Appendicitis

Definition

Appendicitis is a condition in which the infection occurs in the appendix. In mild cases may recover without treatment, but many cases require laparotomy with removal of the infected appendix.

Classification

Classification of appendicitis is divided into 2 namely:
Acute appendicitis, were divided into:
Acute appendicitis fokalis or segmentalis, which will occur after the recovery of local stricture. Purulenta Appendisitis diffusion, which is already stacked pus.
Chronic appendicitis, divided up: Appendicitis chronic fokalis or partial, recovery will occur after the local stricture. Chronic appendicitis appendix obliteritiva the side, usually found in old age.
Anatomy and Physiology of the Appendix is a small organ and vestigial (an organ that does not work) which is attached a third finger.

Location of the appendix.

Appendix at the end of the sacrum is located approximately 2 cm below the anterior ileo saekum, tributaries of the posterior and medial part of saekum. At the third meeting of the taenia: taenia anterior, medial and posterior. In appendix clinic located in Mc region. Burney is the 1 / 3 the line connecting the center-right Messiah.

The size and contents of the appendix.

Long appendix average 6 to 9 cm. Width from 0.3 to 0.7 cm. Fill 0.1 cc, the alkaline fluid containing amylase and musin.
The position of the appendix.
Laterosekal: ascending colon laterally. In the inguinal region: turned in the direction of the abdominal wall. Pelvis minor.

Aetiology

The occurrence of acute appendicitis is generally caused by bacterial infection. But there are many factors trigger the occurrence of this disease. Including obstruction that occurs in the lumen of the appendix. Obstruction in the lumen of the appendix is usually caused by a heap of hard stools (fekalit), hipeplasia lymphoid tissue, worm diseases, parasites, foreign bodies in the body, the primary cancer and stricture. But the most common cause is obstruction of the appendix lumen fekalit and lymphoid tissue hyperplasia. (Irga, 2007)

Pathophysiology

Appendix terinflamasi and experienced edema as a result of the possibility of folding or blocked by fekolit (hard mass of faeces) or a foreign object. The process of inflammation increased intraluminal pressure, causing upper abdominal pain or a great spread progressively, in a few hours localized in the lower right quadrant of the abdomen. Finally, the appendix which contained pus terinflamasi.
Clinical Manifestation
Appendicitis has a unique combination of symptoms, which consists of: Nausea, vomiting and great pain in the lower right abdomen. Pain may be sudden starts in the upper abdomen or around the navel, and nausea and vomiting. After several hours, the nausea disappeared and the pain moved to the lower right abdomen. If doctors hit this area, the patient felt dull pain and if this pressure is released, the pain may increase sharply. Fever may reach 37,8-38,8 ° Celsius.
In infants and children, the pain is a thorough, in all parts of the stomach. In the parents and pregnant women, the pain is not too heavy and in this area is not too tumpulnya pain felt. If the appendix ruptured, pain and fever can be severe. Worse infection can cause shock. (Anon, Appendicitis, 2007)

Diagnostic tests

To establish the diagnosis of appendicitis based on anamnese coupled with laboratory tests and other investigations.
Symptoms of appendicitis is established with anamnese, there are 4 important things: first pain in epigastrium (visceral pain) that some time later spread to the lower right abdomen. Vomiting due to visceral pain. Heat (because germs that live in the intestinal wall).
Other symptoms are a weak body and loss of appetite, the patient appeared ill, preventing movement, pain in the stomach.

Localization another examination.
If perforation has occurred, the pain will occur in the stomach, but most felt pain in the area Mc point. Burney. If it infiltrates, local infections also occur if the person can withstand pain, and we will feel like a tumor at the point of Mc. Burney.

Test rectal.

In the toucher rectal examination will be palpable lump and the patient felt pain in prolitotomi area.
Leukocytes increased laboratory examination as a physiological response to protect the body against microorganisms that attack.
In acute appendicitis and perforation will occur lekositosis higher. Hb (hemoglobin) appeared normal. Creep rate of blood (LED) to increase the state of appendicitis infiltrates. Routine urine is important to see what there is infection in the kidney. On radiological examination can not help the image for diagnosis of acute appendicitis, except in case of peritonitis, but sometimes can be found in the following picture: There is a fluid level due to air and liquids. Sometimes there fecolit (obstruction). Perforation was found on the state of free air in the diaphragm.

Management

Surgery is indicated when the diagnosis of appendicitis has been established. Antibiotics and IV fluids given to surgery. analgesics can be given after the diagnosis is established. Apendektomi (surgery to remove the appendix) as soon as possible to reduce the risk of perforation.
Apendektomi can be done under general or spinal anesthesia with a lower abdominal incision or by laparoscopy, which is the latest method is very effective. Concept Farm Nursing Before the surgery the client needs to be prepared physically and psychologically, besides that the client also needs to be given the knowledge of the events that will be experienced after surgery and given physical exercises (deep breathing, leg movement and sitting) for use in post operative period. This is important because many clients feel anxious or worried when will the surgery and anesthesia as well against acceptance.