The inflammation of the vermiform appendix that prevents mucus from passing into the cecum. If unmanaged, ischemia occurs, which develops into gangrene, rupturing the appendix, and causing peritonitis. It may be caused by:
- Mechanical obstruction: fecaliths, calcium-phosphate rich mucus and inorganic salts, worms, tumors, vital infection, and inflammation.
- Decreased dietary fiber, or a diet high in refined carbohydrate.
Pathophysiology
It begins with an obstruction of the appendix lumen. The mucosa in the appendix continues to secrete fluids until the pressure in the appendix equals venous pressure. This pressure and stasis results in ischemia of the appendix, mucosal inflammation, and bacterial proliferation. Gangrene develops within 24 to 36 hours from hypoxia; an abscess forms. This eventually leads to Peritonitis.
flowchart LR
A(Obstruction)
B(Ischemia)
C(Inflammation)
D(Infection)
E(Gangrene)
F(Abscess)
G(Peritonitis)
A-->B
A-->C
A-->D
B-->E
E-->F
D-->F
F-->G
Assessment Findings
- Pain, the main presenting symptom, starting at the epigastric or umbilical region. It becomes localized at McBurney’s point, the midpoint between the anterior iliac spine and the umbilicus.
- Blumberg’s Sign: rebound tenderness.
- Psoas Sign: pain with extension of the right thigh.
- Rovsing’s Sign: referred pain; right quadrant pain when the left quadrant is palpated.
- Obturator Sign: pain on passive internal rotation of the flexed thigh.
- Nausea and Vomiting
- Anorexia
- Decreased bowel sounds
- Fever: low grade (38.0 to 38.5°C) that escalates to high grade if the appendix ruptures.
Diagnostic Examinations
- WBC Count (≥10,000/mm³)
- Ultrasound and Abdominal X-ray (for detection of fecalith obstruction)
- Differential Diagnosis for Ectopic Pregnancy: pregnancy test
Nursing Interventions
- Administer antibiotics and antipyretics as ordered.
- NPO in anticipation for emergency surgery.
- Prevent rupture of the appendix. Don’t give enemas, cathartics, or use heating pads.
- Cold Therapy for pain.
Surgical Management
- ==Appendectomy==.