The appendix is a small, finger-like appendage about 10 cm (4in) long that is attached to the cecum just below the

ileocecal valve. The appendix fills with food and empties regularly into the cecum. Because it empties inefficiently and its lumen is small, the appendix is prone to obstruction and is particularly vulnerable to infection. (www.emedicine.com) Obstruction of the narrow appendiceal lumen is the primary cause of appendicitis and may often be secondary to impacted fecal material or hyperplasia of the submucosal lymphoid follicles, which is associated with respiratory disease, infectious mononucleosis, and gastroenteritis. Fecaliths result from the inspissation of fecal material and inorganic salts within the appendiceal lumen, are the most common causes of obstruction, and are present in 11-52% of patients with acute appendicitis. Appendiceal calculi are rarely observed, and their presence is usually associated with perforating appendicitis. Appendiceal lumenal obstruction may also be secondary to strictures, parasitic infection, the presence of foreign bodies, Crohn disease, primary or secondary metastatic cancer, carcinoid syndrome, kinks, and adhesions. (www.emedicine.com) The incidence of appendicitis is higher in more affluent countries that have a prevalence of low-fiber diets. Low-fiber diets change the bacterial flora, increasing stool viscosity, bowel transit time, and intraluminal pressure, which encourage the formation of fecaliths. These diets contribute to low-residue stool, which can become impacted within the appendiceal lumen. (www.emedicine.com) In the United States, 250,000 cases of appendicitis are reported annually, representing 1 million patient-days of admission. The incidence of acute appendicitis has been declining steadily since the late 1940s, and the current annual incidence is 10 cases per 100,000 populations. The overall lifetime risk of developing appendicitis is approximately 7%. Some familial predisposition exists. (www.emedicine.com) Controversy exists as to whether imaging is required in patients with the classic history and physical findings of acute appendicitis. Opinion varies as to whether these modalities should be performed in all patients with suggested appendicitis or if radiology should be reserved for select patients with atypical or confusing clinical presentations. (www.emedicine.com) Helical CT scanning and graded-compression Doppler US are powerful imaging methods that substantially improve diagnostic accuracy in patients with clinically equivocal appendicitis. (www.emedicine.com)

Before the 1980s, abdominal radiographs and barium enema were the primary radiologic methods used in the diagnosis of acute appendicitis. On plain radiographic films, the presence of an appendicolith is the most specific sign, but it is rarely observed. On barium enema examination, nonfilling or incomplete filling of the appendix indicates appendiceal inflammation. (www.emedicine.com) Continuous improvements in imaging technology, technique, and interpretation that have been achieved over the past 15 years have substantially increased the accuracy of imaging methods. Since 1986, US and, after the 1990s, CT scanning have gained acceptance as the primary imaging techniques for acute appendicitis by virtue of their ability to directly image the appendix, adjacent fat, and gut. (www.emedicine.com) Graded-compression US of the RLQ has been shown to be a useful examination because of this technique's safety and high accuracy (approximately 90%) in the diagnosis of acute appendicitis. Advantages of US include lack of radiation exposure, noninvasiveness, short acquisition time, and the potential for diagnosis of other causes of abdominal pain, particularly in the subset of patients who are women of childbearing age. Several authors suggest that US should be the first imaging method used in pregnant women and pediatric patients because x-ray exposure is especially undesirable in these groups. (www.emedicine.com) Contrast-enhanced, thin-section (0.5 mm) helical CT scanning has become the preferred imaging technique in the diagnosis of acute appendicitis and its complications, with a high diagnostic accuracy of 95-98%.The literature suggests that limited helical CT scanning with rectal contrast is a highly accurate, time-efficient, cost-effective way to evaluate adult patients with equivocal presentations for appendicitis. CT scanning is particularly preferred in patients in whom appendiceal perforation is suspected, because the diagnostic accuracy remains high and because CT scanning is useful for characterizing periappendiceal inflammatory masses. (www.emedicine.com) Other advanced radiologic examinations, such as magnetic resonance imaging (MRI), scintigraphy, and color Doppler US, have been used in the diagnosis of acute appendicitis, with a diagnostic accuracy of approximately 91-95%. Currently, no practical role exists for MRI and scintigraphy in acute appendicitis. Advantages of MRI include better visualization of abnormal appendices and adjacent inflammatory processes, visualization of the appendix in an atypical location, delineation of pathology, operator independence, and ease of examination of patients

who are obese. MRI, similar to enhanced CT scanning, can demonstrate the extent of inflammatory infiltration. (www.emedicine.com) The decision to obtain US or CT scan studies depends on institutional preference and the available user expertise, although patient age, sex, and body habitus are important influencing factors. US and CT scanning have similar diagnostic value for detecting an alternative diagnosis in a patient in whom acute appendicitis is suspected. Balthazar et al showed that CT scanning is superior to US in the diagnosis of acute appendicitis6; however, US is rapid, safe, inexpensive, and noninvasive, and it requires no contrast material or patient preparation. (www.emedicine.com) As student nurses assigned in Rafael Lazatin Memorial Hospital-MS ward we should find a case that can we use for our case study but we have a hard time what case we should choose to present. So at the end of our group discussion the group decided to choose Pendix as our case subject. Because in our initial contact we already established harmonious relationship with the patient and also with his significant others so because of that we had established the trust we yearn from them and that makes it easy for us to ask certain questions we need for our case and interact with them properly. Most importantly, the term Appendicitis is not accustomed to us that much. Therefore, we want to further enhance our knowledge about the disease such as to ensure appropriate evaluation of the etiology, reassess and address the course the illness takes in its progression. And also we want to gain deeper knowledge on the said surgical procedure and the underlying disease which is Appendicitis. Being student nurses, this case study will enhance our skills and knowledge in MedicalSurgical ward. The entire lesson that we learned during our classroom lecture can be useful as we apply on this actual experience. The group will also find out the reason behind this procedure, especially the factors that lead the patient to undergo with this surgical procedure, the treatment to be given and most importantly the appropriate nursing care and management catered to this specific case. The group would like to emphasize the importance of prompt diagnosis and treatment not only in this case but to every other kind of diseases. It is important not to ignore the unusual feelings or sensation that you feel unto your own body. Any different feeling might indicate something bad or wrong. And finally, the group would also like to impart the information on this study to all clinical instructors or even to the student nurses so that they can use it as a guide in teaching their students and patient, respectively, especially when they exposed to the said case.