Appendicitis is an acute inflammation of the appendix, a small tube-like structure attached to the large intestine. It is a medical emergency because it can quickly progress to rupture and serious infection.
🧬 Pathophysiology (What happens in the body)
Appendicitis usually begins with a blockage of the appendix caused by:
- Hardened stool (fecalith)
- Swollen lymph tissue
- Foreign bodies
- Tumours (rare)
What happens next:
- Mucus builds up inside the appendix
- Pressure increases inside the appendix
- Blood flow is reduced (ischemia)
- Bacteria multiply rapidly
- Inflammation develops
Disease progression:
- Simple inflammation
- Suppurative (pus formation)
- Gangrenous (tissue death)
- Perforation (rupture)
⏱️ Rupture can occur within 24–36 hours
⚠️ Risk Factors
- Most common in adolescents and young adults
- Can occur at any age
- Blockage of appendix lumen is the key trigger
🩺 Clinical Presentation
Early symptom:
- Dull pain around the umbilicus (belly button)
Pain progression:
- Pain shifts to the Right Lower Quadrant (RLQ)
- Localised at McBurney’s point
Other symptoms:
- Nausea
- Vomiting
- Loss of appetite (anorexia)
- Low-grade fever
🔍 Clinical Signs
- Rebound tenderness (pain when pressure is released)
- Rovsing’s sign (RLQ pain when left side is pressed)
-
Pain worsens with:
- Walking
- Coughing
- Movement
🧪 Diagnosis
Imaging:
- CT scan (most accurate and commonly used)
Blood tests:
- Raised white blood cell (WBC) count
Scoring system:
- Alvarado Score (MANTRELS) used to assess likelihood
🏥 Medical & Nursing Management
Definitive treatment:
- Appendectomy (surgical removal of appendix)
- Usually done laparoscopically
Pre-operative care:
- Keep patient NPO (nothing by mouth)
- Avoid laxatives or heat (risk of rupture)
- Apply ice pack to RLQ
- Position with knees bent for comfort
Post-operative care:
- Early mobilisation to prevent blood clots (VTE)
- Monitor for infection
- Administer antibiotics if needed
-
If rupture occurred:
- Wound may be left open
- Requires regular dressing changes
- Healing by secondary intention
⚖️ Common Differential Diagnoses
Appendicitis can be confused with:
- Ovarian cysts
- Kidney stones
- Pelvic inflammatory disease (PID)
- Mesenteric adenitis
📌 Key Takeaway
- Appendicitis is a rapid-onset surgical emergency
- Starts with central abdominal pain → moves to RLQ
- Caused by blockage and inflammation
- Requires urgent surgery to prevent rupture
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