Appendicitis is inflammation of the appendix that is most common in adolescents and young adults. It is usually caused by obstruction of the appendix, such as by a hard piece of stool, which leads to swelling and increased pressure that cuts off blood flow. The most common symptom is abdominal pain localized to the lower right side. Diagnosis involves physical examination, blood tests, and imaging scans. Treatment is surgical removal of the appendix (appendectomy) to prevent rupture, along with antibiotics and intravenous fluids. Nursing care focuses on pain management, preventing infection and fluid imbalance, and monitoring for complications after surgery.

1. APPENDICITIS
DEFINITION
• Appendicitis is an inflammation of appendix that develops most common in adolescents
and young adults.
• Appendicitis is acute inflammation of the appendix, and is the most common cause for
acute, severe abdominal pain.
• The abdomen is most tender at McBurney’s point – one third of the distance from the
right anterior superior iliac spine to the umbilicus. This corresponds to the location of the
base of the appendix
RISK FACTORS
• Infection, possibly stomach infection that has travelled to the site of appendix.
• Obstruction such as a hard piece of stool getting trapped in the appendix leading to
infection of the appendix.
• Extreme of age
• Previous abdominal surgery
CAUSES
• Acute appendicitis seems to be the end result of a primary obstruction of the appendix.
• Once this obstruction occurs, the appendix becomes filled with mucus and swells. This
continued production of mucus leads to increased pressures within the lumen and the walls
of the appendix.
• The increased pressure results in thrombosis and occlusion of the small vessels, and stasis
of lymphatic flow.
Common Causes
1. Fecal impaction and/or a fecality
• A layered buildup of calcium salts and fecal debris around a piece of fecal material within
the appendix
2. Lymphoid Hyperplasia
• The appendix contains lymphoid (immune system) tissue that can become inflamed as a
result of infection or inflammatory bowel disease (IBD)
3. Parasites
• Examples: Schistosomes species, pinworms, Strongyloides, stercoralis
Uncommon Causes
1. Tumors
2. Foreign Material
• A wide variety of foreign objects can become lodged in the appendix. Some of these
include: shotgun pellets, intrauterine devices, tongue studs, and activated charcoal
• Trauma, intestinal worms, lymphadenitis.

2. TYPES
Acute Appendicitis:
• Acute appendicitis, as its name implies, develops very fast, usually in a span of several
days or hours. It is easier to detect and requires prompt medical treatment, usually surgery.
• Acute appendicitis occurs when the vermiform appendix is completely obstructed, either
because of a bacterial infection, feces or other types of blockage. Infection may also cause
swelling of the lymph nodes, which then adds pressure on the appendix, cutting off its blood
supply.
Appendicitis Can Be Chronic (But It's a Rare Condition)
• Chronic appendicitis is an inflammation that can last for a long time. This is rare according
to a report published in Therapeutic Advances in Gastroenterology, it only occurs in only
1.5 percent of recorded acute appendicitis cases.
• Basically, chronic appendicitis means that the appendiceal lumen is only partially
obstructed, causing inflammation. The inflammation worsens over time, causing internal
pressure to buildup.
Stump Appendicitis: A Rare Appendectomy SideEffect
• In most instances of appendicitis, an appendectomy is the usual procedure recommended,
and it works by completely taking out the appendix to prevent it from rupturing. • If the
appendix has already ruptured, additional treatment measures are performed during an
appendectomy, as the infection needs to be prevented from spreading.
CLINICAL MANIFESTATIONS
• Local tenderness is elicited at McBurney’s point when pressure is applied. Rebound
tenderness (ie, production or intensification of pain when pressure is released) may be
present.
Symptoms
• Abdominal pain >95%
• Anorexia >70%
• Constipation 4-16%
Obstruction of the
appendiceal lumen
(inside the
appendix)
Build up of mucus in
the appendix
Appendix constantly
secreting mucous
 appendiceal
lumen pressure
Ulceration
(lesion)of the
appendix mucosal
lining
↓ oxygen delivery
(hypoxia)
↓ blood flow to
the appendix
Promotes
microbe invasion
(ex. Bacterial)
Inflammation and
swelling of the
appendix
Appendicitis

3. • Diarrhea 4-16%
• Fever 10-20%
• Migration of pain to right lower quadrant 50-60%
• Nausea Vomiting >65%
Signs
• Abdominal tenderness >95%
• Right lower quadrant tenderness >90%
• Rebound tenderness 30-70%
• Rectal tenderness 30-40%
• Cervical motion tenderness 30%
• Rigidity 10%
• Psoas sign 3-5%
• Obturator sign 5-10%
• Rovsing's sign 5%
• Palpable mass <5%
• Rovsing’s sign: Palpating in the left lower quadrant causes pain in the right lower quadrant
• Obturator’s sign: Internal rotation of the hip causes pain, suggesting the possibility of an
inflamed appendix located in the pelvis
• Dunphy's sign: Increased pain in the right lower quadrant with coughing.
• Iliopsoas sign: Extending the right hip causes pain along posterolateral back and hip,
suggesting Retrocecal appendicitis.
• Sitkovskiy (Rosenstein)'s sign: Increased pain in the right iliac region as the person is
being examined lies on his/her left side.
Diagnosis
• Diagnosis is based on results of a complete physical examination and on laboratory and
x-ray findings.
• The complete blood cell count demonstrates an elevated white blood cell count.
• The leukocyte count may exceed 10,000 cells/mm3, and the neutrophil count may exceed
75%.
ALVARADO SCORE
• The Alvarado score is the most widely used scoring system. A score below 5 suggests
against a diagnosis of appendicitis, whereas a score of 7 or more is predictive of acute
appendicitis.

4. Abdominal x-ray films
Ultrasound studies
• Aperistaltic, non- compressible, dilated appendix (>6 mm outer diameter)
• Distinct appendiceal wall layers
• Periappendiceal fluid collection/enlargement
CT scans
• Dilated appendix with distended lumen ( >6 mm diameter)
• Thickened and enhancing wall
• Thickening of the caecal apex (up to 80%)
MANAGEMENT
• Surgery is indicated if appendicitis is diagnosed.
• To correct or prevent fluid and electrolyte imbalance and dehydration, antibiotics and
intravenous fluids are administered until surgery is performed.
• Analgesics can be administered after the diagnosis is made. (Morphine sulphate 10
mg/ml)
• Antibiotics
Cefotaxime 250mg, 500mg
Levofloxacin 500 mg
Metronidazole 500mg/100ml, 400 mg tablet
• Appendectomy (ie, surgical removal of the appendix) is performed as soon as possible to
decrease the risk of perforation. It may be performed under a general or spinal anesthetic
with a low abdominal incision or by laparoscopy.
NURSING MANAGEMENT
• Goals include relieving pain, preventing fluid volume deficit, reducing anxiety,
eliminating infection from the potential or actual disruption of the GI tract, maintaining
skin integrity, and attaining optimal nutrition.
• The nurse prepares the patient for surgery, which includes an intravenous infusion to
replace fluid loss and promote adequate renal function and antibiotic therapy to prevent
infection.
SCORE SIGNIFICANCE
1-4 Unlikely to be acute appendicitis
5-6 Possible diagnosis of acute appendicitis
7-8 Acute appendicitis present
9-10 Defintie acute appendicitis requiring surgery

5. Pre-Operative care:
• Assessment History taking physical examinations, Regarding pain, nausea vomiting,
abdominal rebound tenderness, Anorexia
• Monitor vital signs B.P., Temperature for baseline data
• NPO and I.V. Fluids be started
• Naso-gastric aspiration
• Monitor for signs of ruptured appendix and peritonitis
• Position right-side lying or low to semi fowler position to promote comfort.
• Auscultate Bowel Sounds
• Administer antibiotics as prescribed
• Preparation for surgery i.e. physically & psychologically
• Alley anxiety & fears
• Written consent for surgery
• Prepare and send the patient for surgery without delay
• OT clothes and pre medications to be given 45 minutes before operation
Post-Operative Nursing care:
• Clear airway
• Proper breathing and adequate tissue perfusion by IVF
• Naso-gastric suction to be done regularly to relieve tension on sutures
• Provide safety & effective care environment to the patient
• Care of all drainage tubes
• Care of surgical wounds. Watch for soapage/bleeding
• Daily A.S. dressing and watch for signs of infections
• Nutritional status maintained by I.V. fluids
• Observe for return of bowel sounds,
• Intake and output maintained
• Monitor vital signs & fluid, electrolytes balance
• Encourage early ambulation to prevent post operation complications.
• Maintain NPO till bowel sounds return then start clear fluids orally
• Medication as per prescription to be given by using 6 rt of Nursing standards of
medication
• Drugs – Antibiotics, analgesic & Anticholenergies i.e. Injection Aciloc as per prescription
• After surgery, the nurse places the patient in a semi-Fowler position. This position reduces
the tension on the incision and abdominal organs, helping to reduce pain.
NURSING DIAGNOSIS
• Acute Pain May be related to, Distension of intestinal tissues by inflammation, Presence
of surgical incision
• Risk for Fluid Volume Deficit, Risk factors may include, Preoperative vomiting,
postoperative restrictions (e.g., NPO), Hypermetabolic state (e.g., fever, healing process)
Inflammation of peritoneum with sequestration of fluid
• Risk for Infection, Risk factors may include, Inadequate primary defenses;
perforation/rupture of the appendix; peritonitis; abscess formation, Invasive procedures,
surgical incision
• Deficient Knowledge May be related to Lack of exposure/recall; information
misinterpretation, Unfamiliarity with information resources

6. Discharge and Home Healthcare Guidelines
• MEDICATIONS - Be sure the patient understands any pain medication prescribed,
including doses, route, action, and side effects.
• INCISION - Sutures are generally removed in the physician’s office in 5 to 7 days.
• COMPLICATIONS - Instruct the patient that a possible complication of appendicitis is
peritonitis.
• NUTRITION - Instruct the patient that diet can be advanced to her or his normal food
pattern as long as no gastrointestinal distress is experienced.