Appendicitis Case Study

ANSWERS

The appendix is a small finger-like appendage that attaches to the cecum below the ileocecal valve. In humans, no definite functions can be assigned to it. Because the appendix fills with food and empties as frequently as the cecum, which is small, it is prone to becoming obstructed and is especially vulnerable to infection (appendicitis).

The most common cause of acute inflammation in the right lower quadrant of the abdominal cavity is appendicitis. Appendicitis affects approximately 7% of the population at some point in their lives, with males being affected more than females and teenagers being affected more than adults. It is most common between the ages of 10 and 30.

The disease is more prevalent in countries where people eat a diet high in refined carbohydrates and low in fiber.

Lower quadrant pain is typically accompanied by a low-grade fever, nausea, and, in some cases, vomiting. It is common to experience a loss of appetite. Local tenderness is elicited in up to 50% of presenting cases at Mc Burney’s point, which is located halfway between the umbilicus and the anterior spine of the Ilium.

There may be rebound tenderness (the production or intensification of pain when pressure is released). The degree of tenderness and muscle spasm, as well as the presence of constipation or diarrhea, are determined by the location of the appendix rather than its severity.

Pain and tenderness in the lumbar region may be felt if the appendix curls around behind the cecum. Palpating the left lower quadrant may elicit Rovsing’s sign. If the appendix ruptures, the pain becomes more diffuse, abdominal distention develops due to paralytic ileus, and the patient’s condition deteriorates.

Constipation can also occur due to an acute condition such as appendicitis. In this case, laxative administration may result in perforation of the inflamed appendix. A laxative should never be given to someone with a fever, nausea, or pain.

Digestive System Anatomy and Physiology

The oral cavity, or mouth, is the first part of the digestive tract. It is designed to take in food, break it down into small particles with mastication, and mix it with saliva. The boundaries are formed by the lips, cheeks, and palate. The oral cavity houses the teeth and tongue and receives salivary gland secretions.

Cheeks and Lips

The lips and cheeks help keep food in the mouth while chewing. They are also used in the formation of spoken words. The lips have many sensory receptors that help us judge the temperature and texture of food.

Palate

The palate is the oral cavity’s roof. It is the membrane that separates the oral cavity from the nasal cavity. Bone supports the anterior portion, known as the hard palate. The soft palate comprises skeletal muscle and connective tissue in the back. The soft palate terminates posteriorly in a projection known as the uvula. The soft palate and uvula move upward during swallowing to direct food away from the nasal cavity and into the oropharynx.

Tongue

The tongue is used in speech and to manipulate food in the mouth. The surface is covered with papillae, which provide friction and keep the taste buds in place.

Teeth

There are 20 teeth in a complete set of deciduous (primary) teeth. A complete permanent (secondary) set has 32 teeth. Each tooth type’s shape corresponds to how it handles food.

Pharynx

The pharynx is a fibromuscular passageway that connects the nasal and oral cavities to the esophagus and larynx. It functions as a channel for air and food in the respiratory and digestive systems. The nasopharynx, or upper region, is posterior to the nasal cavity. It contains the pharyngeal tonsils or adenoids, serves as an air passageway, and has no digestive function. The oropharynx is the middle region posterior to the oral cavity. When food is swallowed, it enters this region first. The fauces are the openings from the oral cavity into the oropharynx. The palatine tonsils are masses of lymphoid tissue located near the fauces. The laryngopharynx, or hypopharynx, is the lower region posterior to the larynx. The laryngopharynx connects the esophagus to the larynx.

Esophagus

The esophagus is a collapsible muscular tube that connects the pharynx to the stomach. It is posterior to the trachea and anterior to the vertebral column as it descends. It empties into the stomach after passing through an opening in the diaphragm known as the esophageal hiatus. The mucosa contains glands that secrete mucus to keep the lining moist and lubricated to facilitate food passage. The upper and lower esophageal sphincters control the movement of food into and out of the esophagus. The lower esophageal sphincter, also known as the cardiac sphincter, is located at the esophagogastric junction.

Stomach

The stomach is located in the upper left quadrant of the abdomen and receives food from the esophagus. The stomach is divided into four sections: the fundic, cardiac, body, and pyloric. The smaller and larger curvatures are on the right and left sides of the stomach, respectively.

The Small Intestine

From the pyloric sphincter to the ileocecal valve, the small intestine empties into the large intestine. The small intestine completes digestion, absorbs nutrients, and passes the residue to the large intestine. The liver, gallbladder, and pancreas are digestive system accessory organs that work closely with the small intestine. The small intestine is divided into three sections: the duodenum, the jejunum, and the ileum. The small intestine has a mucosa with simple columnar epithelium, submucosa, smooth muscle with inner circular and outer longitudinal layers, and serosa, similar to the rest of the digestive tract. The small intestine’s porous surface area is increased by plicae circulares, villi, and microvilli. Mucus, peptidase, sucrase, maltase, lactase, lipase, and enterokinase are all secreted by exocrine cells in the mucosa of the small intestine. Cholecystokinin and secretin are secreted by endocrine cells. The presence of chyme is the most crucial factor in regulating secretions in the small intestine. This is primarily a local reflex action in response to chemical and mechanical irritation from the chyme and intestinal wall distention. Because this is a direct reflex action, the more chyme there is, the more secretion there is.

The Large Intestine

The large intestine is wider than the small intestine. It runs from the ileocecal junction (where the ileum enters the large intestine) to the anus. The colon, rectum, and anal canal make up the large intestine. The large intestine wall contains the same tissue found in other parts of the digestive tract, but some differences exist. The mucosa contains a large number of goblet cells but no villi. Although present, the longitudinal muscle layer is incomplete. The longitudinal muscle comprises three distinct bands known as teniae coli that run the colon length. Contraction of the teniae coli causes pressure on the wall and the formation of a series of pouches known as haustra along the colon. Epiploic appendages are fat-filled connective tissue pieces attached to the colon’s outer surface. Unlike the small intestine, the large intestine does not produce digestive enzymes. Before the chyme reaches the large intestine, it undergoes chemical digestion in the small intestine. The large intestine’s functions include water and electrolyte absorption and feces elimination.

Anus and Rectum

The rectum is a thick muscular layer that extends from the sigmoid colon to the anal canal. It curves around the sacrum and is firmly attached to it by connective tissue. The rectum ends about 5 cm below the coccyx tip at the start of the anal canal. The anal canal is the last 2 to 3 cm of the digestive tract, continuing from the rectum and opening to the outside at the anus. The rectum mucosa is folded to form longitudinal anal columns. The smooth muscle layer is thick and forms the internal anal sphincter at the anal canal’s superior end. This sphincter is controlled involuntarily. At the low end of the anal canal, there is an external anal sphincter. This sphincter is made of skeletal muscle and is governed by the user.

Clinical Significance

Abdominal pain, either generalized or localized, in the epigastric or periumbilical areas and the upper right abdomen. Within 2 to 12 hours, the pain settles in the right lower quadrant and becomes more intense.

Anorexia, moderate malaise, mild fever, nausea, and vomiting are all symptoms.

Constipation is more common than diarrhea.

Tenderness in the limbs, involuntary guarding, and generalized abdominal rigidity

Diagnostic Testing

Clinical manifestations are supported by physical examination.

WBC count reveals moderate leukocytosis (10,000 to 16,000/mm3) with left shift (increased immature neutrophils).

Urinalysis eliminates urinary disorders.

An abdominal x-ray may show a shadow consistent with a fecalith in the appendix; perforation will show free air.

A CT scan or abdominal ultrasound can visualize the appendix and rule out other conditions, such as diverticulitis and Crohn’s disease. Appendicitis can be diagnosed quickly with focused appendiceal CT.

• Medications
• Analgesics
• Replacement of intravenous fluids
• Analgesics
• Treatment
• If peritonitis develops, appendectomy is the most effective treatment.
• gastrointestinal intubation
• Parenteral fluid and electrolyte replacement
• Antibiotic Administration

If appendicitis is diagnosed, surgery is recommended. Until surgery, antibiotics and IV fluids are administered. Following the diagnosis, analgesics can be issued.

To reduce the risk of perforation, an appendectomy (surgical removal of the appendix) is performed as soon as possible. The appendectomy can be performed under (general or spinal anesthesia) with small abdominal incisions or by (laparoscopy), a newer and more effective method.

Complications

The most severe complication of appendicitis is perforation, which can result in peritonitis, abscess formation (collection of purulent material), or portal pylephlebitis, septic thrombosis of the portal vein caused by vegetative emboli arising from septic intestines.

Perforation usually occurs within 24 hours of the onset of pain symptoms, which include a fever of 37.7 degrees Celsius or 100 degrees Fahrenheit or higher, a toxic appearance, and continued abdominal pain or tenderness.

Interventions in Nursing

Monitor for signs and symptoms of deterioration, such as perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia).

Notify your doctor immediately if your pain suddenly stops; this indicates a perforation or a medical emergency.

Assist the patient in finding a comfortable position, such as semi-fowlers with knees flexed.

Coughing and ambulation are two activities that can aggravate pain.

For relief, place an ice bag on your abdomen.

To avoid aggravating the patient’s discomfort, avoid indiscriminate palpation of the abdomen.

Once the diagnosis is established, prepare the patient for surgery as soon as possible.

Explain to the report the signs and symptoms of postoperative complications, such as elevated temperature, nausea, vomiting, or abdominal distention, which could indicate infection.

Instruct the patient on how to turn, cough, or breathe deeply, how to use an incentive spirometer, and how to ambulate. Discuss the purpose of these maneuvers and their continued importance during recovery.

Teach incision care and the importance of not doing heavy lifting or driving until the surgeon says so.

Avoid enemas or harsh laxatives; instead, increase fluid intake and use stool softeners to treat postoperative constipation.

Planning for Discharge

M Infection-fighting antibiotics

Analgesics (morphine) can be given to relieve pain after surgery.

E You can get up and move around within 12 hours of surgery.

After laparoscopic surgery, you can usually resume your normal activities in 2-3 weeks.

T Pretreatment of foods with lactase preparations (e.g., Lactaid drops) before consumption can help to alleviate symptoms.

Lactase enzyme tablets taken with the first bite of food can help to alleviate symptoms.

H To care for the wound, perform dressing changes and irrigations as directed. Avoid taking laxatives or applying heat to the abdomen if you have abdominal pain of unknown origin.

Reiterate the importance of a follow-up appointment with the surgeon.

In case of increased pain at the incision site, contact your doctor.

O Record bowel sounds and the passage of flatus or bowel movements (these are signs of the return of peristalsis)

Keep an eye out for surgical complications such as persistent pain or fever, which could indicate an abscess or wound dehiscence.

Between the fifth and seventh days, the stitches were removed (usually in the physician’s office)

D Liquid or soft diet until the infection clears up.

Soft diets are low in fiber and easily broken down in the digestive tract.

QUESTION

Appendicitis Case Study

Please provide complete, thorough, and detailed answers to all questions in the case study. Multiple choice answers should include the correct choice and rationale for that choice and/or rationale why other choices are incorrect.