Appendicitis Case Study: Pathophysiology, Growth and Development Theories, and Family Centred Care

Running head: APPENDICITIS CASE STUDY
Appendicitis case study
Name of the student:
Name of the university:
Author note:

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APPENDICITIS CASE STUDY
Introduction:
For a minor patient with adverse health complications, the care planning and
implementation is required to be holistic, taking into consideration the emotional and
psychological needs of the patient along with the growth and development oriented aspects, as
the disease process can significantly affect the growth and developmental pace as well (Regan,
Curtin & Vorderer, 2017). Furthermore, the impact of the disease and subsequent hospitalization
is extreme on the psychological wellbeing status of the patient and their family members. Hence
the care plan made for the patient should also incorporate family centred care principles to
ensure adequate interventions provided. This nursing case study will attempt to discuss the case
of Anne, who had been admitted to the emergency department (ED) of the facility with acute
gangrenous appendicitis with peritonitis, the pathophysiology of the disease process, the growth
and development oriented care planning and family centred interventions applicable to her case
study.
Pathophysiology:
Exploring the pathophysiology of the appendicitis (Alvarado, 2018). The most plausible
etiological pathway leading to inflammation of the appendix is due to the luminal obstruction.
Which leads to restricting the blood flow in the surrounding region completely, paving way for
bacterial overgrowth in the blocked region which distends the lumen and enhances the
intraluminal pressure causing lymphatic and venous obstruction and oedema and the resultant
inflammatory response (Bhangu et al., 2015). These series of events leads to necrosis of the
appendiceal wall and spills the bacterial mass into the peritoneal cavity giving rise to the
gangrenous perforated appendix. The lack of adequate and immediate interventions led to

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APPENDICITIS CASE STUDY
infection of the peritoneal cavity and the serosal membrane became infected leading to
peritonitis.
Cellular level
Approximately 95% of serotonin is found in the gastrointestinal tract, located primarily in
neuroendocrine cells. A rapid increase in serotonin secretion in the appendix plays a significant
function in the pathogenesis of inflammation. Once the blockage occurs, secretions released by
the epithelial mucosa cause an elevated luminal pressure. Pressure receptors found in the
enterochromafin cells upon detecting luminal pressure, they secrete 5-HT into the lamina
propria. This release worsens smooth muscle contraction, vasoconstriction and venous
engorgement. There is also an increase in vasoactive intestinal polypeptide and substance P in
the appendix which is the leading cause of pain on the right iliac fossa (Escolino et al., 2018).
During inflammation, white blood cell count rises rapidly with the advancement of appendicitis.
The leucocyte migrate from the peripheral circulation to the appendix to fight infection.
Organ level
Rapid increase in size ensues because of its little lumen capacity. The intraluminal pressure
can attain 50 to 65 mm Hg. The cecum enlarges due to this appendicle condition. The cecal
collection is stored and is not carried on to the right colon. An increase in luminal pressure leads
to increase in venous pressure resulting to mucosal ischemia. Venules that empty blood to the
appendix undergo thrombosis leading to the damage of the lymphatic and venous drainage. Due
to mucosal hypoxia, ulceration begins causing damage of the mucosal barrier. This leads to
invasion intraluminal bacteria such as Escherichia coli in the appendiceal wall.
Systemic level