Appendicitis Overview and Clinical Signs

Study Notes

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.

Description

This quiz covers the essential aspects of appendicitis, including its causes, pathophysiology, and clinical manifestations. Understanding the symptoms and diagnostic signs is crucial for effective identification and treatment of this common condition. Test your knowledge on appendicitis and learn about its significance in emergency medicine.