Appendicitis

Mr. ASHOK BISHNOILecturer JINR

Anatomy &physiology of appendix:-

The appendix is a slender, worm-shaped pouch, averaging 5-10cm in length, that protrudes from the top of the colon in the lower right abdomen.

Blood & nerve supply:- Blood supply by -Appendix artery from

ileocolic artery.

Blood return by -Appendix vein -portalal vein

Nerve supply by -Sympathetic nerve.

 Definition:-

“It is inflammation of the vermiform appendix”

Incidence:-

Occurs mainly in 10 to 30 year of age.

Etiology:-

Obstruction (accumulated feces in lumen)

TumorForeign bodiesKing-King of appendix (Twisting)Swelling of the bowel wall

Types of appendicitis:-Four type:1.Acute simple appendicitis

2.Acute purulent appendicitis

3.Perforation and gangrenous

4.Appendiceal abscess

1.Acute simple appendicitis-

2.Acute purulent appendicitis-

3.Perforation and gangrenous-

Gangrenous

Perforation

4.Appendiceal abscess-

Pathophysiology:-

Due to etiological factor

Inflammatory process

Increase intra-luminal pressure

Severe pain

Clinical manifestation:-Subjective sign & symptoms- Epigastric pain spread to right lower

quadrant. Malaise Anorexia Vomiting Moderate leukocytosis ( leukocyte in blood)

Rebound tenderness Constipation Diarrhea

Objective sign & symptoms- Pain at McBurney’s point.(between umbilical &

iliac crest)

Rovsing’s sign: (pain in the right lower quadrant upon palpation of the left lower quadrant)

Obturator sign: (pain on internal and external rotation of the hip)

Psoas sign : (pain on active elevation of the legs)

Tachycardia Tachypnoea Low grad fever

Diagnostic evaluation:-

History Physical examination WBC count Urinalysis Abdominal x-ray CT Scan USGpregnancy test (women only)

Management:- Medical management- Bed rest NPO I/V fluid Antibiotic eg. Ampicillin, Sulbactam, Gentamycin

Antipyretic Antiemetic Analgesic

Surgical management-

Appendectomy

New method-

laparoscopy appendectomy

Incision-

McBurney’s

incision

transvers skin incision

Operation- Process: Appendix is divided between

clamps and ligated

a

b c

Complication:- Abdomen abscess

Perforation

Peritonitis

Infection

Nursing management:-

Pre-operative-Pain R/t inflamed appendix.Fluid volume deficit R/T vomiting.

Post-operative-Risk for infection R/T Perforation.Altered nutrition less then body requirement

R/t less intake of food.