Presented by: J. Karl Pineda Appendicitis Presented by: J. Karl Pineda
Etiology/Pathophysiology Obstruction of the appendiceal lumen is the primary cause of appendicitis. Obstruction of the lumen leads to distention of the appendix due to accumulated intraluminal fluid. Ineffective lymphatic and venous drainage allows bacterial invasion of the appendiceal wall and, in some cases, perforation and spillage of pus into the peritoneal cavity
Mortality/Morbidity/Frequency In the U.S. appendicitis occurs in 7% of the population, with an incidence of 1.1 cases per 1000 people per year Incidence of appendicitis is approximately 1.4 times greater in men than women The overall mortality rate of 0.2-0.8% is attributable to complication of the disease rather than to surgical intervention.
Mortality/Morbidity Mortality rate rises above 20% in patients older than 70 years, primarily because of diagnostic and therapeutic delay. Perforation rate is higher among patients younger than 18 years and patients older than 50 years, possibly because of delays in diagnosis
Clinical Manifestation Light palpation of the abdomen will elicit rebound tenderness Pain on percussion Rigidity Gaurding
Objective Data Vomiting Low grade fever (99-102 F) Elevated WBC count Rebound tenderness A rigid abdomen Decreased or absent bowel sounds
Diagnostic Tests WBC count with differentials CT scan Hypaque contrast studies Ultrasounds labaroscomy
Ct scan
Ultrasound
Medical Management Emergency surgical intervention is the treatment of choice for acute appendicitis
Interventions Bed rest NPO status Comfort measures for pain( medication may mask symptoms) Fluid and electrolyte replacement Vitals are monitored every hour because of the threat of perforation with peritonitis
Intervention Sedatives for pain No heat applied because it may lead to appendix rupturing Patient teaching
Prognosis The rate of cure through surgical interventions is high in patients with appendicitis. The patient’s prognosis is altered if peritonitis complicates this diagnosis