APPENDICITIS

Kerry D. Christy

Overview

Acute appendicitis is one of the primary causes of abdominal pain in children and a leading contributor to the emergency department visits worldwide. A thorough assessment and examination must be conducted to distinguish appendicitis from other diseases that could cause acute abdominal pain. Once identified, attentive monitoring for potential complications preoperatively and postoperatively will ensure patient safety.

Background

Butler (2015) defines acute appendicitis as the inflammation of the appendix, which is a blind-ending pouch that arises where the small and large intestine meet (cecum). Although appendicitis has been treated for more than 300 years, the cause is still not entirely known (Rentea, St. Peter, & Snyder, 2016). In most cases, it is presumed that luminal obstruction by stool may incite the process; alternatively, a neoplasm, parasite, or lymphocyte proliferation may induce the appendix to swell (Rentea et al., 2016). The obstruction leads to inflammation and decreased blood flow to the appendix with subsequent bacterial overgrowth (Brown, 2014). This progression generates an inflammatory exudate on the surface of the appendix, which locally irritates the perineum (peritonitis) causing symptoms classic to appendicitis (Butler, 2015). Appendicitis can be described in three categories: simple acute appendicitis, gangrenous appendicitis, or complicated perforated appendicitis. Acute appendicitis is the inflammation of the appendix while gangrene suggests a microscopic perforation or discoloration of the appendix (Pennington & Burke, 2015). Appendiceal perforation is described by Butler (2015) as having generalized peritonitis and formation of an abscess or phlegmon.

The lifetime risk of getting appendicitis in the Western world is about 7% (Pennington & Burke, 2015). The U.S. incidence is one per 1,000 (Rentea et al., 2016), but geographical differences have been reported (Bhangu, Søreide, Di Saverio, Assarsson, & Drake, 2015). The incidence of acute appendicitis typically peaks in the summer months. It most often occurs between the ages of 10 and 19 years, and males have a slightly higher prevalence (Bhangu et al., 2015). It has been found that up to 40% of children who present with appendicitis have perforated appendix (Tian, Heiss, Wulkan, & Raval, 2015). Children are often unable to specify their symptoms or location of pain when it occurs, delaying the evaluation and allowing time for perforation to occur. Fortunately, overall mortality with appendicitis is low in the United States and only slightly higher in low- and middle-income countries (Bhangu et al., 2015). The key to treating 14appendicitis is to have an accurate assessment and timely intervention. This is how nursing plays a large role in the management of appendicitis.

Clinical Aspects

ASSESSMENT

Nurses are most often the first line of evaluation both preoperatively and postoperatively, so knowing the pertinent symptoms, risk factors, and complications of appendicitis are key for a positive outcome. Beginning with a thorough primary assessment in triage and asking the relevant questions to both the patient and his or her caregiver leads to an accurate diagnosis. The assessment of symptoms, including timing and location, as well as nausea, vomiting, anorexia, diarrhea or constipation, fevers, chills, or sepsis is critical. A hallmark symptom of appendicitis is the gradual onset of diffuse abdominal pain most often starting around the umbilicus (Bishop & Carter, 2013

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