Appendicitis
OVERVIEW
The appendix is a small, vermiform appendage about 8 to 10
cm (3 to 4 inches) long that is attached to the cecum just below
the ileocecal valve.
The appendix fills with by-products of digestion 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.
The purpose of the appendix is unknown. Some believe it
contains tissue that helps your immune system process
infections in your body.
Appendicitis
Infection, and Inflammation of the Appendix.
TWO TYPES:
1. Acute Appendicitis
The symptoms tend to be severe and develop
suddenly. The symptoms tend to develop quickly over the
course of one to two days.
2. Chronic Appendicitis
The symptoms may be milder and may come and go over
several weeks, months, or even years. is less common
than acute appendicitis.
Pathophysiology
CAUSE
Unknown
*Blockage or Obstruction
Predisposing Factors: Precipitating Factors:
-Any Age: (15 to 30 yrs. Old) -Low-fiber diets
-Sex: More common in Male -Foreign bodies (undigested
Materials like fruit seeds)
than females -Abdominal injury or trauma
-Family History -Digestive tract infection
-Inflammatory bowel disease
-Intestinal/parasitic infections
-Tumor growths inside the appendix
Blockage or obstruction of the Appendix (Fecalith)
Interferes with drainage of secretions from the appendix
Accumulation of fecalith and secretion in the confined space
Increased growth and multiplication of bacteria in the area
Inflammatory response activation
Lymphoid hyperplasia: swelling, enlargement and abscess or
pus formation.
Increased pressure in the blood vessels
compresses surrounding blood vessels
Decreasing blood flow leading to ischemia
Weakens the wall of the appendix
Gangrene and perforation
Rupture of Appendix
Leakage of bacteria and pus in the peritoneum
Peritonitis
Septic Shock
Death
SIGNS AND SYMPTOMS
- Dull or vague around the umbilical region and often shifts to right
lower abdomen.
- Right lower quadrant pain: McBurney’s point- positive for Rebound
Tenderness
Psoas sign
is elicited by having the patient lie on his or her left side while the
right thigh is flexed backward.
Rovsing’s sign is pain felt in the right lower quadrant after
the left lower quadrant has been palpated.
Obturator sign: pain on internal rotation of the right thigh
Guarding behavior: Patient maintains hip flexion with
knees drawn up for comfort.
Loss of appetite
Nausea and vomiting
Weight loss
Low-grade fever 38-degree Celsius
Abdominal bloating
Decrease or absent bowel sound
Constipation and Diarrhea
Sign of pending ruptured Appendix: Severe, excruciating sharp
pain in the right lower quadrant.
DIAGNOSTIC TEST
Complete Physical Assessment
CBC: demonstrates an elevated WBC
- Leukocyte count may exceed 10,000 cells/mm3
- Neutrophil count exceed 75%
Imaging Devices: X-rays, CT scan, MRI and Abdominal
Ultrasound
- may reveal a lower quadrant density or localized
distention of the bowel
MANTREL SCORING FOR APPENDICITIS
MIGRATION 2
ANOREXIA 2
NAUSEA 1
TEMPERATURE 1
REBOUND 2
LEUKOCYTOSIS 2
4-6 = OBSERVE
7-10 = FOR APPENDECTOMY
Alvarado
score
Medical
Management
Page 1 of 2
Symptoms
Migratory right iliac fossa pain.
1 Point
Anorexia.
1 Point
Nausea and vomiting.
1 Point
Signs
Right iliac fossa tenderness.
2 Points
Rebound tenderness.
1 Point
Fever.
1 Point
Laboratory
Leucocytosis.
2 Points
Shift to left (segmented neutrophils).
1 Point
Total Score
10 Points
