Pathophysiology: Appendicitis
Appendicitis
Valerie Guidone
Helene Fuld College of Nursing
Pathophysiology
March 20, 2014
Appendicitis
The appendix is small close-ended narrow tube that attaches to the first part of the colon, also known as the cecum. It is located in the lower right part of your abdomen. Although medical researchers know where the appendix is, the purpose it serves in our body is still unknown because the removal causes no noticeable symptoms (Mohan, 2010). Appendicitis is defined as the inflammation of the appendix. It is a condition in which your appendix becomes inflamed and filled with pus ("Appendicitis," 2009). There are many possible causes of appendicitis such as; blockage of the appendix due to swelling of the lymphatic tissue, buildup of mucus or stool entering the appendix, or bacteria …show more content…
invading the wall of the appendix (Mohan, 2010). Once the symptoms begin, there is no known medical solution, so appendicitis is treated very seriously and is considered a medical emergency. If treated right away, sufferers of appendicitis will in most cases recover without any adverse reactions. If there is a delay in treatment, the appendix can burst which can cause serious infection, and in some cases death. Appendicitis is the most common acute surgical procedure performed on the abdomen (Mohan, 2010). Anyone can develop appendicitis and it is unpreventable, although studies have shown it is less common in people who have a high fiber diet. It is most common between 10 and 30 years old ("Appendicitis," 2009). Appendicitis is more common in boys than in girls, and can run in some families.
The first initial symptom of appendicitis is abdominal pain. The pain begins poorly localized or not confined to one spot and patients are unable pinpoint a specific point of the abdomen that hurts ("Appendicitis," 2009). Loss of appetite, nausea, vomiting, aching pains, low grade fever, diarrhea, and tender abdomen are all also very common symptoms (Mohan, 2010). Pain becomes sharper over several hours to the point where it becomes difficult for the person to talk, walk, or sit still. The pain changes and can be localized to a small area between the front of the right hip bone and the belly button ("Appendicitis," 2009). The pain may quickly aggravate even in a small twist or walk. The pain may also increase when you sneeze, cough and other activity that requires movements. Because the symptoms of appendicitis can be so similar to those of other medical conditions, it 's often a challenge for doctors to diagnose it (Mohan, 2010).
The diagnosis of appendicitis begins with a thorough history and physical examination. When doctors perform the physical part of examination one common symptom is rebound tenderness which is when the doctor puts pressure by pressing on the abdomen and suddenly releases, the pain becomes drastically worse (Mohan, 2010). Depending on how the physical examination goes, the doctor may order a urinalysis, abdominal x-ray, CAT scan, ultrasound, or laparoscopy. A urinalysis is given because appendicitis can mimic symptoms of urinary or kidney infections ("Appendicitis," 2009). X rays, ultrasound, and computed tomography (CT) scans can produce images of the abdomen. Plain x-rays can show signs of obstruction, perforation, foreign bodies, and sometimes an appendicolith, which is hardened stool in the appendix (Mohan, 2010). Ultrasound may show inflammation in appendix and can diagnose gall bladder disease and pregnancy. By far the most common test used, however, is the CAT scan. This test provides a series of cross-sectional images of the body and can identify many abdominal conditions (Mohan, 2010). Once a diagnosis of appendicitis is made, an appendectomy is performed as soon as possible. Antibiotics are usually given prior to surgery and as soon as appendicitis is suspected (Mohan, 2010). Laparoscopy is a surgical procedure where a small tube with a camera is inserted into the abdomen through a small puncture on the abdominal wall, allowing doctors to see the internal organs ("Appendicitis," 2009). This is a way of diagnosing as well as removing the appendix. The laparoscopy can remove the appendix with many benefits compared a regular appendectomy. This procedure avoids radiation, but requires general anesthesia. Laparoscopic surgery allows you to recover faster with less post-operative pain and heal with much less scarring (Mohan, 2010). The reason everyone doesn’t have laparoscopic surgery is because if the appendix is already ruptured, an open appendectomy is required. An open appendectomy is the "traditional" way of removing an infected appendix. Basically, a surgeon makes an incision in the abdomen and locates the infected appendix. After the doctor enters the abdomen and examines the area around to appendix to make sure there are no further problems, the appendix is cut from its attachment to the abdomen and colon and removed (Mohan, 2010). The incision is then closed with stitches. Patients usually experience severe pain from appendicitis. Strong pain medications such as morphine are used in hospitals to care for adults and children for pain management prior to surgery ("Appendicitis," 2009). Most patients have a notable decrease in pain after surgery, even with the pain of the incision.
Most patients are discharged within twenty four hours of surgery to continue recovering from surgery. The incision is usually held closed with small strips of adhesive that will slowly fall off as the patient showers and goes about their normal activities (Mohan, 2010). Internal sutures will slowly dissolve and do not need to be removed. Some patients may need a mild pain medication during this part of recovery, and most will continue to take antibiotics for up to a week after surgery. Most patients are able to return to normal activities within a few weeks, more strenuous activities may take a week or two longer. Most people recover quickly and uneventfully from surgery. Although incision site should be monitored daily for any signs of infection. It 's normal for the incision site to look a bit pink, slightly inflamed and feel tender. The site should be monitored for possible signs of infection such as; drainage, bright redness or excessive swelling (Mohan, 2010). While recovering from surgery, patients must not lift anything that weighs over 15 pounds. Heavy lifting puts too much strain on the lower abdomen and abdominal muscles. Strain on the lower abdomen can rupture the repairs accomplished on the inside while the tissues and muscles are healing (Mohan, 2010). Heaving lifting can also open the stitches at the incision site.
The complications of appendicitis include perforation, inflammation, and sepsis ("Appendicitis," 2009).
Perforation is due to delay in diagnosis and treatment. It can lead to a periappendiceal abscess which is a collected of infected pus in the appendix. This is the main reason of why when a patient is diagnosed with appendicitis, surgery is done as soon as possible. Another complication is when blockage of the intestine occurs due to inflammation surrounding the appendix, causing the intestinal muscles to stop working (Mohan, 2010). The intestines above the point of blockage fill with liquid and gas which causes nausea and vomiting. If severely blocked, it may be necessary for doctors to drain the contents of the intestine through a tube. The most serious complication of appendicitis is sepsis, which is a condition where infecting bacteria enter the blood and travel to other parts of the body ("Appendicitis," 2009). This is life threatening and a very serious complication. People developing symptoms of appendicitis need to be rushed to the hospital before it bursts to prevent complications like these from occurring (Mohan,
2010).
References
Appendicitis. (2009, August 15). Retrieved from http://www.mayoclinic.com/health/appendicitis/
Cunhan, J.P. (2008, November 21). Appendicitis causes. Retrieved from http://www.emedicinehealth.com/appendicitis/ Mohan, V. (2010, March 1). Appendicitis symptoms and causes. Retrieved from
http://www.webmd.com/digestive-disorders/appendicitis
Valerie Guidone
Helene Fuld College of Nursing
Pathophysiology
March 20, 2014
Appendicitis
The appendix is small close-ended narrow tube that attaches to the first part of the colon, also known as the cecum. It is located in the lower right part of your abdomen. Although medical researchers know where the appendix is, the purpose it serves in our body is still unknown because the removal causes no noticeable symptoms (Mohan, 2010). Appendicitis is defined as the inflammation of the appendix. It is a condition in which your appendix becomes inflamed and filled with pus ("Appendicitis," 2009). There are many possible causes of appendicitis such as; blockage of the appendix due to swelling of the lymphatic tissue, buildup of mucus or stool entering the appendix, or bacteria …show more content…
invading the wall of the appendix (Mohan, 2010). Once the symptoms begin, there is no known medical solution, so appendicitis is treated very seriously and is considered a medical emergency. If treated right away, sufferers of appendicitis will in most cases recover without any adverse reactions. If there is a delay in treatment, the appendix can burst which can cause serious infection, and in some cases death. Appendicitis is the most common acute surgical procedure performed on the abdomen (Mohan, 2010). Anyone can develop appendicitis and it is unpreventable, although studies have shown it is less common in people who have a high fiber diet. It is most common between 10 and 30 years old ("Appendicitis," 2009). Appendicitis is more common in boys than in girls, and can run in some families.
The first initial symptom of appendicitis is abdominal pain. The pain begins poorly localized or not confined to one spot and patients are unable pinpoint a specific point of the abdomen that hurts ("Appendicitis," 2009). Loss of appetite, nausea, vomiting, aching pains, low grade fever, diarrhea, and tender abdomen are all also very common symptoms (Mohan, 2010). Pain becomes sharper over several hours to the point where it becomes difficult for the person to talk, walk, or sit still. The pain changes and can be localized to a small area between the front of the right hip bone and the belly button ("Appendicitis," 2009). The pain may quickly aggravate even in a small twist or walk. The pain may also increase when you sneeze, cough and other activity that requires movements. Because the symptoms of appendicitis can be so similar to those of other medical conditions, it 's often a challenge for doctors to diagnose it (Mohan, 2010).
The diagnosis of appendicitis begins with a thorough history and physical examination. When doctors perform the physical part of examination one common symptom is rebound tenderness which is when the doctor puts pressure by pressing on the abdomen and suddenly releases, the pain becomes drastically worse (Mohan, 2010). Depending on how the physical examination goes, the doctor may order a urinalysis, abdominal x-ray, CAT scan, ultrasound, or laparoscopy. A urinalysis is given because appendicitis can mimic symptoms of urinary or kidney infections ("Appendicitis," 2009). X rays, ultrasound, and computed tomography (CT) scans can produce images of the abdomen. Plain x-rays can show signs of obstruction, perforation, foreign bodies, and sometimes an appendicolith, which is hardened stool in the appendix (Mohan, 2010). Ultrasound may show inflammation in appendix and can diagnose gall bladder disease and pregnancy. By far the most common test used, however, is the CAT scan. This test provides a series of cross-sectional images of the body and can identify many abdominal conditions (Mohan, 2010). Once a diagnosis of appendicitis is made, an appendectomy is performed as soon as possible. Antibiotics are usually given prior to surgery and as soon as appendicitis is suspected (Mohan, 2010). Laparoscopy is a surgical procedure where a small tube with a camera is inserted into the abdomen through a small puncture on the abdominal wall, allowing doctors to see the internal organs ("Appendicitis," 2009). This is a way of diagnosing as well as removing the appendix. The laparoscopy can remove the appendix with many benefits compared a regular appendectomy. This procedure avoids radiation, but requires general anesthesia. Laparoscopic surgery allows you to recover faster with less post-operative pain and heal with much less scarring (Mohan, 2010). The reason everyone doesn’t have laparoscopic surgery is because if the appendix is already ruptured, an open appendectomy is required. An open appendectomy is the "traditional" way of removing an infected appendix. Basically, a surgeon makes an incision in the abdomen and locates the infected appendix. After the doctor enters the abdomen and examines the area around to appendix to make sure there are no further problems, the appendix is cut from its attachment to the abdomen and colon and removed (Mohan, 2010). The incision is then closed with stitches. Patients usually experience severe pain from appendicitis. Strong pain medications such as morphine are used in hospitals to care for adults and children for pain management prior to surgery ("Appendicitis," 2009). Most patients have a notable decrease in pain after surgery, even with the pain of the incision.
Most patients are discharged within twenty four hours of surgery to continue recovering from surgery. The incision is usually held closed with small strips of adhesive that will slowly fall off as the patient showers and goes about their normal activities (Mohan, 2010). Internal sutures will slowly dissolve and do not need to be removed. Some patients may need a mild pain medication during this part of recovery, and most will continue to take antibiotics for up to a week after surgery. Most patients are able to return to normal activities within a few weeks, more strenuous activities may take a week or two longer. Most people recover quickly and uneventfully from surgery. Although incision site should be monitored daily for any signs of infection. It 's normal for the incision site to look a bit pink, slightly inflamed and feel tender. The site should be monitored for possible signs of infection such as; drainage, bright redness or excessive swelling (Mohan, 2010). While recovering from surgery, patients must not lift anything that weighs over 15 pounds. Heavy lifting puts too much strain on the lower abdomen and abdominal muscles. Strain on the lower abdomen can rupture the repairs accomplished on the inside while the tissues and muscles are healing (Mohan, 2010). Heaving lifting can also open the stitches at the incision site.
The complications of appendicitis include perforation, inflammation, and sepsis ("Appendicitis," 2009).
Perforation is due to delay in diagnosis and treatment. It can lead to a periappendiceal abscess which is a collected of infected pus in the appendix. This is the main reason of why when a patient is diagnosed with appendicitis, surgery is done as soon as possible. Another complication is when blockage of the intestine occurs due to inflammation surrounding the appendix, causing the intestinal muscles to stop working (Mohan, 2010). The intestines above the point of blockage fill with liquid and gas which causes nausea and vomiting. If severely blocked, it may be necessary for doctors to drain the contents of the intestine through a tube. The most serious complication of appendicitis is sepsis, which is a condition where infecting bacteria enter the blood and travel to other parts of the body ("Appendicitis," 2009). This is life threatening and a very serious complication. People developing symptoms of appendicitis need to be rushed to the hospital before it bursts to prevent complications like these from occurring (Mohan,
2010).
References
Appendicitis. (2009, August 15). Retrieved from http://www.mayoclinic.com/health/appendicitis/
Cunhan, J.P. (2008, November 21). Appendicitis causes. Retrieved from http://www.emedicinehealth.com/appendicitis/ Mohan, V. (2010, March 1). Appendicitis symptoms and causes. Retrieved from
http://www.webmd.com/digestive-disorders/appendicitis