Appendicitis Overview and Diagnosis

Appendicitis

• Inflammation of the appendix, a tube extending from the cecum.
• Most common cause of emergency abdominal surgery.
• Affects about 7% of people, most commonly between ages 10-30.
• Often caused by luminal obstruction, leading to distention, venous engorgement, mucus/bacteria build-up, and possible gangrene, perforation, and peritonitis.

Clinical Manifestations

• Symptoms can be subtle, often starting with dull periumbilical pain.
• Other symptoms include anorexia, nausea, and vomiting.
• Pain progressively shifts to the right lower quadrant, localizing to McBurney point.
• Low-grade fever is possible.
• Additional assessments include rigidity, rebound tenderness, and muscle guarding.
• Positive psoas, obturator, and Rovsing signs suggest appendicitis.
• Coughing or sneezing worsens pain.
• Patients often prefer to lie still, with the right leg flexed.

Diagnosis and Treatment

• Diagnosis often involves a complete history, physical assessment, differential WBC count (often mildly to moderately elevated).
• Urinalysis rules out genitourinary conditions.
• CT scan is the preferred diagnostic method; ultrasound or MRI are also options.
• Untreated appendicitis can lead to rupture and life-threatening peritonitis.
• Immediate appendectomy is the standard treatment.
• Localized inflammation calls for prompt surgery.
• Pre-operative antibiotics and fluid resuscitation are crucial.
• Ruptured appendix with peritonitis or abscess: IV fluids and antibiotics for 6-8 hours prior to surgery are necessary for prevention of dehydration and sepsis.

Nursing Management

• Focuses on preventing fluid volume deficit, relieving pain, and preventing complications.
• Keep patient NPO (nothing by mouth) until evaluation.
• Monitor vital signs and assess for deterioration.
• Administer IV fluids, analgesics, and antiemetics as prescribed.
• Provide comfort measures.

Postoperative Care

• Similar to laparotomy post-operative care.
• Uncomplicated laparoscopic appendectomies: discharge typically within 24 hours.
• Early ambulation and advancing diet as tolerated.
• Patients with perforation typically have longer hospital stays and need IV antibiotics.
• Normal activities usually resumed within 2-3 weeks after surgery.