1. Appendicitis
Mr. ASHOK BISHNOI
Lecturer JINR

2. Anatomy &physiology of appendix:-

3. The appendix is a slender, worm-shaped
pouch, averaging 5-10cm in length, that
protrudes from the top of the colon in the
lower right abdomen.

4. Blood & nerve supply: Blood supply by -Appendix artery from
ileocolic artery.
 Blood return by -Appendix vein -portalal vein
 Nerve supply by -Sympathetic nerve.

5. Definition:“It
is inflammation of the vermiform
appendix”

6. Incidence:-
 Occurs mainly in 10 to 30 year of age.

7. Etiology: Obstruction (accumulated feces in
lumen)
 Tumor
 Foreign bodies
 King-King of appendix (Twisting)
 Swelling of the bowel wall

8. Types of appendicitis:Four type:
1.Acute simple appendicitis
2.Acute purulent appendicitis
3.Perforation and gangrenous
4.Appendiceal abscess

9. 1.Acute simple appendicitis-

10. 2.Acute purulent appendicitis-

11. 3.Perforation and gangrenous-

12. Gangrenous
Perforation

13. 4.Appendiceal abscess-

14. Pathophysiology:Due to etiological factor
Inflammatory process
Increase intra-luminal pressure
Severe pain

15. Clinical manifestation:Subjective sign & symptoms Epigastric pain spread to right lower
quadrant.
 Malaise
 Anorexia
 Vomiting
 Moderate leukocytosis ( leukocyte in blood)
 Rebound tenderness
 Constipation
 Diarrhea

16. Objective sign & symptoms Pain at
McBurney’s point.(between umbilical &
iliac crest)
 Rovsing’s sign: (pain in the right lower quadrant upon
palpation of the left lower quadrant)
 Obturator sign: (pain on internal and external rotation of
the hip)
 Psoas sign : (pain on active elevation of the legs)
 Tachycardia
 Tachypnoea
 Low grad fever

17. Diagnostic evaluation: History
 Physical examination
 WBC count
 Urinalysis
 Abdominal x-ray
 CT Scan
 USG
 pregnancy test (women only)

18. Management: Medical management Bed rest
 NPO
 I/V fluid
 Antibiotic eg.
 Antipyretic
 Antiemetic
 Analgesic
Ampicillin, Sulbactam, Gentamycin

19.  Surgical management Appendectomy
 New method laparoscopy appendectomy

20. Incision McBurney’s
incision

21.  transvers skin
incision

22. Operation Process: Appendix is divided between
clamps and ligated

23. a
b
c

24. Complication:Abdomen abscess
Perforation
Peritonitis
 Infection

25. Nursing management:Pre-operative Pain R/t inflamed appendix.
 Fluid volume deficit R/T vomiting.
Post-operative Risk for infection R/T Perforation.
 Altered nutrition less then body requirement
R/t less intake of food.