2. Introduction
The Appendix is:-
• A small, finger-like appendage about 8 to 10 cm
long Attached to the cecum just below the ileo-
cecal valve
• Fills with food and empties regularly into the
cecum
• appendix is prone to obstruction and is
particularly vulnerable to infection
• Because it empties inefficiently and its lumen is
small
3. Definition
Appendicitis- is an inflammation of the vermiform
appendix
pathophysiology
Obstruction of the lumen by:
• A fecalith (accumulated feces)
• Foreign bodies
• Worms (e.g., Pinworms, ascaris)
• Intramural thickening caused by lymphoid
hyperplasia
• Tumours of the cecum or appendix
4. • The inflammatory process
• increases intra luminal pressure
• initiating progressively sever, generalized peri
umbilical pain that became localized to the
right lower quadrant of the abdomen with in a
few hours .
• Finally the inflamed appendix fills with pus
5. Clinical Manifestations
• Vague epigastric or peri-umbilical pain
Progressing to RLQ
May be accompanied by:
A low-grade fever
Nausea and vomiting
Loss of appetite
• Local tenderness is elicited at McBurney’s point
when pressure is applied
• Guarding the abdominal area by lying still with
the right leg flexed at the knee
7. Possible signs of Appendicitis
a. Rovising sign &Rebound tenderness
applying pressure to the right lower quadrant
then release quickly the pateint exepreinces
sever pain when the pressure relased
If the appendix curls around behind the cecum,
pain and tenderness may be felt in the lumbar
region
8. b. referred rebound tenderness
Press deeply and evenly in the left lower
quadrant Then quickly withdraw your fingers
Pain in the right lower quadrant during left-
sided pressure
9. .
c. Positive Psoas Sign
Psoas Sign: 2 methods
1st Method
• Place your hand just above the patient’s right knee
• Ask the patient to raise that thigh against your hand
(extending right thigh)
2nd Method
• Ask the patient to turn onto the left side
• Then extend the patient’s right leg at the hip
• Flexion of the leg at the hip makes the psoas muscle
contract; extension stretches it
10.
11. .
d. Positive Obturator Sign
• Flex the patient’s right thigh at the hip, with
the knee bent, and rotate the leg internally at
the hip
• This maneuver stretches the internal
obturator muscle
12.
13. C/M
• The extent of tenderness depends on the
location of the inflamed appendix
• Pain on defecation suggests that the tip of the
appendix is resting against the rectum.
• Pain in urination suggest that the tip is near to
the bladder
• If tip is in the pelvis can be elicited only on
rectal examination.
16. Medical Management
• Surgery is indicated if appendicitis is diagnosed
• Antibiotics and intravenous fluids
• To correct or prevent fluid and electrolyte imbalance
and dehydration, until surgery is performed
• Used for 6 to 8 hrs before the appendectomy
• If the appendix has ruptured and there is evidence of
peritonitis or an abscess
• Analgesics after diagnosis
• Appendectomy
17.
18. Nursing Management
• Patient preparation for surgery
• IV infusion to replace fluid loss and promote adequate
renal function
• Antibiotic therapy to prevent infection
• Enema is not administered because risk of perforation
• Avoid self-treatment like the use of laxatives and enema to
prevent perforation
• Cold compress to the RLQ to decrease blood flow to the
area and impend the inflammatory process
• Heat is never used because it may cause the appendix to
rupture
19. Postoperative care
• Placing the patient in a semi-Fowler position
• Opioid, usually morphine sulfate
• Oral fluids as tolerated
• Food is provided as desired and tolerated on the day
of surgery
• Ambulation begins the day of surgery or the first
postoperative day
• Discharge on the first or second postoperative day
• Normal activities are resumed 2 to 3 weeks after
surger
