Appendicitis Overview and Clinical Signs

Appendicitis: Overview

• Appendicitis is inflammation of the appendix, a small, tube-like structure extending from the cecum.
• It's a common cause of emergency abdominal surgery.
• About 7% of people develop appendicitis during their lifetime, most commonly between ages 10 and 30.
• The primary cause is believed to be luminal obstruction.

Pathophysiology

• Obstruction leads to distension, congestion, and accumulation of mucus and bacteria.
• This can progress to gangrene, perforation, and peritonitis.

Clinical Manifestations

• Symptoms can be subtle, making diagnosis challenging.
• Initial symptoms often include dull periumbilical pain, anorexia, nausea, and vomiting.
• Pain progressively localizes to the right lower quadrant, often at McBurney's point.
• Low-grade fever is a possible manifestation.
• Key physical exam findings include rigidity, rebound tenderness, and muscle guarding.
• Positive psoas, obturator, and Rovsing signs are supportive diagnostic indicators.
• Pain can worsen with coughing or sneezing; the patient often prefers a still position with the right leg flexed.

Diagnostic Studies and Treatment

• Comprehensive history and physical exam are crucial initial steps.
• CBC will likely show a mildly to moderately elevated white blood cell count.
• Urinalysis is important to rule out genitourinary issues.
• CT scan is the preferred diagnostic tool. Ultrasound and MRI are alternative options.
• Appendectomy (surgical removal) is the standard treatment.
• Delay in diagnosis can lead to rupture and potentially fatal peritonitis.
• Preoperative antibiotics and fluid resuscitation are critical, especially in ruptured cases.
• Ruptured cases necessitate IV fluids and antibiotics for 6-8 hours before surgery to prevent dehydration and sepsis.

Nursing Management

• Focus on preventing fluid loss, relieving pain, and avoiding complications.
• Maintain NPO status until the healthcare provider evaluates the patient to prevent complications.
• Monitor vital signs and assess the patient's condition for any deterioration.
• Administer IV fluids, analgesics, and antiemetics as prescribed.
• Provide comfort measures.

Postoperative Care

• Similar to laparotomy post-operative care.
• Discharge (uncomplicated cases) is usually within 24 hours post-laparoscopic appendectomy.
• Ambulation is encouraged a few hours after surgery.
• Diet is advanced gradually.
• Cases involving perforation tend to have a longer hospital stay and need IV antibiotics.
• Most patients resume normal activities within 2-3 weeks.