APPENDIX – a small finger like appendages about 10cm long that is attached to the cecum just below the ileocecal valve.

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

ROVSING’S SIGN – an indication of acute appendicitis in which pressure on the left lower quadrantof the abdomen causes pain in the right lower quadrant.

LAPAROSCOPY – technique to examine the abdominal cavity with a laparoscope through one or more small incision in the abdominal wall, usually at the umbilicus.

PERITONITIS –inflammation of the peritoneum. ABSCESS- collection of pus.

Tenderness elicited by palpating the right lower quadrant over the Mc Burney’s point

Indicator of localized peritoneal inflammation in acute appendicitis.

Eliciting the Mc Burney’s sign Place patient to supine position, knees slightly flexed

and abd. Muscle relaxed. Palpate deeply and slowly in the RLQ over the Mc

Burney’s point (Located about 2”(5cm) from the right anterior superior spine of the ileum, on the line between the spine and the umbilicus. Point of pain and tenderness, a positive Mc Burney’s sign, indicates appendicitis.

The appendix is a blind-ending tube that comes off of the first part of the colon, the cecum. In fact, the appendix resembles a worm arising from the colon, hence its full name vermiform appendix which in Latin means worm.The appendix has no known function. It is believed that it may have a role in the immune system.

The main thrust of events leading to the development of acute appendicitis lies in the appendix developing a compromised blood supply due to obstruction of its lumen and becoming very vulnerable to invasion by bacteria found in the gut normally.

Obstruction of the appendix lumen by faecolith, enlarged lymph node, worms, tumour, or indeed foreign objects, brings about a raised intra-luminal pressure, which causes the wall of the appendix to become distended.

Normal mucus secretions continue within the lumen of the appendix, thus causing further build up of intra-luminal pressures. This in turn leads to the occlusion of the lymphatic channels, then the venous return, and finally the arterial supply becomes undermined.

Reduced blood supply to the wall of the appendix means that the appendix gets little or no nutrition and oxygen. It also means a little or no supply of white blood cells and other natural fighters of infection found in the blood being made available to the appendix.

The wall of the appendix will thus start to break up and rot. Normal bacteria found in the gut gets all the inducement needed to multiply and attack the decaying appendix within 36 hours from the point of luminal obstruction, worsening the process of appendicitis.

This leads to necrosis and perforation of the appendix. Pus formation occurs when nearby white blood cells are recruited to fight the bacterial invasion.

A combination of dead white blood cells, bacteria, and dead tissue makes up pus.

The content of the appendix (faecolith, pus and mucus secretions) are then released into the general abdominal cavity, bringing causing peritonitis.

So, in acute appendicitis, bacterial colonisation follows only when the process have commenced.

These events occur so rapidly, that the complete pathophysiology of appendicitis takes about one to three days. This is why delay can be deadly

Periumbilical pain progresses to right lower quadrant pain and is usually accompanied by a low grade fever and nausea.

Loss of appetite Rebound tenderness Rovsing’s sign Positive Mc Burney’s sign Constipation

COMPLETE BLOOD COUNT - it demonstrate an elevated WBC count with an elevation of the neutrophils.

Abdominal x-ray films Ultrasound CT scan

Perforation Abscess Peritonitis

Immediate surgery

Administration of IV fluids and antibiotic - To correct or prevent fluid and electrolyte imbalance, dehydration and sepsis until surgery is performed.

Relieving Pain Preventing Fluid Volume Deficit Reducing Anxiety Eliminating Infection Maintaining Skin Integrity Attaining Optimal Nutrition

Definition Appendectomy is the surgical

removal of the appendix. The appendix is a worm-shaped hollow pouch attached to the cecum, the beginning of the large intestine.

Laparotomy Laparoscopy

Basic Set

Basic Sharps, AP, OS, Babcock, Silk

All diagnostic tests and procedures are explained to promote cooperation and relaxation.

The patient is prepared for the type of surgical procedures as well as the post operative care.

Measures to prevent postoperative complication are taught, including coughing,turning, and deep breathing using splint at the incision site.

I.V fluids or total parenteral nutrition before surgery maybe ordered to improved fluid and electrolyte balance and nutritional status.

Intake and output is monitored Preoperative laboratory are obtained. Bowel cleansing will be initiated 1 to 2 days

before surgery for better visualization. Antibiotics are ordered to decrease the

bacterial growth in the colon. Patient may not have anything by mouth

after midnight the night before surgery. Medication may be withheld, if ordered.

Thiswill keep the GI tract clear.

Position the patienton the OR table Skin preparation Induction of anesthesia Procedures done aseptically Closing of the incision Dressing of the site

Monitor vital signs for sign of infection and shock such as fever, hypotension and tachycardia.

Monitor I and O for sign of imbalance, dehydration, and shock.

Assess abdomen for increased pain, distention, rigidity, and rebound tenderness because these may indicate postoperative complications.

Evaluate dressing and incision.

Evaluate the passing of flatus or feces Monitor for nausea and vomiting. Laboratory values are monitored and patient

is evaluated for sign and symptoms of electrolyte imbalances.

Wound drains, I.V, and all other catheter are monitored and evaluated for signs of infections.

Turning , coughing, deep breathing, and incentive spirometry are performed every 2 hours.

Diet is advanced as ordered. Administration of medications as ordered

Instruct patient to avoid heavy lifting for 4 to 6 weeks after surgery.

Instruct patient to report symptoms of anorexia, nausea, vomiting, fever, abdominalpain, incisional redness and drainage postoperatively.