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Appendicitis - Coggle Diagram
Appendicitis
Pathophysiology
inflammation of the appendix
appendix becomes swollen and sore
blood supply to appendix stops
impaired blood flow causes appendiceal tissue to die
if left untreated or progresses, appendix may burst
bursting may cause the development of tears or holes in the appendix, potentially causing peritonitis
occurs in individuals ages 10 to 30
risk factors: family history of appendicitis, cystic fibrosis diagnosis
medical emergency
Stages of appendicitis
Early; mucosal edema, mucosal ulceration, bacterial diapedesis, appendiceal distention due to accumulated fluid, and increasing intraluminal pressure. Mild visceral periumbilical/epigastric pain lasting 4-6 hours
Suppurative; transmural spread of bacteria, classic shift of pain from periumbilicus to RLQ (continuous, more severe than early visceral pain)
Gangrenous; intramural venous/arterial thromboses occur, results in a gangrenous appendicits
Perforated; persisting tissue ischemia, resulting in appendiceal infarction/perforation (may cause localized/generalized peritonitis)
Phlegmonous stage: Inflamed/ perforated appendix, results in phlegmonous appendicitis or focal abscess.
Spontaneous resolving stage: If the obstruction of the appendiceal lumen is relieved, acute appendicitis may resolve spontaneously (i.e when a fecalith is expelled from the lumen).
Recurrent stage: Patient underwent similar occurrences of RLQ pain at different times that, after appendectomy, were histopathologically proven to be the result of an inflamed appendix.
Chronic stage: (1) Patient has a history of RLQ pain of at least 3 weeks’ duration without an alternative diagnosis; (2) after appendectomy, the patient experiences complete relief of symptoms; (3) histopathologically, the symptoms were proven to be the result of chronic active inflammation of the appendiceal wall or fibrosis of the appendix.
caused by: blockage in the lining of the appendix due to virus, bacteria, or parasite in the digestive tract
other blockage causes: stools. fecaliths, foods (i.e unchewed fruit seeds), parasites, tumors, or overgrowth of white blood
Once infected, bacteria can spread and multiply rapidly which results in the appendix becoming inflamed, swollen, and filled with pus
Mucus builds up in the appendix as a result of the blockage, causing the appendix to swell, ischemia begins to occur, leading to death of appendiceal tissues. As appendiceal tissues die, infection starts to occur.
Patient Education
resting when tired
walk a bit every day but should avoid any strenuous activity such as lifting
eating a regular diet (avoiding foods that will cause their stomach to become upset)
drinking plenty of fluids (increasing fluid intake)
only taking medications if prescribed to them by the doctor
postoperative care (keeping the surgical wounds clean and dry, being extra careful when cleansing the wound areas (done within one or two days after surgery, or as directed by the doctor), pat drying the area
If patient underwent laparoscopy, avoid and limit strenuous activity for three to five days
If patient underwent open appendectomy, strenuous activity should be limited for ten to fourteen days
take medications as prescribed by their primary care physician
antibiotics should be taken for the full term they were prescribed
When coughing, some patients may be advised to support their abdomen when they cough, by placing a pillow over the abdomen and applying pressure before they cough, laugh, or move in order to reduce pain.
Reporting worsening symptoms or conditions or if pain medication is not working to the primary care provider
discussing with doctor when it's appropriate return to work, school, or other daily activities
make an appointment with the surgeon to remove sutures between the fifth and seventh days after surgery
Pertinent Assessment Findings
S/S: sudden pain- originating from umbilicus and moves towards lower right-hand side of the abdomen, pain that starts at lower right-hand side of the abdomen, pain may progress/become more severe over time and excasterbates during movment (coughing, sneezing)
S/S: upset stomach, vomiting, loss of appetite, low-grade fever that may worsen, chills, constipation, abdominal bloating, diarrhea, trouble passing flatus, swollen stomach
tenderness at McBurney's point
Rovsing's sign may be used to diagnose appendicitis
Other diagnostic tools: CBC count (showing an elevated WBC count), imaging studies (CT scan, MRI, x-ray), physical exam, pregnancy test, urine test, laparoscopy, C-reactive protein
Alvarado scale: (five warning signs [abrupt onset of abdominal pain that starts around the belly button and localizes to the right lower quadrant of the abdomen, rebound pain in that same area, nausea, and loss of appetite] add up to a score high enough on the Alvarado scale to move to surgery without the use of other tests/imaging)
Interventions
Open appendectomy
Laparoscopic appendectomy
broad-spectrum antibiotics
pain management: NSAIDs, opioids
Percutaneous drainage procedure if appendix is perforated
Medications
Antibiotics (broad-spectrum)
Penicillin-type drugs with a beta-lactamase inhibitor: Zosyn (piperacillin and tazobactam)
Unasyn (ampicillin-sulbactam)
Cephalosporins: Rocephin (ceftriaxone)
Cefotan (cefotetan)
Carbapenems: Merrem (meropenem)
Invanz (ertapenem)
Aminoglycosides: Gentak (gentamicin)
Nitroimidazoles: Flagyl (metronidazole)
Lincomycins: Cleocin (clindamycin)
NSAIDs/opioids
Opioid: Ultram (tramadol)
NSAID: Diclofenac