Appendicitis

Definition

Appendicitis is inflammation of the vermiform appendix, usually due to obstruction by fecalith, lymphoid hyperplasia, or tumor. Untreated, it progresses to gangrene, perforation, and peritonitis within 24 to 72 hours.

Classic Signs

• Periumbilical pain migrating to right lower quadrant (McBurney's point)
• Rebound tenderness at McBurney's point
• Rovsing's sign (RLQ pain on LLQ palpation)
• Psoas sign, obturator sign
• Low-grade fever, nausea, anorexia
• Leukocytosis with left shift

Red Flag: Sudden Pain Relief

A sudden decrease in pain may signal perforation. Assess for rigid abdomen, high fever, hypotension, and tachycardia. Signs of peritonitis requiring emergent surgery and broad-spectrum antibiotics.

Nursing Interventions

Keep the patient NPO, administer IV fluids and antibiotics, avoid heat application or enemas (may cause rupture), and prepare for laparoscopic or open appendectomy. Post-op: monitor for infection, early ambulation, pain control, and progression of diet.

NCLEX Relevance

Pain at McBurney's point is the classic cue. Avoid heat, laxatives, and enemas preoperatively.