Appendicitis
The most common disease requiring major surgery, appendicitis is an inflammation of the vermiform appendix, a small, fingerlike projection attached to the cecum just below the ileocecal valve. Although the appendix has no known function, it does regularly fill and empty itself of food. Appendicitis occurs when the appendix becomes inflamed from ulceration of the mucosa or obstruction of the lumen.
Appendicitis may occur at any age and affects both sexes equally; however, between puberty and age 25, it’s more prevalent in males. Since the advent of antibiotics, the incidence and mortality of appendicitis have declined. If untreated, this disease is invariably fatal.
Causes
Appendicitis probably results from an obstruction of the appendiceal lumen, caused by a fecal mass, stricture, barium ingestion, or viral infection. This obstruction sets off an inflammatory process that can lead to infection, thrombosis, necrosis, and perforation.
Complications
The most common and perilous complication of appendicitis occurs when the appendix ruptures or perforates. When this happens, the infected contents spill into the abdominal cavity, causing peritonitis. Other complications include appendiceal abscess and pyelophlebitis.
Assessment
During the initial phase of appendicitis, the patient typically complains of abdominal pain. Pain may be generalized but, within a few hours, becomes localized in the right lower abdomen (McBurney’s point). He may also report anorexia, nausea, and one or two episodes of vomiting. Later signs and symptoms include malaise, constipation, or diarrhea (rare). He may have a low-grade fever.
Pediatric pointerIn assessing a child for appendicitis, remember that the pain initially may be periumbilical, then move to the lower right quadrant. A child with an unperforated appendix may have only a slight temperature elevation. If the appendix perforates, the temperature rises dramatically.
Inspection typically shows a patient who walks bent over to reduce right lower quadrant pain. When sleeping or lying supine, he may keep his right knee bent in an upward position to decrease pain.
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