Appendicitis and Peritonitis

Appendicitis is inflammation or infection of the appendix.

The appendix is a small structure attached to the cecum of the large intestine.

Its true function is uncertain, although some believe it may have an immune role.

 Appendicitis usually occurs when the lumen of the appendix becomes obstructed by stool, a foreign body, tumor, bacteria, or enlarged lymph tissue.

Once blocked, the appendix becomes engorged with fluid, blood, mucus, and bacteria.

Internal pressure rises, blood flow is impaired, pain develops, and the appendix can eventually form an abscess or perforate.

Appendicitis is common in young adults and often occurs between ages 5 and 45.

 The classic symptom pattern begins with dull periumbilical pain that later localizes to the right lower quadrant at McBurney’s point.

McBurney’s point is halfway between the umbilicus and the right iliac crest.

The client may also have anorexia, nausea, vomiting, rebound tenderness, guarding, and worsened pain with coughing, sneezing, or deep breathing.

The client often prefers to lie still with the right leg flexed.

A low-grade fever may occur, but a fever over 101°F suggests possible perforation or peritonitis.

One very important warning sign is that sudden relief of pain may indicate rupture, not improvement, because the pressure in the appendix has been released.

Diagnosis includes history, physical exam, abdominal palpation, CBC with differential, imaging such as CT, ultrasound, or MRI, and urinalysis to rule out urinary or pelvic causes.

White blood cells and neutrophils are often elevated, but normal WBC does not fully rule appendicitis out.

Clients are kept NPO in case surgery is needed.

Treatment includes pain control, but opioids may be used carefully so symptoms are not masked too early.

Ice may be applied to the right lower quadrant because cold decreases blood flow and inflammation.

Heating pads, laxatives, and enemas are avoided because they can increase the risk of rupture.

Definitive treatment is usually emergent appendectomy.

Laparoscopic surgery is common if rupture has not occurred.

If rupture has occurred, open surgery may be needed, and the client may require antibiotics, IV fluids, and a longer hospital stay.

Peritonitis is a life-threatening inflammation and infection of the visceral and parietal peritoneum and the endothelial lining of the abdominal cavity.

It occurs when bacteria or GI contents contaminate the sterile peritoneal cavity.

Peritonitis can result from a perforated appendix, diverticulitis, peptic ulcer, gallbladder rupture, bowel obstruction, or severe gastritis-related ulcer perforation.

Classic signs and symptoms of peritonitis include a rigid, board-like abdomen, abdominal pain, tenderness, distention, nausea, vomiting, diminished to absent bowel sounds, rebound tenderness, high fever, and tachycardia.

The board-like abdomen is the classic hallmark finding.

Peritonitis is a major cause of death from surgical infections, so the nurse must recognize it quickly.

Postoperative care after appendectomy includes ABC assessment, pain management, incision care, and monitoring for signs of peritonitis, especially if the appendix was perforated.

The nurse monitors bowel sounds, nausea, vomiting, fever, abdominal rigidity, tenderness, and tachycardia.

Early ambulation is encouraged after surgery to promote peristalsis, and diet is advanced based on tolerance, bowel sounds, passage of flatus, and absence of nausea or vomiting.