Appendicitis : Types, Diagnosis, management, Complications

Appendicitis:

Appendicitis is inflammation of the vermiform appendix caused by obstruction of the intestinal lumen from infection, stricture, fecal mass, foreign body or tumor.

Etiology:

Appendicitis commonly affects the male than female between ten to thirty years of age.

Pathophysiology:

Obstruction of the intestinal lumen is followed by edema, infection and ischemia of the appendix. As intraluminal tension develops, necrosis and perforation usually occur.

Signs and symptoms:

The typical symptoms of acute appendicitis are

1.     Pain around the umbilicus and / or throughout the abdomen.

2.     Rebound tenderness at McBurney' s point (McBurney' s point is halfway between the umbilicus and the iliac crest).

3.     Anoxia.

4.     Moderate malaise, mild fever

5.     Nausea and vomiting.

6.     Usually constipation occurs.

Diagnosis:

1.     Physical examination. Rebound tenderness at Mc Burney' s point

2.     Laboratory test : complete blood count will show

a.     leucocytosis

b.     Urinalysis

3.     Abdominal X-ray to visualize shadow consistent with fecalith in appendix.

Management:

Surgical management:

1.Pre-operative care

Provide bedrest to the patient

Keep the pateient in nil per oral status (NPO)

Maintain adequate hydration with IV infusions

Administer antibiotics and analgesics as prescribed

Monitor pain level including location, intensity and pattern.

Assign patient to semi- Fowlers position to relax the abdominal muscles to promote comfort.

2.Types of surgery:

Appendicectomy

Laparoscopic  appendicectomy.

3. Post-operative management:

Keep the patient in the nil per oral status for the first 48 hours after surgery or until the restoration of bowel movements.

Maintain hydration and caloric requirements with intravenous (IV) infusions

After 48 hours give bland diet and plenty of water.

The patient usually resume their normal activities in two to four weeks.

Complication:

Peritonitis.

Perforation

Abscess formation