Overview
This lecture covers the causes, symptoms, diagnosis, treatment, and complications of appendicitis and peritonitis, with key exam questions for review.
Appendicitis
- Appendicitis is inflammation of the appendix, usually caused by obstruction (e.g., fecalith, tumor, or infection).
- Obstruction leads to inflammation, ischemia (impaired blood flow), and bacterial overgrowth.
- Key symptom: right lower quadrant pain at McBurney's point.
- Other symptoms: rebound tenderness, loss of appetite, nausea, vomiting, and fever.
- Diagnosis: CT scan and elevated white blood cell count.
- Treatment: NPO (nothing by mouth), IV fluids, antibiotics, and appendectomy (removal of appendix).
- Surgical approach is usually laparoscopic unless ruptured; rupture may require open surgery.
- Complications include peritonitis and perforation.
- Sudden relief of pain in appendicitis can indicate appendix rupture (red flag).
Peritonitis
- Peritonitis is inflammation of the peritoneum (membrane around abdominal organs) due to bacterial contamination.
- Causes include trauma, infection, or perforation of organs (e.g., appendix, diverticulitis, peptic ulcer).
- Key symptom: rigid, board-like abdomen.
- Other symptoms: abdominal pain, nausea, vomiting, fever, rebound tenderness, and tachycardia.
- Diagnosis: abdominal x-ray, CT scan, or ultrasound.
- Treatment: NPO, NG tube for stomach decompression, IV fluids, antibiotics, analgesics.
- Surgery and intra-abdominal lavage are needed if caused by a ruptured organ.
- Monitor closely for sepsis, a serious complication of peritonitis.
Key Terms & Definitions
- Appendicitis — inflammation of the appendix.
- Peritonitis — inflammation of the peritoneum.
- McBurney’s point — location in the right lower quadrant of the abdomen, key in diagnosing appendicitis.
- Rebound tenderness — pain when pressure on the abdomen is released.
- NPO — nothing by mouth.
- Fecalith — hard mass of feces causing obstruction.
- Intra-abdominal lavage — washing out the peritoneal cavity.
Action Items / Next Steps
- Review signs, symptoms, and treatments for appendicitis and peritonitis.
- Remember key complications (rupture, sepsis).
- Know the location of McBurney’s point and its clinical importance.
- Complete any assigned medical-surgical nursing readings related to these disorders.