Pathophysiology and Nursing Care for a Patient with Appendicitis and Peritonitis

Running head: MENTAL HEALTH NURSING
Mental health nursing
Name of the student
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Author Note

1MENTAL HEALTH NURSING
Introduction
This essay sheds light on the case study of Anne who is a 10 year old girl and she is has
admitted to the hospital with severe right iliac fossa pain. According to the symptoms, doctors
have suspected that it might be appendicitis. After appendectomy, she was diagnosed again with
peritonitis, which is gangrenous in nature. Due to the infection, she had been receiving the IV
antibiotic treatment. The pathophysiology of the both the diseases are discussed in this essay.
Along with this, the nursing care that should be used to treat Anne had also been highlighted.
The family centered care, effect of hospitalization on the Anne is also highlighted in this essay.
Discussion
Anne was suffering from left iliac fossa pain, which is major sign of the Appendicitis, but
it does not mean that always appendicitis will be diagnosed with this pain. Appendicitis refers to
the inflammation of appendix, which is a finger shaped part of colon, and it is located on the
lower right side of the abdomen. It is suspected that appendix has a role in securing immune
system. The main causative factors for Anne to have appendicitis may be fecalitis, foreign
bodies, lymphoid hyperplasia, and parasites. Fecaliths and fecal stasis are the most common
reason of appendicitis (Petroianu & Barroso, 2016).Another reasons may be obstructions and
may be by the fruit seeds, vegetable matter and intestinal worms like ascarids (Kim, 2013).The
obstruction leads to the inflammation and that results in increased intraluminal pressure and
finally ischemia. As a result, appendix increases in size and causes inflammatory changes in the
tissue of that surrounding area such as peritoneum. Distension of appendix is resulted due to
restricted luminal capacity and increased intraluminal pressure can reach to 50-65 mm hg (Abbas
et al., 2016).This leads to enlargement of cecum that is due to the inflammation. After increased
luminal pressure, the venous pressure is also increased and that leads to mucosal ischemia. When

2MENTAL HEALTH NURSING
the luminal pressure exceeds the value of 85mm hg ,the venous and lymphatic drainages are
altered and causes ischemia to develop (Narci et al.,2013).The bacteria that may involve in
Anne’s disease, are E.coli,Enterococcus, Pseudomonas (Zhong et al.,2014).The obstruction in
appendiceal lumen is a crucial cause of Anne’s gangrenous appendix (Ishizuka, Shimizu,&
Kubota,2013).However the obstruction may be developed due to inflammation. The resulted
inflammation stretches in to the peritoneum, serosa and other nearby organs. This results in the
stimulation of visceral afferent nerve fiber that take entry into the spinal cord at T8-T10 region.
In this case, if the situation is neglected, arterial blood flow is altered and causes infarction. This
infarction results in gangrene and perforation of organ in Anne after the appendectomy. In
appendicitis, the inflammation is supported by the expression of IL-6 and TNF-alpha. The
increased level of TF production and decreased level of tissue factor pathway inhibitor are
responsible for the gangrenous appendicitis. On the other hand, the peritonitis refers to the
inflammated condition of peritoneum due to the medical condition Anne have. In this case study
Anne have diagnosed with peritonitis due to the ruptured appendix. The peritonitis is associated
with the increased amount of tumor necrosis factors, proinflammatory cytokines, IL-1, and
interpheron gamma. In response to an inflammation, the cytokines are produced by the
macrophages (Impellizzeri et al., 2013).In this condition, cytokines are directly transferred to the
intestinal barrier. Another important factor that is associated with the perforated appendicitis is
the increased level of serotonin and it is mainly associated with the inflammation of the tissue.
The release of serotonin causes hike in intraluminal pressure and vasoconstriction and that
ultimately results in inflammation ( de Lambert et al.,2016). Ultimately, it can be concluded that
the blockage in appendicular artery and veins are responsible for the gangrene and perforation of
the organ and ultimately results in peritonitis (Drake et al., 2014).