Appendicitis for Medical Surgical Nursing Students.

1. APPENDICITIS
HI, MYSELF
A.PAVITHRA
M.SC (NURSING) – I YEAR
DEPT., OF MEDICAL SURGICAL NURSING

2. INTRODUCTION:
 The appendix is also known as vermiform which comes from Latin word meaning
worm shaped.
 It is a vestigial organ which means the structure that has lost all or most of its original
function through the process of evolution.
A tubular structure with a lumen attached to a cecum.

3. ANATOMY:
 It is blind ended muscular tube attached to the
posteromedial wall of caecum, about 2 cm below ileocecal
junction.
 The appendix is around (7 to 11 cm) in length.
 It is located near the junction of the small intestine and
large intestine in right lower quadrant of the abdomen near
the right hip bone.
The position within the abdomen corresponds to a point on
the surface known as Mc burney’s point.
Appendix is divided into three parts as Base, Body and Tip.

4. the location of the tip of the appendix can vary. According to the position
it is named as,

5. BLOOD SUPPLY:
The arterial supply of the appendix is by means of the appendicular artery, inferior
branch of the ileocecal artery of the superior mesenteric trunk.
NERVE SUPPLY:
PARASYMPATHETIC: Vagus
SYMPATHETIC : T10 segment of spinal cord.

6. PHYSIOLOGY:
 Maintain homeostatic.
 Immune function. (during early years of development)
 Maintain gut flora.
 Helps to have proper digestion and a healthy colon.
 Recent advances: It helps for reconstructive surgery
to recreate a sphincter muscles in the bladder surgeries.

7. DEFINITION:
Appenditicitis is inflammation of the appendix, a narrow blind tube that
extends from the inferior part of the cecum.
BRUNNER (2nd edition)
Appendicitis is the infection and the inflammation of the lumen attached to
the caecum. LEWIS (2015)

8. INCIDENCE:
 Males are affected more than females
 Teenagers more frequently than adults.
 The highest incidence is in those between the ages of 10 and 30 years.

9. ETIOLOGY:
 Decreased dietary fiber intake and increased consumption of refined carbohydrates.
 Obstruction of the appendix lumen.
 Fecolith (composed of inspissated faecal material, calcium
phosphates, bacteria, epithelial debris, rarely a foreign body)
 Tumor (carcinoma of caecum)
 Intestinal parasites (Enterobicus vermicularis – pinworm)
 Trauma

10. TYPES:
There are 2 types of appendicitis,

11. ACUTE APPENDICITIS:
 Acute appendicitis, develops very fast and usually in a span of several days or hours.
It is easier to detect and requires prompt medical treatment usually surgery.
 Basically, in acute appendicitis means that the appendiceal lumen is only partially
obstructed, causing inflammation. The inflammation worsen over time, causing
internal pressure to buildup and shows clinical manifestations like pain.

12. CHRONIC APPENDICITIS:
 Chronic appendicitis is an inflammation that can last for a long time. This is rare
according to American association Appendicitis report.
 The incidence for chronic appendicitis finds of about 1.5% of recoded total
appendicitis rate.
 The inflammation formed in acute stage worsens over time, causes internal pressure
and rupture is termed as chronic appendicitis.

13. PATHOPHYSIOLOGY:
Obstruction of the appendiceal
lumen (inside the appendix)
Build up of mucous in the appendix
(appendix constantly secreting
mucous)
Increased appendiceal lumen
pressure

14. Ulceration of the appendix
mucosal lining
Decrease oxygen delivery
(hypoxia)
Decreased blood flow to the
appendix

15. Promotes microbe invasion
Inflammation and swelling of
the appendix
APPENDICITIS

16. RISK FACTORS:
 Extremes of age
 Immunosuppression.
 Diabetes Mellitus
 Faecolith obstruction
 Pelvic appendix
 Previous abdominal surgery

17. CLINICAL MANIFESTATION:
SYMPTOMS:
• Peri umbilical colic.
• Pain shifts to the Mc burney’s point
• Anorexia.
• Nausea.
• Diarrhea or constipation.

18. SIGNS
 Pyrexia
 Rebound Tenderness in the Mc burney’s point or
BLUMBERG’S sign
 Muscular guarding.
 Rigidity

19. SIGNS TO ELICIT
ROVSING’S SIGN:
Mild or Deep palpation of the left iliac fossa may cause
pain in the right iliac fossa
PSOAS SIGN:
Patient will lie with the right hip flexed for pain relief.
OBTURATOR SIGN:
The hips is flexed and internally rotated, if an inflamed
appendix is in contact with the obturator internus,
this maneuver will cause pain in the hypogastrium.

20. DUNPHY’S SIGN:
Increased pain in the right lower quadrant while coughing.
SITKOVSKLY (ROSENSTEIN’S SIGN):
Increased pain in the right iliac region as the person is
being examined lies on his/ her left side
ILLIOPSOAS SIGN:
Extending the right hip causes pain along postero lacteral back
and hip,retrocecal appendicitis.

21. DIAGNOSTIC EVALUATION:
• History collection
• Physical examination
• X-ray
• Abdominal ultra sonography.
• Lab investigation
 WBC’s will be elevated
 TLC > 20,000 (Perforation)
 Microscopic hematuria.(rare)
 Minimal pyuria

22. MANAGEMENT:
MEDICAL MANAGEMENT:
To prevent fluid and electrolyte imbalance and dehydration antibiotics and intravenous
fluids are administered until surgery is performed.
 Analgesics can be performed after the diagnosis is made (Morphine sulphate 10mg/ml)
 Antibiotics
@. Cefotamine - 250mg -500 mg
@. Levofloxacin – 500 mg.
@. Metronidazole – 500 mg/100ml, 400 mg tablet.

23. SURGICAL MANAGEMENT:
Appendectomy (surgical removal of 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.
Usually open appendectomy will be preferred.

24. NURSING MANAGEMENT:
• Goals include to relieve pain, preventing fluid volume deficit, reduce 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 fluids loss and promotes adequate renal function and
antibiotic therapy to prevent infection.

25. PRE OPERATIVE CARE:
 Frequent Physical examination (to avoid worsening of symptoms).
 Monitor vital signs for baseline data.
 NPO and I.V fluids can be administered to avoid fluid and electrolyte imbalance.
 Nastro-gastric aspiration.
 Position right side lying or low to semi fowler position to promote comfort.
 Auscultate bowel sounds.
 Administer antibiotics as prescribed.
 Preparation for surgery both physically & psychologically.
 Alleviate fear and sufferings.

26. POST OPERATIVE CARE
 Clear airway.
 Check for tissue perfusion.
 Naso gastric suction to be done regularly to relieve tension on sutures.
 Care of surgical wounds. Watch for soapage/bleeding.
 Nutritional status maintained by I.V status.
 Observe return of bowel sounds.
 Intake and output chart
 Encourage early ambulation to prevent post operative complication.
 Maintain NPO until return of bowel sounds then start with clear liquid fluids.
 Maintain semi – fowler position ( to relieve tension over incision site)
 Check for the signs of infection.

27. POSSIBLE NURSING DIAGNOSIS:
 Acute pain related to distension of intestinal tissue by inflammation as evidenced by
pain scale scoring.
 Fluid volume deficit related to vomiting or inability to take food as evidenced by
fatigue and dryness of mouth.
 Infection relation to obstruction of food particles in lumen as evidenced by fever and
imaginary studies.
 Anxiety and fear related to increased level of pain and clinical symptoms as evidenced
by fascial reaction.
 Knowledge deficit related to appendicitis as evidenced by frequently asking questions.

28. FOLLOW UPS:
• Be sure that patient is clearly understand about medications prescribed.
• Advice patient to visit hospital if, finds with any pain, oozing or colour changes in
skin over incision site.
• Advice patient to avoid advances in food pattern, until no gastrointestinal distress is
experienced.
• Avoid pressure over the incision site providing either mechanically or physically.
• Explain with possible complication to aware about it.
• advice to take more fiber rich diet.

29. COMPLICATION:
• Peritonitis.
• Pelvic abscess.
• Sub phrenic abscess( abscess under the diaphragm).
• Ileus (both paralytic and mechanical).
• Perforation.
• Bowel obstruction.