Appendix – The appendix is a finger-like projection present at the end of the cecum. Appendicitis – Appendicitis is an acute and chronic inflammation of the vermiform appendix. Appendicitis is a medical emergency that is always required surgical treatment as soon as to remove the appendix. Appendicitis mainly occurs at 10 – 30 years of age.

Cause of appendicitis

• Idiopathic
• Faecalith ( hard stool stored in appendix )
• Obstruction and tumor
• Knot in appendix
• Undigested seeds
• Foreign bodies
• Inflammation and fibrosis of the colon
• Abdominal surgery
• Infection
• Intestinal parasites
• Constipation
• Diabetes mellitus and immunosuppression.

Types of appendicitis

1. Acute simple appendicitis
2. Acute purulent appendicitis
3. Obstructed appendicitis
4. Malignant appendicitis
5. Perforation and gangrenous appendicitis

Pathophysiology of appendicitis

Cause / Etiology

↓

Inflammation and obstruction of an appendix

↓

Increase the intra luminal pressure

↓

Affect the blood supply of the appendix

↓

Edema or swelling in the appendix

↓

Sever pain (appendicitis)

Appendicitis Symptoms

• Acute abdominal pain –
• at right lower quadrant
• At  McBurney point
• Between umbilicus and anterior spine of the ilium.
• Nausea, vomiting
• Dehydration and GI disturb
• Anorexia
• Abdominal tenderness and rigidity
• Rovsing sign
• Rebound tenderness
• Tachycardia and tachypnea
• Fever ( 99 – 102° )
• Swollen belly
• Severe cramps.

Appendix pain symptoms

Rovsing sign – Pain occurs in the right lower quadrant when palpate in the left lower quadrant.

Rebound tenderness Sign– Also know the Blumberg sign. It is a clinical sign of appendicitis in which pain or tenderness occurs when sudden release of abdominal pressure.

Appendicitis Tests

• History collection and physical examination.
• Blood test – WBC increased ESR increase.
• Laparoscopic test.
• Rectal examination
• Stool examination
• Urine analysis
• CT scan and USG
• Positive signs and symptoms.

Treatment of appendicitis

• Maintain NPO
• Provide adequate bed rest
• Treatment of appendicitis starts with antibiotic therapy and IV fluid.
• Antispasmodic, antiemetic, analgesics.
• Provide comfortable position
• Cold application apply at pain site
• Proton pump inhibitors.

Surgical management  

• Appendectomy (remove inflamed appendix).

Complication of appendicitis  

• Peritonitis
• Perforation
• Post-operative wound infection
• Abscess.

Nursing management of Appendicitis

Preoperative care of appendicitis

• Nurses establish nurse patient relationships.
• Nurses collect patient files and all diagnostic examinations.
• Nursing informs the sector to explain surgical procedures to the patient.
• If pain occurs before surgery, provide the right lateral position and legs are flexed.
• Collect patient consent.
• Instruct to patient for NPO.
• Enema contraindicated in appendicitis, because enema rupture appendicitis.
• Cold applications apply for relief pain.
• Prepare the patient for surgery.

Intraoperative care of appendicitis

• Nurses provide appropriate positions.
• Prepare the MCBurney point with an antiseptic solution.
• Provide prescribe IV fluid.
• Check vital signs.
• Prepare for anaesthesia.
• Use all aseptic techniques during surgery.
• Follow the instructions of surgeons.
• After surgery, nurses transport patients to the recovery room.

Post-operative care of appendicitis

• Nurses assess patient vital signs and general appearance.
• Monitor operative site dressing.
• Provide prescribed medication.
• Provide comfortable rest and sleep.
• After surgery, provide left lateral position and flexed legs to relieve pain.
• Provide a high fiber diet and fresh fruits or vegetables.
• Instruct patients about follow up care.

Read also – Pancreatitis

Key Points about Appendicitis

1. Finger-like projection at the end of the cecum – Appendix.
2. Most common cause of appendicitis – Faecalith.
3. Most common site of appendicitis pain – MCBurney point.
4. Enema is contraindicated in – Appendicitis.
5. Rovsing and rebound tenderness is a sign of – Appendicitis.
6. Most common nursing action in appendicitis –  Apply cold application.
7. Right quadrant pain when palpate left lower quadrant – Rovsing sign.
8. Suddenly abdominal pressure causes pain, as is known – the Blumberg sign.
9. Stool appearance in appendicitis – Melena.
10. Most common surgery in appendicitis – Appendectomy.
11. Which site prepares for appendicitis surgery – Right lower quadrant.
12. Most common complication of appendicitis – Peritonitis.
13. Common symptom of appendicitis – Pain in McBurney point.
14. Accumulation of hard stool appendix is called – Faecalith.
15. Hot application contraindicated in – Appendicitis.