Appendicitis Overview

Appendicitis

• Inflammation of the appendix, a narrow tube extending from the cecum.
• Most common cause of emergency abdominal surgery.
• Affects approximately 7% of individuals at some point in their lives, most often between ages 10 and 30.
• Typically caused by luminal obstruction, leading to distention, congestion, mucus accumulation, and bacterial growth. This can result in gangrene, perforation, and peritonitis.

Clinical Manifestations

• Initial pain is often dull and located around the navel (periumbilical).
• Anorexia, nausea, and vomiting can accompany the pain.
• Pain gradually shifts to the lower right quadrant, localising around McBurney's point (midway between the belly button and the right hip bone).
• Low-grade fever might be present.
• Physical examination may reveal guarding, rigidity, rebound tenderness, and positive psoas, obturator, and Rovsing signs.
• Pain is often worsened by coughing or sneezing.
• Patients usually prefer to lie still, with the right leg flexed.

Diagnosis & Treatment

• Comprehensive patient history and physical exam are essential.
• Mild to moderate elevated white blood cell count is common.
• Urinalysis to rule out urinary tract issues.
• CT scan is the preferred diagnostic method, although ultrasound and MRI are options.
• Immediate appendectomy (surgical removal of the appendix) is the standard treatment, ideally performed as soon as possible after diagnosis.
• Antibiotic therapy and IV fluids are often initiated prior to surgery, especially if the appendix has ruptured or peritonitis is suspected. This aids in preventing sepsis.
• A longer hospital stay and extended IV antibiotic therapy may be required for patients with perforated appendix.

Nursing Management (Appendicitis)

• The key focus is preventing fluid loss, managing pain, and avoiding complications.
• Patients are kept NPO (nothing by mouth) until assessed by healthcare professionals.
• Frequent monitoring of vital signs and continuous assessment are crucial to identify any symptom deteriorations.
• IV fluids, pain relievers (analgesics), and anti-nausea medications (antiemetics) are administered as prescribed.
• Comfort measures are provided.

Postoperative Care

• Post-appendectomy care is similar to laparotomy recovery.
• The majority of patients undergoing laparoscopic appendectomies are discharged within 24 hours.
• Ambulation begins shortly after surgery.
• Diet is progressed as tolerated.
• Patients with perforated appendix generally require a longer hospital stay and IV antibiotics.
• Most individuals return to normal activities within 2-3 weeks.