This document provides a comprehensive overview of appendicitis and appendicectomy, detailing the anatomy, etiology, symptoms, and physical examination findings associated with acute appendicitis. It emphasizes the treatment protocol of appendicectomy, which can be performed via laparotomy or laparoscopy, and outlines the necessary nursing responsibilities and post-operative care. Additionally, the document addresses complications, special populations, and investigative measures essential for accurate diagnosis.

1. Appendicitis and
Appendicectomy
Mr S. Chinyowa
MBChB III 2021

2. Anatomy
• Average adult length is 9cm.
• Base of appendix is constant – at the base of the
caecum.
• Position of tip varies
widely.

3. Function of Appendix
• It is an immunological organ
• Secretes IgA
• Function not essential to life -> removal
of the appendix does not lead to
compromised immunity or sepsis

4. Acute Appendicitis
• Definition: Acute Inflammation of
the appendix.

5. Epidemiology
• Appendicitis M:F is 1.2:1
• Typically 2nd – 4th decade of life.
• Lifetime incidence of appendicectomy is
15% Men and 25% Women

6. Pathophysiology
• Obstruction of the lumen from faecal
matter, adhesions, or lymphoid
hyperplasia
• Mucosal secretions continue to increase
intraluminal pressure
• Increased pressure → Vascular
compromise → Bacterial invasion →
Gangrene → Perforation → Peritonitis

7. History
• Abdominal Pain
• Initial luminal distention causes pain which
is generally vague and felt in the
periumbilical or epigastric area.
• As inflammation continues, the serosa and
adjacent structures become inflamed and
this triggers somatic pain causing pain in
the Right Lower Quadrant (RLQ)

8. History
Associated symptoms:
• Anorexia
• Nausea and vomiting
• Indigestion
• Flatulence
• Urge to defecate
• Constipation
• Diarrhoea
• Dysuria

9. Physical Exam
• Findings depend on duration of illness
prior to exam.
• Early on patients may not have localized
tenderness
• With progression there is tenderness to
deep palpation in RLQ

10. McBurney’s point

11. Physical Exam
• Fever: a late finding.
• At the onset of pain, fever is usually not
found.
• Temperatures >38 C are uncommon in first
24 h, but not uncommon after rupture

12. Physical Exam
• Additional components: rebound
tenderness, guarding, muscular rigidity,
tenderness on rectal exam
• Rovsing sign
• Psoas sign
• Obturator sign

14. Investigations
• FBC: the WBC may be elevated in 70-90%
of patients but is of limited value since it is
not specific.

15. Investigations
• Imaging studies: include X-rays,
Ultrasound, CT Scan
• Abnormal findings include: faecalith,
appendiceal gas, localized paralytic ileus,
blurred right psoas, and free air

17. Special Populations
• Very young, very old, pregnant, and HIV
patients present atypically and often have
delayed diagnosis
• High index of suspicion is needed in the
these groups to get an accurate diagnosis

18. Treatment
• Appendicectomy is the standard of care
• Patients should be NPO, given IV fluids,
and preoperative antibiotics

19. Nursing responsibilities
• Relieving pain
• Reducing anxiety
• Preventing fluid volume deficit
• Eliminating infection
• Maintaining skin integrity
• Attaining optimal nutrition

20. Complications of Appendicitis
• Perforation
• Abscess formation
• Peritonitis

21. Appendicectomy
● Definition: Removal of the appendix
● It is performed as soon as possible to decrease the
risk of perforation.
● Can be performed at laparotomy or laparoscopy

22. How is it done? Laparotomy
• An incision through the skin and the layers
of the abdominal wall is made in the area
overlying the appendix.
• The surgeon enters the abdomen and
looks for the appendix. (usually RLQ)
• After examining the area around the
appendix to make sure there are no
additional problems, the appendix is
removed and its stump is sutured.

23. How is it done? Laparotomy
• If an abscess is present, the pus is drained
via rubber tubes that go from the abscess
out through the skin.
• The abdominal incision is then closed.

25. How is it done? Laparoscopy
• Newer techniques involve using a
Laparoscope.
• This is a thin telescope that is introduced
into the abdomen via a small puncture
wound in the abdominal wall.
• The appendix is then removed using
special instruments that are also passed
into the abdomen via small puncture
wounds.

28. Laparoscopy: Advantages
• Less post-operative pain.
• Quicker recovery.
• Allows the surgeon to look inside the
abdomen and make a clear diagnosis in
cases where the diagnosis of appendicitis
is in doubt.

29. Post-op care and Nursing
Management
• Monitor vital signs for evidence of infection
or shock such as fever, tachycardia and
hypotension.
• Monitor input and output for signs of
imbalance, dehydration and shock.
• Evaluate dressing and incision
• Evaluate the passing of flatus or stool

30. Post-op care and Nursing
Management
• Monitor for nausea and vomiting.
• Wound drains, iv lines and all other
catheters as evaluated for signs of
infection.
• Administration of drugs as ordered
• Diet is advanced as ordered

31. Thank you