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Acute appendicitis

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Abstract

VOL: 99, ISSUE: 03, PAGE NO: 28

AETIOLOGY AND RISK FACTORS

AETIOLOGY AND RISK FACTORS
- Acute appendicitis can occur at any age, although it is more common in adolescents. When the condition is suspected, prompt action is necessary to avert possibly serious complications.

 

- Acute appendicitis refers to an acute inflammation of the appendix, a narrow sack (referred to as vermiform or ‘worm like’) that is attached to the caecum. The appendix has no known physiological function in humans.

 

- Appendicitis occurs more frequently in males.

 

- The aetiology of the condition is not known. Suspected causes relate to obstruction that leads to a build-up of pressure within the appendix. Such obstruction could be due to a hard mass of faeces or a foreign body.

 

- Appendicitis is the most common form of emergency requiring an operation and there are about 70,000 cases per year in the UK.

 

- In general, the incidence of the condition is falling.

 

SIGNS AND SYMPTOMS
- The patient experiences central abdominal pain near the umbilicus, moving to the right iliac fossa. There the pain becomes more constant.

 

- Movement exacerbates the pain and the patient will tend to lie still for pain relief.

 

- Rovsing’s sign: pain in the right iliac fossa when pressure is applied in the left iliac fossa.

 

- Tachycardia, flushed face and furred tongue.

 

- Anorexia, vomiting and pyrexia.

 

- Dysuria or diarrhoea can occur.

 

- Untreated appendicitis can lead to peritonitis and complications such as intra-abdominal abscess.

 

DIAGNOSIS
- Clinical examination.

 

- Rectal examination.

 

- Diagnostic laparoscopy.

 

TREATMENT AND THERAPIES
- The standard treatment for acute appendicitis is appendicectomy, which can be performed via open or laparoscopic surgery.

 

- Antibiotic therapy postoperation.

 

NURSING IMPLICATIONS
- Fluid balance: the preoperative patient is usually resuscitated with intravenous fluids; the patient may require a nasogastric tube to prevent aspiration.

 

- Wound care: the wound may have been closed with dissolvable sutures or clips.

 

- Observe for postoperative complications such as wound infection and paralytic ileus.

 

- There should be a gradual reintroduction of fluids and diet.

 

- Postoperative recovery can be slower and more complex if peritonitis is present or suspected at the time of surgery.

 

RESEARCH AND DEVELOPMENT
- Laparoscopic and open surgery have been compared for suspected appendicitis.

 

- Research on the use of diagnostic laparoscopy in women with right iliac fossa pain aims to reduce the removal of normal appendices.

 

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