- Is inflammation of the vermiform appendix caused by an obstruction attributable by infection, stricture, fecal mass, foreign body or tumor.
- It can affect by either gender at any age, but is most common in males ages 10 to 30.
- It is the most common disease requiring surgery. If left untreated, appendicitis may progress to abscess, perforation, subsequent peritonitis, and death.
- Generalized or localized abdominal pain occurs in the epigastric or periumbilical areas in the upper right abdomen.
- Within 2 to 12 hours, the pain localizes in the right lower quadrant and intensity increases.
- Anorexia, fever, nausea, vomiting, and constipation may also occur.
- Bowel sounds may be diminished.
- Tenderness anywhere in the right lower quadrant.
- Often localized at McBurney’s point, just below midpoint of line between umbilicus and iliac crest on the right side.
- Guarding and rebound tenderness to right lower quadrant and referred rebound when palpating the left lower quadrant.
- Positive Psoas Sign.
- Have the patient attempt to raise the right thigh against the pressure of your hand placed over the right knee.
- Increased abdominal pain indicates inflammation of the psoas muscle in acute appendicitis.
- Positive Obturator Sign.
- Flex the patient’s right hip and knee and rotate the leg internally.
- Hypogastric pain indicates inflammation of the obturator muscle.
- WBC count shows moderate leukocytosis (10,000 to 16,000/mm) with shift to the left (increased immature neutrophils) in WBC differential.
- Urinalysis rules out urinary disorders.
- Abdominal X-ray visualizes shadow consistent with fecalith in appendix.
- Pelvic sonogram rules out ovarian cyst or ectopic pregnancy.
- Surgical removal is the only effective treatment (simple appendectomy or laparoscopic appendectomy).
- Preoperatively, maintain patient on bed rest, NPO status, I.V. hydration, possible anti-biotic prophylaxis, and analgesia, as directed.
- Monitor frequently for signs and symptoms of worsening condition, indicating perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia).
- Notify health care provider immediately if pain suddenly ceases, this indicates perforation, which is a medical emergency.
- Assist patient to position of comfort such as semi-fowlers with knees are flexed.
- Restrict activity that may aggravate pain, such as coughing and ambulation.
- Apply ice bag to abdomen for comfort.
- Avoid indiscriminate palpation of the abdomen to avoid increasing the patients discomfort.
- Promptly prepare patient for surgery once diagnosis is established.
- Explain signs and symptoms of postoperative complications to report-elevated temperature, nausea and vomiting, or abdominal distention; these may indicate infection.
- Instruct patient on turning, coughing, or deep breathing, use of incentive spirometer, and ambulation. Discuss purpose and continued importance of these maneuvers during recovery period.
- Teach incisional care and avoidance of heavy lifting or driving until advised by the surgeon.
- Advise avoidance of enemas or harsh laxatives; increased fluids and stool softeners may be used for postoperative constipation.