMENT

25. Y

26. SURGICAL MANAGEMENT
 OPEN APPENDECTOMY
LAPAROSCOPIC
APPENDECTOMY

27. OPEN APPENDECTOMY
 During an open appendectomy, a surgeon
makes one incision in the lower right side
of your abdomen. Your appendix is
removed and the wound is closed with
stitches. This procedure allows your
doctor to clean the abdominal cavity if
your appendix has burst.
 Your doctor may choose an open
appendectomy if your appendix has
ruptured and the infection has spread to
other organs. It’s also the preferred option
for people who have had abdominal
surgery in the past.

28. (LAPAROSCOPIC APPENDECTOMY)
TECHNIQUE
• Anaesthesia- GA
•Ports-
INFRA-UMBILICAL 10MM FOR TELESCOPE
RIF 10MM/5MM PORT.
LIF 5MM PORT
• Position of OT table- Trendlenberg/Right up
• Position of surgeon and camera assistant- Left side
and 2nd assistant on right side
• Video monitor on right side
• Urinary bladder should be evacuated before trocar
insertion

29. STEPS OF SURGERY
• Sub-umbilical port 10mm ,insertion of Veress
needle and creation of pneumoperitonium
• Intra-abdominal pressure 12mm HG
• First diagnostic laparoscopy starting from RIF
and inspect all four quadrants
• Visualize uterus and adnexa
• Identify caecum, trace taenia coli to the base
of appendix
• Hold appendix with atraumatic grasper and lift
up
• Bipolar cauterization of mesoappendix up to
the base of appendix

30. CONTINUED….
Ligation of the base with Roeders knot 2 proximally and one ,
1cm distally
• Incise appendicular wall partially in between proximal and
distal sutures, suck out the purulent contents or faecoliths
• Resect the appendix, bipolar cautery of the stump
• Removal of resected appendix through 10 mm port
• Give drain if necessary through RIF port
• Closure of the ports.

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32. POST OPERATIVE COMPLICATION
 Wound infection
 Intra- abdominal abscess -8%
 Haemorrhage
 Generalised peritonitis
 Respiratory infections
 UTI
 Venous thrombosis and embolism
 Portal pyemia
 Faecal fistula
 Adhesive intestinal obstruction

34. 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.

35. 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.

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