Appendicitis: Clinical Features, Diagnosis, Treatment & Home Based Care

Appendicitis is the inflammation of vermiform appendix of the gastrointestinal tract. The appendix is a small, finger-like appendage attached to the caecum just below the ileocecal valve. Because it empties into the colon inefficiently and its lumen is small, it is prone to become obstructed and vulnerable to infection (appendicitis). The obstructed appendix becomes inflamed and oedematous and eventually fills with pus. It is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity and the most common cause of emergency abdominal surgery. Although it can occur at any age, it commonly occurs between the ages of 10-30 years.

Clinical features of Appendicitis

  • Lower right quadrant pain usually accompanied by low-grade fever, nausea, and sometimes vomiting; loss of appetite is common; constipation can occur.
  • Local tenderness with pressure and some rigidity of the lower portion of the right rectus muscle.
  • Rebound tenderness may be present; location of appendix dictates the amount of tenderness, muscle spasm, and occurrence of constipation or Diarrhoea.
  • Rovsing’s sign (elicited by palpating left lower quadrant, which paradoxically causes pain in right lower quadrant).
  • If the appendix ruptures, pain becomes more diffuse; abdominal distension develops from paralytic ileus, and the condition worsens if not managed in time.

In the elderly, signs and symptoms of appendicitis may vary greatly. Signs may be very vague and suggestive of bowel obstruction or another process; some patients may experience no symptoms until the appendix ruptures. The incidence of the perforated appendix is higher in the elderly patients because many of these people do not seek health care as quickly as younger ones.

Diagnostic assessment

  • Diagnosis is based on a complete physical examination and laboratory and imaging tests
  • Elevated WBC count with an elevation of the neutrophils; abdominal radiographs, ultrasound studies, and CT scans may reveal right lower quadrant density or localized distension of the bowel.

Treatment of Appendicitis

  • As soon as the patient is suspected of appendicitis. It has to be confirmed and treated.
  • Surgery  (conventional or laparoscopic) is indicated if appendicitis is diagnosed and should be performed as soon as possible to decrease the risk of perforation.
  • Appendectomy ( surgical removal of the appendix) is done under the influence of spinal anaesthesia.
  • Administer antibiotics and iv fluids until surgery is performed and also given postoperatively to prevent infection prior to surgery.
  • Analgesic agents can be given after the diagnosis is made and after the surgery to relieve the pain.
  • Alternative dressings are done and the wound is cleaned until it heals.

Complications of Appendectomy

  • The major complication is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal Pyle phlebitis
  • Perforation generally occurs 24 hours after the onset of pain. Symptoms include a hyperthermia 37.7°C (100°F) or greater, a toxic appearance and continued abdominal pain or tenderness.

Nursing care

  • Nursing goals include relieving pain, preventing fluid volume deficit, reducing anxiety, eliminating infection due to the potential or actual disruption of the GI tract, maintaining skin integrity, and attaining optimal nutrition.
  • In preoperative management, prepare the patient for surgery, start intravenous access, administer antibiotics and insert a nasogastric tube (if evidence of paralytic ileus). Do not give an enema or laxative because it could cause perforation.
  • In postoperative management, place the patient in high Fowler’s position only after the spinal anesthesia influence is gone, give analgesic as ordered, administer oral fluids when tolerated, give food as desired as per the advice of a doctor.
  • If a drain is left in place in the area of the incision, monitor carefully for signs of intestinal obstruction, secondary haemorrhage, or secondary abscesses ( e.g. fever, tachycardia, elevated leukocyte count).

Home-based care

  • Teach patient and family to care for the wound and have dressing changes and irrigations as prescribed.
  • Reinforce the need for follow up an appointment with a surgeon.
  • Discuss incision care and activity guidelines.
  • Refer to home care nursing as indicated to assist with care and continued monitoring of complications and wound healing.

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