Appendix

Appendix
The appendix is a small, finger-like

appendage about 10 cm (4in) long that is attached to the cecum just below the ileocecal valve. Long 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.

Pathophysiology
The appendix become inflamed and edematous as a result of either becoming kinked or occluded by a fecalith, tumor, or foreign body.
The inflammatory process increases intraluminal pressure, initiating a progressively severe, generalized or upper abdominal pain that become localized in the right lower quadrant of the abdomen within a few hours. Eventually, the inflamed appendix fills with pus.

Clinical Manifestation
Vague epigastric or periumbilical pain progresses to lower

quadrant pain and usually accompanied by a low-grade fever and nausea and sometimes by vomiting. Loss of appetite is common. Local tenderness is elicited at McBurneys point when pressure is applied. Rebound tenderness maybe present. The extent of tenderness and muscle spasm and the existence of constipation and diarrhea depend not so much of the severity of the appendeceal infection as on the location of the appendix.

 If the appendix curls around behind the cecum, pain

and tenderness maybe felt in the lumbar region. If its tip in the pelvis, this signs maybe elicited only on rectal examination Rovsings sign maybe elicited by palpating the lower quadrant; this paradoxically cues pain to be felt in the right lower quadrant. Constipation can also occur with an acute process such as appendicitis. Laxatives administered in this instance may produce perforation of inflamed appendix. In general, a laxative or cathartic should never be given while the person has fever, nausea, or pain.

Assessment and Diagnostic Findings

complete physical examination
Laboratory and X-ray findings. The complete blood cell count demonstrates and

elevated white blood cell count. Leukocytes count may exceed 10,000 cell/mm3 Neutrophil count may exceed 75%. Abdominal X-ray films, ultrasound studies, and CT scan may reveal a right lower quadrant density or localized distension of the bowel.

COMPLICATIONS
The major complication of appendicitis is perforation

of the appendix, which can lead to peritonitis or an abscess. The incidence of perforation is 10% to 32%. The incidence is higher in young children and elderly. Perforation generally occurs 24 hours after the onset of pain. Symptoms include a fever of 37.7oC or higher, a toxic appearance, and continued abdominal pain or tenderness.

MEDICAL MANAGEMENT
Surgery is indicated if appendicitis is diagnosed. To

correct or prevent fluid and electrolyte imbalance and dehydration, anti-biotics and intravenous fluids are administered until surgery is performed. Analgesics can be administered after the diagnosis is made. Appendectomy (surgical removal of 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

Relieving pain Preventing fluid volume deficit Reducing anxiety Maintaining skin integrity Attainting optimal nutrition

Preoperative Care
Administered Intravenous Fluids (IV) Administer opioid analgesics The client should not receive laxatives

or enema. Prepare for surgery and anesthesia

Operative Procedures
Appendectomy is the removal of inflamed

appendix.
Most uncomplicated appendectomies today

are done via laparoscopy

Postoperative Care
If peritonitis was present, a nasogastric (NG) tube is placed to decompress the stomach and prevent abdominal distension.
IV antibiotics are typically prescribed if peritonitis is present. Opioid analgesics are administered for pain as needed Most client can return to usual activities in 1 to 2 weeks.