appendicitis and it management

1. 1
Appendix

2. 2
Appendicitis
• The appendix is a small, finger-like tube about 10 cm (4
in) long that is attached to the cecum just below the
ileocecal valve. The appendix fills with food and empties
regularly into the cecum. Because it empties inefficiently
and its lumen is small, the appendix is prone to
obstruction and is particularly vulnerable to infection (ie,
appendicitis).
In the adult, the average length of the appendix is 6 to 9 cm; however, it can
vary in length from <1 to >30 cm. The outer diameter varies between 3 and 8
mm, whereas the luminal diameter varies between 1 and 3 mm.
The appendix receives its arterial supply from the appendicular branch of the
ileocolic artery. This artery originates posterior to the terminal ileum, entering
the mesoappendix close to the base of the appendix. The lymphatic
drainage of the appendix flows into lymph nodes that lie along the ileocolic
artery. Innervation of the appendix is derived from sympathetic
elements contributed by the superior mesenteric plexus (T10-L1) and
afferents from the parasympathetic elements via the vagus nerves.

3. 3
Pathophysiology
• The appendix becomes inflamed and edematous as a
result of either becoming kinked or occluded by a fecalith
(ie, hardened mass of stool), tumor, or foreign body. The
inflammatory process increases intraluminal pressure,
initiating a progressively severe, generalized or upper
abdominal pain that becomes localized in the right lower
quadrant of the abdomen within a few hours.

4. 4
Clinical Manifestations
• Epigastric or periumbilical pain progresses to the right
lower quadrant.
• Low-grade fever, nausea and sometimes vomiting. Loss
of appetite.
• 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.
• Rovsing’s sign may be elicited by palpating the left lower
quadrant; this causes pain to be felt in the right lower
quadrant.
• If the appendix has ruptured, the pain becomes more
diffuse; abdominal distention develops, and the patient’s
condition worsens.

5. 5
Location of McBurney's point (1), located two thirds the distance from
the umbilicus (2) to the anterior superior iliac spine (3).

6. 6
Assessment and Diagnostic Findings
• Health history and physical exam.
• Complete blood cell count demonstrates an elevated
white blood cell count (> 10,000 cells/mm3). The
neutrophil count may exceed 75%.
• Abdominal x-ray films, ultrasound studies, and CT scans
may reveal a right lower quadrant density or localized
distention of the bowel.

7. 7

8. 8
Medical Management
• Surgical intervention (appendectomy), as soon as
possible after diagnosis to decrease the risk of
perforation.
• Before surgery, correction or prevention of fluid and
electrolyte imbalance and dehydration could be through
antibiotics and intravenous fluids.
• Analgesics can be administered after the diagnosis is
made.

9. 9
An appendectomy in progress

10. 10
Management
• Prepare the patient for surgery, which includes an
intravenous infusion to replace fluid loss and promote
adequate renal function and antibiotic therapy to prevent
infection.
• Post-operatively, Place the patient in a semi-Fowler
position to reduce the tension on the incision and, thus,
reduce pain.
• Administer pain killers (usually morphine sulfate), as
prescribed.
• Start oral fluids when tolerated and intravenous fluids as
indicated. Food is provided as desired and tolerated on
the day of surgery.

11. 11
Management (Continued…..)
• Instruct the patient to make an appointment to have the
surgeon remove the sutures between the fifth and
seventh days after surgery.
• Teach incision care (dressing) and activity guidelines;
normal activity can usually be resumed within 2 to 4
weeks.