Pathophysiology of Appendicitis: A Case Study of Anne

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PATHOPHYSIOLOGY OF APPENDICITIS
The appendix or the vermiform appendix is situated in the right lower quadrant of the
abdomen arising from the ceacum. An acute inflammation in this vestigial organ of the body is
termed as appendicitis which most commonly results due to the hyperplasia of the lymphoid
sub-mucosal follicles due to dehydration or viral etiology or blockage by a very hard piece of the
stool called as fecalith, leading to a bacterial infection invading the wall of the appendix and the
less common causes may include any foreign body, tumor, worms or other infections. This
obstruction traps the bacteria, which begins to multiply in the lumen of appendix making it
distended. This distended part increases the intra luminal pressure obstructing the venous
drainage of the organ and resulting in congestion and ischemic response. The combined effect
of bacterial infection and blood flow blockage leads to further inflammation which then
proceeds to necrosis resulting in gangrene. The obstruction to perforation progresses in a
period of over 72 hours. This obstruction progressing into appendix perforation is a most
common finding in young children rather than in adults which was noted to occur within 24
hours of onset of symptoms in about 7.7% of the children (Adam et al., 2017). This pathology
presents itself as pain, nausea, vomiting with a low grade fever initially. The visceral nerve
fibers of the appendix are affected with the inflammation prior to the further progression which
then starts involving the somatic sensory fibers of the lining of peritoneum.
Thus, the pain starts as a referred vague pain in the pre umbilical region which gradually shifts
to the lower right abdominal region and the tenderness is then localized at the region of the

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inflamed area. This initial pre umbilical pain is due to the innervations of T10 of the appendix
and with the increase in inflammation in the appendix the formation of exudates result in the
involvement of peritoneal lining which further intensifies the pain and distress. This intense
pain is now more localized and affects the lower abdominal region of right side. With further
progression of inflammation the inflammatory exudates and the bacteria gets released in the
abdominal cavity due to the resultant perforation. This increases the inflammatory process and
leads to peritonitis which can differ in site and extent based on the capacity of adjacent bowel
loops containing the inflammatory fluid. If the contents get contained in a localized area and
form an abscess the symptoms are felt on a specific site where the abscess is present and if the
contents have not been walled off then the fluids travel the peritoneal cavity and a generalized
pain is felt. Thus, this degree of spillage and inflammation determines whether the pain is
localized or diffuse.
EVALUATION OF THE NURSE’S ROLE TO DELIVER DEVELOPMENTALLY
APPROPRIATE NURSING CARE
The symptoms and presentation of Anne’s pain helped in the assessment and diagnosis of the
appendicitis. The severity of the symptoms and possible complications associated alarmed the
emergency surgical appendectomy. Anne was found to have a gangrenous perforated appendix
with peritonitis. Such severe presentation of appendicitis associated with the complications
suggests neglect towards the initial symptoms which may be due to the lack of proper
communication between the children and their working parents and Anne being the eldest