APPENDICITIS

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DESCRIPTION OF THE APPENDIX
A narrow, blind tube protruding from the cecum, having no known useful function, in humans being 3 to 4 inches (8 to 10 cm) long and situated in the lower right-hand part of the abdomen.

APPENDICITIS
This is the inflammation of the vermiform appendix. it is common in male, than in females.
The peak is between ages 10 and 30

CAUSES
·      Kinking of the appendix/obstruction
·       Fecolith
·       Infection
·       Neoplasm
·       Stricture
·       A foreign body

PATHOPHYSIOLOGY
Obstruction from fecolith or other factors block mucus outflow which distend the organ. pressure within the appendix increases accompanied by inflammation. Bacterial increases and the inflammation process continue thereby affecting blood supply to the organ leading to severe pain. If the process continues there will be ischemia, necrosis and perforation of the appendix. This rupture or perforation of the appendix lead to the spill of the infected content into the abdominal cavity causing peritonitis

CLINICAL MANIFESTATION
·       Abdominal pain at the right iliac fossa
·       Rebound tenderness
·       Nausea and vomiting
·       Low grade fever
·       Fatigue and malaise
·       Constipation
·       Diarrhoea
·       Spasm

DIGNOSTIC EVALUATION
·       Elevated white blood count
·       Tenderness on MC Burney's point on examination
·       MRI, CT scan to visualize the appendix and rule out other conditions

MANAGEMENT
The major management is surgery (appendicectomy), but there are conservative treatments in less severe cases and they include:
·       Analgesic for pain
·       Antibiotics for infections
·       NG tube to relief abdominal distension if present
·       Parenteral replacement of fluid and electrolytes
·       Appendicectomy is the surgical removal of the vermiform appendix

PREOPERATIVE NURSING DIAGNOSIS
·       Acute abdominal pain related to inflammation of of the vermiform appendix as evidenced by verbalization of pain, grimacing.
·       Hyperthermia related to stimulation of the thermo regulatory center in the hypothalamus by endogenous pyrogens evidenced by elevated temperatures.
·       Imbalance nutrition less than body requirement related to decrease oral intake, nausea feeling of fullness evidenced by weight loss.



POST OPERATIVE DIAGNOSIS
Ø Ineffective breathing pattern related to the depressant effect of anaesthesia and some medications; reluctance to breath deeply because of pain evidenced by shallow or slow respiration
Ø Ineffective airway clearance related to relaxation of the tongue resulting from effect of anaesthesia and some medication evidenced by abnormal breath sound
Ø Acute pain related to tissue trauma evidenced by patient verbalization

COMPLICATION
·       Perforation
·       Peritonitis
·       Abscess
·       Paralytic illeus

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