APPENDICITIS

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Appendicitis, a prevalent surgical emergency worldwide, poses significant health risks,

particularly in developing countries. Diagnosing appendicitis can be complex due to its
nonspecific signs and symptoms, which often overlap with other conditions. However, advances
in imaging, scoring systems, and treatment options are refining management approaches,
enabling more accurate diagnoses and effective care. This evolution in management is crucial for
reducing morbidity and mortality associated with appendicitis (Dixon & Singh.,2023).

Appendicitis mainly occurs due to the obstruction of the appendiceal lumen, which leads to
inflammation. This obstruction can result from several factors, including appendicoliths, tumors
in the appendix, intestinal parasites, or enlarged lymphatic tissues. These mechanical blockages
contribute to the onset of acute appendicitis. It's essential to recognize that the underlying causes
of these obstructions can differ across age groups, emphasizing the importance of age-specific
considerations in the evaluation and management of appendicitis (Dixon & Singh.,2023).

The appendix naturally harbors both aerobic and anaerobic bacteria, such as Escherichia coli and
Bacteroides spp. When the appendiceal lumen is obstructed by any means, it can lead to bacterial
overgrowth, resulting in acute inflammation and abscess formation. Recent studies using next-
generation sequencing have found that patients with complicated perforated appendicitis have a
significantly higher load of bacterial phyla compared to those with uncomplicated appendicitis.
This indicates that the severity and complications of appendicitis may be linked to a greater
abundance of certain bacterial species (Bhangu et al., 2015).

In children, acute appendicitis is primarily caused by lymphoid hyperplasia, which is the

excessive growth of lymphoid tissue in the appendix. This overgrowth results in inflammation
and localized ischemia, raising the risk of appendiceal perforation, the development of contained
peri appendiceal abscesses, and subsequent peritonitis. Reactive lymphoid hyperplasia is often
misdiagnosed as one of the causes of appendicitis (Ucar et al., 2022)
The vermiform appendix is a small, blind-ended tube that protrudes from the caecum, a pouch-
like structure in the large intestine. It has a similar structure to the surrounding bowel, with a
layer of peritoneum, muscle, and mucous membrane containing goblet cells that secrete mucus.
A notable feature of the appendix is the presence of lymphoid tissue, which can become inflamed
in response to infection. The base of the appendix is consistently located at the convergence of
the taenia coli, but the rest of the appendix can vary in position, sometimes extending into the
pelvis or lying behind the caecum or ileum. The appendix typically measures between 7-10 cm in
length, although it can be up to 26 cm long. Its blood supply comes from the appendicular artery,
a branch of the ileocolic artery, which is itself a branch of the superior mesenteric artery. During
embryonic development, the appendix forms from the midgut and rotates counterclockwise to its
final position in the right lower abdomen. However, in some cases, intestinal malrotation can
cause the appendix to be located in unusual positions, such as near the gallbladder or even in the
left upper quadrant. Rarely, the appendix may be congenitally absent. While once thought to be a
vestigial organ with no function, recent research suggests that the appendix may play a role in
immune modulation and serve as a reservoir for beneficial bacteria. These bacteria can help
repopulate the gut after a diarrheal illness, such as Clostridium difficile infection (Dixon &
Singh.,2023).

Appendicitis, or inflammation of the appendix, typically occurs when the appendix becomes
obstructed, leading to infection and potentially serious complications. If left untreated, the
appendix can swell, leading to local ischemia, necrosis, and potentially life-threatening
perforation, abscess, or peritonitis. Obstruction is most often caused by a calcified fecalith, but it
can also result from hyperplasia of lymphoid tissue (typically due to viral infections), neoplasia,
parasitic infections like worms, or even foreign objects. Chronic obstruction may lead to a
mucin-filled swelling known as a mucoceles of the appendix, which must be removed because of
a slight risk of underlying malignancy. Appendicitis can also develop without any obvious
luminal obstruction, and the reasons for this remain unclear. Possible explanations include
genetic predisposition, environmental factors, and various infectious agents.
1.2 EPIDEMIOLOGY OF THE STUDY

The lifetime risk of developing appendicitis is about 7%, with roughly 35,000 appendectomies
performed annually in the UK. The condition is most common among older children and young
adults, but it can occur at any age, with a male-to-female ratio of 1.4:1. Young children typically
have a wider, funnel-shaped appendix, which lowers the chance of blockage and subsequent
appendicitis. In older adults, the lumen often becomes narrowed, leading to a similar effect.

Appendicitis is a worldwide issue, but its incidence varies significantly by country, with newly
industrialized nations seeing an increase. It is believed that low dietary fiber intake may
predispose individuals to appendicitis, potentially explaining the higher rates observed in
Western countries. Additionally, global incidence tends to be lower in winter compared to
summer, although the reasons for this are not well understood (Ferris et al., 2017).

In developed countries, the mortality rate from acute appendicitis is low, at 0.3%. However, this
rate increases significantly to 1.7% if perforation occurs, and can rise to as high as 5% in cases of
generalized peritonitis. This highlights the critical importance of early diagnosis and treatment
(D’Souza., 2011).

Appendicitis is a prevalent surgical emergency in Nigeria, affecting an estimated 22.1 to 49.8

individuals per 100,000 people annually (Alatise and Ogunweide, 2008)

A study conducted at Olabisi Onabanjo University Teaching Hospital in Ogun State revealed key
demographic and clinical patterns among appendicitis patients. The average age was 24.1 years,
with nearly two-thirds (62.9%) of patients falling between 10 and 30 years old. The gender
distribution showed a slight male predominance, with 54% male and 46% female patients. Most
patients (62.8%) resided in urban areas. Postoperative complications were notable, with pyrexia
(14.2%) and wound infection (10.6%) being the most common issues (Ayoade et al., 2006).
1.3 AIM OF THE STUDY
The aim of this study is to fulfill the requirement for the completion of nursing and midwifery
council of Nigeria mandatory one year internship programme

1.4 OBJECTIVE OF THE STUDY

1. To gain more knowledge about appendicitis

2. To identify the causes, clinical manifestation, pathophysiology, management and
complications of appendicitis.
3. To provide appropriate nursing care for patient and assist in restoring the patient’s health
status to optimal level.
REFERENCE

Ayoade, B. A., Olawoye, O. A., Salami, B. A., & Banjo, A. A. F. (2006). Acute appendicitis in
Olabisi Onabanjo University Teaching Hospital Sagamu, a three year review. Nigerian Journal of
Medical Practice, 9(1), 52-56.

Alatise, O. I., & Ogunweide, T. (2008). Acute Appendicitis: Incidence and Management in
Nigeria. Journal of the Obafemi Awolowo University Medical Students Association (IFEMED),
14(1). doi: 10.4314/ifemed.v14i1.41738

Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern
understanding of pathogenesis, diagnosis, and management. Lancet. 2015 Sep
26;386(10000):1278-1287. [PubMed] [Reference list]

Dixon, F., & Singh, A. (2023). Acute appendicitis. Surgery, 41(7), 418-425. (ISSN 0263-9319,

https://doi.org/10.1016/j.mpsur.2023.02.029.)

Ferris M, Quan S, Kaplan BS, et al. The global incidence of appendicitis: a systematic review of
population-based studies. Ann Surg 2017; 266: 237e41.

D’Souza N. BMJ clinical evidence e appendicitis. BMJ Publishing Group, 2011.

Ucar Karabulut K, Erinanc H, Yonar A, Kisinma A, Ucar Y. Correlation of histological

diagnosis and laboratory findings in distinguishing acute appendicitis and lymphoid
hyperplasia. Ann Surg Treat Res. 2022 Nov;103(5):306-311. [PMC free article]
[PubMed] [Reference list]