a. book based i.

Schematic Diagram Modifiable Factors: Nutritional Intake (less intake of high Fiber foods) Non Modifiable factors: Age Sex
Classic history for appendicitis

Obstruction of the appendix (By fecalith, lymph node, tumor, foreign objects)

Mucosa of the appendix secretes

Distention of the appendix

pain

Increased intraluminal pressure

Decreased venous drainage

Blood flow and oxygen restriction to the appendix

Bacterial invasion of the blood wall

Necrosis of the appendix Disruption of cell membrane of the appendix Start of inflammatory process

N/V

Elevated temperature Loss of appetite Constipation Abdominal swelling

Inflammation of the appendix

ii. Synthesis of the disease 1. Definition Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, it might be that the lymphatic tissue in the appendix swells and blocks the opening. After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside of the appendix. The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue, for example, inflammation, that lines the wall of the appendix.) If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a periappendiceal abscess). Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the infection and accompanying inflammation do not spread throughout the abdomen. The inflammation, pain and symptoms may disappear. This is particularly true in elderly patients and when antibiotics are used. The patients then may come to the doctor long after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to the scarring that occurs during healing. This lump might raise the suspicion of cancer.

2. Predisposing/ Precipitating factors

Predisposing Factors Sex: male to female ratio is approximately 2:1 Age: appendicitis occurs in all age groups (children 2 years of age or younger andpeople 70 years of age or older are at higher risk for a ruptured appendix)

 Classic history for appendicitis- patients with a classic history for appendicitis require prompt surgical lconsultation. Anatomical variations in the positioning of the appendix.

Precipitating Factors: Diet deficient in fiber

3. Sign and Symptoms Nausea or vomiting Elevated temperature Loss of appetite Constipation Abdominal swelling b. client based i. Schematic Diagram Modifiable Factors: Nutritional Intake (less intake of high Fiber foods) Non Modifiable factors: Age Sex classic history for appendicits

Obstruction of the appendix (By fecalith, lymph node, tumor, foreign objects)

Mucosa of the appendix secretes

Distention of the appendix

pain

Increased intraluminal pressure

Decreased venous drainage

Blood flow and oxygen restriction to the appendix

Bacterial invasion of the blood wall

Necrosis of the appendix

ii. Synthesis of the disease 1. Definition Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, it might be that the lymphatic tissue in the appendix swells and blocks the opening. After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside of the appendix. The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue, for example, inflammation, that lines the wall of the appendix.) If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a periappendiceal abscess). Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the infection and accompanying inflammation do not spread throughout the abdomen. The inflammation, pain and symptoms may disappear. This is

particularly true in elderly patients and when antibiotics are used. The patients then may come to the doctor long after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to the scarring that occurs during healing. This lump might raise the suspicion of cancer. 2. Predisposing/ Precipitating factors

Predisposing Factors Sex: male to female ratio is approximately 2:1 Age: appendicitis occurs in all age groups (children 2 years of age or younger andpeople 70 years of age or older are at higher risk for a ruptured appendix) Classic history for appendicitis- patients with a classic history for appendicitis require prompt surgical lconsultation. Anatomical variations in the positioning of the appendix.

Precipitating Factors: Diet deficient in fiber

3. Signs and symptoms

Nausea or vomiting Elevated temperature Loss of appetite Constipation Abdominal swelling

The pathophysiology of appendicitis is the constellation of process that leads to the Development Of acute appendicitis from a normal appendix. The man thrust of eventsl e a d i n g t o t h e d e v . O f a c u t e a p p e n d i c i t i s l i e s i n n t h e a p p e n d i x d e v e l o p i n g a compromised blood supply due to obstruction of its lumen and becoming veryvulnerable to inasion by bacteria found in gut normally.Obstruction of the appendix lumen by fecalth, enlarge lymph rode, wormstumor, or indeed foreign objects, brings about a raised intra-luminal pressure, w/cCause the wall of the appendix to become distended. Normal mucus secrations con-w/in the lumen of the appendix, thus causing further build up of intralumenalpressures. This in turn leads to the ocelusion of the lymphatic channels, then thevarious return, and finally the arterial supply become undermined. Reduce bloodsupply to wall of appendix gets little or nonutrion and O2. H also means a lil or nosupply and other natural fighters of infection found in the blood being modeavailable to the appendix within 36 hours from the point of luminal obstruction,worsening the process of a appendiatis. This leads to necrosis and perforation of theappendix pus formation occurs when nearby wbc are requited to fight the bacterialinvation. A combination of deal wbc bacterial . and dead tissue makes up pus. Thecontent of the appendix (fecalith,pus and macus see) are then released into the gen.abdominal cavity, brining causing peritonitis. So in acute appendicitis, bacterialcolonization folous only when the process have commended.These events occur so rapidly, that the complete pathoof appendicitis takes aboutone to three days. This is why delay can be deadly. Pain in appendicitis is thus caused, initially by the distention of the wall of the appendix.