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a.bookbased
i.SchematicDiagram
ModifiableFactors: NonModifiablefactors:
NutritionalIntake Age
(lessintakeofhigh Sex
Fiberfoods) Classic history for appendicitis
Obstruction oftheappendix
(By fecalith,lymph node,tumor,foreign objects)
Mucosa of the appendix secretes
Distention of the appendix pain
Increased intraluminal pressure
Decreased venous drainage

2. 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.Synthesisof 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 theoryfor 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;

3. however, it usually is confined to a small area surrounding the appendix (forming a peri-
appendiceal 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 elderlypatients 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:maleto femaleratio is approximately2:1
• Age: appendicitis occurs in all age groups (children 2 years of age or younger
andpeople70yearsofageorolder areathigherrisk forarupturedappendix)
•Classichistoryfor appendicitis-patientswithaclassic historyfor appendicitisrequireprompt
surgicallconsultation.
•Anatomical variationsin thepositioningoftheappendix.
Precipitating Factors:
•Diet deficient in fiber
3. SignandSymptoms
Nausea or vomiting
Elevated temperature
Loss of appetite
Constipation
Abdominal swelling

4. b.clientbased
i.SchematicDiagram
ModifiableFactors: NonModifiablefactors:
NutritionalIntake Age
(lessintakeofhigh Sex
Fiberfoods) classichistoryforappendicits
Obstruction oftheappendix
(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.Synthesisof the disease
1. Definition

5. 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 theoryfor 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 peri-
appendiceal 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 elderlypatients 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:maleto femaleratio is approximately2:1
• Age: appendicitis occurs in all age groups (children 2 years of age or younger
andpeople70yearsofageorolder areathigherrisk forarupturedappendix)
•Classichistoryfor appendicitis-patientswithaclassic historyfor appendicitisrequireprompt
surgicallconsultation.
•Anatomical variationsin thepositioningoftheappendix.

6. Precipitating Factors:
•Diet deficient in fiber
3. Signs and symptoms
Nausea or vomiting
Elevated temperature
Loss of appetite
Constipation
Abdominal swelling
The pathophysiologyofappendicitisistheconstellationofprocessthatleadstotheDevelopmentOf acute appendicitis
froma normal appendix.The manthrustof
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 compromisedblood supplydue toobstructionof itslumen andbecomingveryvulnerable
toinasionbybacteriafoundingutnormally.Obstructionof the appendix lumenbyfecalth,enlarge lymphrode,
wormstumor,orindeedforeignobjects,bringsaboutaraisedintra-luminalpressure,w/cCausethe wall of the
appendix tobecome distended.Normal mucussecrationscon-w/inthe lumenof the appendix,thus
causingfurtherbuildupof intralumenalpressures.Thisinturnleadstothe ocelusionof the lymphatic
channels,thenthevariousreturn,andfinallythe arterial supplybecomeundermined.Reduce
bloodsupplytowall of appendix getslittleornonutrionandO2. H alsomeans a lil or nosupplyandother
natural fightersof infectionfound inthe blood beingmodeavailabletothe appendix within36hours
fromthe pointof luminal obstruction,worseningthe processof a appendiatis.Thisleadsto necrosisand
perforationof theappendixpusformationoccurswhennearbywbc are requitedto fight
the bacterialinvation.A combinationof deal wbcbacterial .anddeadtissue makesuppus.Thecontent
of the appendix (fecalith,pusandmacussee) are thenreleasedintothe gen.abdominal cavity,brining

7. causingperitonitis.Soinacute appendicitis,bacterialcolonizationfolousonlywhentheprocesshave
commended.These eventsoccursorapidly,thatthe complete pathoof appendicitistakesaboutone to
three days.Thisis whydelaycanbe deadly.Paininappendicitisisthus caused,initiallybythe distention
of the wall of the appendix.
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