Appendicitis: Inflammation of the appendix, the small worm-like projection from the first part of the colon.

Appendicitis usually involves infection of the appendix by bacteria that invade it and infect the wall of the appendix. Appendicitis can progress to produce an abscess (a pocket of pus) and even peritonitis (inflammation of the lining of the abdomen and pelvis). Symptoms of Appendicitis The pain may begin on the lower right side of the abdomen, but it may also start as a vague discomfort in the center of the abdomen and then move to the lower right side. Although not every pain in the abdomen indicates appendicitis, a person should report any pain that persists and that is accompanied by loss of appetite, nausea, vomiting, and fever to a physician. Until a doctor determines what is wrong and what should be done, a person should not take laxatives or enemas. acute appendicitis appendicitis of acute onset, requiring prompt surgery, and usually marked by pain in the right lower abdominal quadrant, referred rebound tenderness, overlying muscle spasm, and cutaneous hyperesthesia. chronic appendicitis 1. that characterized by fibrotic thickening of the organ wall due to previous acute inflammation. 2. formerly, chronic or recurrent pain in the appendiceal area, without evidence of acute inflammation. fulminating appendicitis that marked by sudden onset and usually death. gangrenous appendicitis that complicated by gangrene of the organ, due to interference of blood supply. obstructive appendicitis a common form with obstruction of the lumen, usually by a fecalith. Treatment The treatment of appendicitis is an immediate appendectomy. This may be done by opening the abdomen in the standard open appendectomy technique, or through laparoscopy. In laparoscopy, a smaller incision is made through the navel. Both methods can successfully accomplish the removal of the appendix. It is not certain that laparoscopy holds any advantage over open appendectomy. When the appendix has ruptured, patients undergoing a laparoscopic appendectomy may have to be switched to the open appendectomy procedure for the successful management of the rupture. If a ruptured appendix is left untreated, the condition is fatal. Causes of Appendicitis The cause of appendicitis relates to blockage of the inside of the appendix, known as the lumen. The blockage leads to increased pressure, impaired blood flow, and inflammation. If the blockage is not treated, gangrene and rupture (breaking or tearing) of the appendix can result.Most commonly, feces blocks the inside of the appendix. Also, bacterial or viral infections in the digestive tract can lead to swelling of lymph nodes, which squeeze the appendix and cause obstruction. This swelling of lymph nodes is known as lymphoid hyperplasia. Traumatic injury to the abdomen may lead to appendicitis in a small number of people. Genetics may be a factor in others. For example, appendicitis that runs in families may result from a genetic variant that predisposes a person to obstruction of the appendiceal lumen. The incidence of acute appendicitis has been declining steadily since the late 1940s, and the current annual incidence is 10 cases per 100,000 population. Appendicitis occurs in 7% of the US population, with an incidence of 1.1 cases per 1000 people per year. Some familial predisposition exists. he incidence of appendicitis gradually rises from birth, peaks in the late teen years, and gradually declines in the geriatric years. The mean age when appendicitis occurs in the pediatric population is 6-10 years. Lymphoid hyperplasia is observed more often among

infants and adults and is responsible for the increased incidence of appendicitis in these age groups. Younger children have a higher rate of perforation, with reported rates of 50-85%. The median age at appendectomy is 22 years. Although rare, neonatal and even prenatal appendicitis have been reported. Clinicians must maintain a high index of suspicion in all age groups.
References: Medical and Surgical Nursing by Brunner and Suddarths Medical Surgical Nursing by Josie Quiambao Udan Manuals of Nursing Practice by Lippincott Mosbys Medical Surgical Nursing

Anatomy of the Digestive System Introduction Digestion is theprocess by which food is broken down into smaller pieces so that the body can use them to build and nourish cells and to provide energy. Digestion involves the mixing of food, its movement through the digestive tract (also known as the alimentary canal), and the chemical breakdown of larger molecules into smaller molecules. Every piece of food we eat has to be broken down into smaller nutrients that the body can absorb, which is why it takes hours to fully digest food. The digestive system is made up of the digestive tract. This consists ofa long tube of organs that runs from the mouth to the anus and includes the esophagus,stomach,small intestine, andlarge intestine, together with the liver, gallbladder, and pancreas, which produce important secretions for digestion that draininto the small intestine.The digestive tract in an adult is about 30 feet long. Mouth: Foodstuffs are broken down mechanically by chewing and saliva is added as a lubricant. Esophagus: A simple conduit between the mouth and stomach - important but only marginally interesting. Stomach: Where the real action begins - chemical digestion of proteins initiated and foodstuffs reduced to liquid form. Liver: The center of metabolic activity in the body - its major role in the digestive process is to provide bile salts to the small intestine, which are critical for digestion and absorption of fats. Pancreas: Important roles as both an endocrine and exocrine organ - provides a potent mixture of digestive enzymes to the small intestine which are critical for digestion of fats, carbohydrates and protein. Small Intestine: The most exciting place to be in the entire digestive system - this is where the final stages of chemical digestion occur and where almost all nutrients are absorbed. Large Intestine: Major differences among species in extent and importance - in all animals water is absorbed, bacterial fermentation takes place and feces are formed. In carnivores, that's about the extent of it, but in herbivores like the horse, the large intestine is huge and of critical importance for utilization of cellulose.

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Discharge Planning M Antibiotics for infection E T Analgesic agent (morphine) can be given for pain after the surgery Within 12 hrs of surgery you may get up and move around. You can usually return to normal activities in 2-3 weeks after laparoscopic surgery. Pretreatment of foods with lactase preparations (e.g. lactacid drops) before ingestion can reduce symptoms.

Ingestion of lactase enzyme tablets with the first bite of food can reduce symptoms. H To care wound perform dressing changes and irrigations as prescribe avoid taking laxative or applying heat to abdomen when abdominal pain of unknown cause is experienced.

Reinforce need for follow-up appointment with the surgeon Call your physician for increased pain at the incision site Document bowel sounds and the passing of flatus or bowel movements (these are signs of the return of peristalsis) Watch for surgical complications such as continuing pain or fever, which indicate an abscess or wound dehiscence Stitches removed between fifth and seventh day (usually in physicians office) D Liquid or soft diet until the infection subsides Soft diet is low in fiber and easily breaks down in the gastrointestinal tract O

Pathophysiology of Appendicitis