Pathophysiology:Acute appendicitis is the inflammation of the appendix and is a common disease seen throughout the world each year. Acute appendicitis usually results from the obstruction of the lumen with either a foreign body, stool, or a tumor (Huether & Mccance, 2016). This obstruction of the lumen causes vascular congestion and edema which results in the inflammation of the appendix (Huether & Mccance, 2016).
The obstruction in the lumen and the inflammation of the appendix causes increased intraluminal pressure which eventually results in ischemia of the appendix. The inflammation and necrosis of the appendix puts the appendix at an increased risk for perforation which can cause a life-threatening complication called peritonitis (Schub & Kornusky, 2017).Epidemiology:• 7 to 10 per 10,000 persons per year;• Lifetime risk of appendicitis 7%;• Can occur at any age even neonates but it is most common between 10 and 19 years old (Huether & Mccance, 2016).• Usually in Caucasians (74%) versus uncommon in African Americans (5%);• Controversy over findings of increase rates of appendicitis during summer months;• Most common abdominal surgery each year in United States;• Equal affects men and women (Schub & Kornusky, 2017)Risk Factors:• High fiber diet;• Decreased bowel transit time;• Decreased fecal viscosity;• Some familial predisposition (Schub & Kornusky, 2017).According to Schub & Kornusky (2017), the clinical manifestations of appendicitis include but are not limited to:• Gastric or periumbilical pain• RLQ abdominal pain• Rebound tenderness• Tenderness at McBurney’s point• Guarding upon abdominal examination• Abdominal spasms• Nausea• Vomiting• Anorexia• Low grade fever• Chills• Diarrhea (children mostly) or constipationAccording to Schub ; Kornusky (2017), the screening and diagnostic tests used for acute appendicitis include:• CBC (usually will show leukocytosis in acute appendicitis)• CMP• C reactive protein• Urinalysis• Abdominal x-ray• Abdominal ultrasound• CT scan of abdomen• MRI of abdomen for children or if the patient is pregnant • Alvarado ScoreComplications:• Perforation- Perforation or rupture of the appendix occurs due to the increase intraluminal pressure. This pressure leads to inflammation and necrosis of the appendix which causes the appendix to rupture (Huether ; Mccance, 2016).
Perforation of the appendix causes contents of the appendix to enter into the abdomen. Increased risk for perforation of the appendix directly relates to symptom onset and the time to surgery (Synder, Guthrie, ; Cagle, 2018).• Periappendicular abscess- Abscess formation from appendicitis is rare but is seen in acute appendicitis when there is a rupture in the appendix (Schub ; Kornusky, 2017). The rupture of the appendix results in bacteria in the abdomen. The bacteria and the inflammation in the abdominal cavity results in the formation of the abscess (Huether ; Mccance, 2016). • Peritonitis- Peritonitis is the inflammation of the peritoneum and can result from a perforated appendix.
The inflammation of the peritoneum is caused by the bacteria that is released from the ruptured appendix (Synder, Guthrie, ; Cagle, 2018).• Sepsis- Sepsis is seen in acute appendicitis when there is a ruptured appendix and peritonitis. Sepsis is caused by the gram-negative bacteria that is released into the abdominal cavity from the perforated appendix (Huether ; Mccance, 2016).