Appendicitis
Appendicitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Appendicitis is inflammation of the vermiform appendix due to an obstruction.
Causes and incidence
Appendicitis probably results from an obstruction of the appendiceal lumen caused by a fecal mass, stricture, barium ingestion, or viral infection. This obstruction sets off an inflammatory process that can lead to infection, thrombosis, necrosis, and perforation. If the appendix ruptures or perforates, the infected contents spill into the abdominal cavity, causing peritonitis, the most common and most perilous complication of appendicitis.
Appendicitis occurs more commonly in men than in women, with a peak incidence in the late teens and early 20s. About 250,000 cases are reported annually. It’s a common cause of surgical emergency in children, with 4 appendectomies per 1,000 admissions for appendicitis annually in the United States.
Signs and symptoms
Typically, appendicitis begins with generalized or localized abdominal pain in the right upper abdomen, followed by anorexia, nausea, and vomiting (rarely profuse). Pain eventually localizes in the right lower abdomen (McBurney’s point) with abdominal “boardlike” rigidity, retractive respirations, increasing tenderness, increasingly severe abdominal spasms and, almost invariably, rebound tenderness. (Rebound tenderness on the opposite side of the abdomen suggests peritoneal inflammation.)
Later signs and symptoms include constipation or diarrhea, slight fever, and tachycardia. The patient may walk bent over or lie with his right knee flexed to reduce pain. Sudden cessation of abdominal pain indicates perforation or infarction of the appendix.
Diagnosis
Diagnosis of appendicitis is based on physical findings and characteristic clinical symptoms. Supportive findings include a temperature of 99° to 102° F (37.2° to 38.9° C) and a moderately elevated white blood cell count (12,000 to 15,000/µl), with increased immature cells.
Diagnosis must rule out illnesses with similar symptoms: gastritis, gastroenteritis, ileitis, colitis, diverticulitis, pancreatitis, renal colic, bladder infection, ovarian cyst, and uterine disease. It may be strongly suspected based on abdominal sonography or computed tomography scan. Appendicitis can be confirmed by exploratory laparos-copy.
Treatment
Appendectomy is the only effective treatment. Laparoscopic appendectomies decrease the recovery time and thus the hospital stay. If peritonitis develops, treatment involves GI intubation, parenteral replacement of fluids and electrolytes, and administration of antibiotics.
Special considerations
If appendicitis is suspected, or during preparation for appendectomy:
❑ Administer I.V. fluids to prevent dehydration. Never administer cathartics or enemas, which may rupture the appendix. Give the patient nothing by mouth, and administer analgesics judiciously because they may mask symptoms.
❑ To lessen pain, place the patient in Fowler’s position. Never apply heat to the right lower abdomen; this may cause the appendix to rupture. An ice bag may be used for pain relief.
After appendectomy:
❑ Monitor the patient’s vital signs and intake and output. Give analgesics, as ordered.
❑ Encourage the patient to cough, breathe deeply, and turn frequently to prevent pulmonary complications.
❑ Document bowel sounds, passing of flatus, and bowel movements. In a patient whose nausea and abdominal rigidity have subsided, these signs indicate readiness to resume oral fluids.
❑ Watch closely for possible surgical complications. Continuing pain and fever may signal an abscess. The complaint that “something gave way” may mean wound dehiscence. If an abscess or peritonitis develops, incision and drainage may be necessary. Frequently assess the dressing for wound drainage.
❑ Help the patient ambulate as soon as possible after surgery.
❑ In appendicitis complicated by peritonitis, a nasogastric tube may be needed to decompress the stomach and reduce nausea and vomiting. If so, record drainage and provide mouth and nose care.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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