EXEMPLAR APPENDICITIS EXAM
QUESTIONS WITH CORRECT ANSWERS
Perforated Appendicitis: - Answer-Gross perforation and contamination of the peritoneal
cavity.
Etiology: - Answer-Almost always caused by an obstruction in the appendiceal lumen,
this obstruction often caused by a hard mass of feces. Other obstructive causes are
calculus, parasites, edema of lymphoid tissue, tumor, or a foreign body. Continued
secretion of mucus following obstruction increases pressure causing ischemia,
inflammation, cellular death, and ulceration.
Risk Factors: - Answer-Adolescent males at greatest risk! Individuals diet whose low in
fiber or high in carbs can develop feces masses.
Prevention: - Answer-Eat foods high in fiber such as fresh fruits and veggies. Staying
hydrated!
Clinical Manifestations: - Answer--Initial symptoms are continuous, mild, generalized or
upper abdominal pain.
-Over next four hours pain intensifies and localizes in the right lower quadrant.
-Pain is aggravated by moving, walking, or coughing. On palpation, localized and
rebound tenderness are noted at McBurneys point. [Rebound tenderness is a relief of
pain with direct palpation, followed by pain on release of pressure]
-Extension or internal rotation of right hip increases pain.
-Low grade fever, anorexia, nausea, vomiting.
cont... - Answer--Older adults don't show acute pain or local tenderness so the
diagnosis is delayed making the course of acute appendicitis more virulent increasing
the mortality rate.
-Pregnant women may get right lower quadrant pain, periumbilical, or right subcostal
(under rib) pain due to displacement of appendix.
-Perforation is manifested by increased pain & a high fever.
-Chronic appendicitis characterized by chronic abdominal pain and recurrent acute
attacks at intervals of several months or more.
, Peritonitis resulting from appendix rupture with bowel contents leaking into the
abdominal cavity: - Answer-*High fever, acute severe abdominal pain, abdominal
distention, can result in death.
*Removal of the appendix, antibiotics, fluid restoration, maintain VS.
Chronic Appendicitis: - Answer-*Chronic recurrent abdominal pain over several months.
*appendectomy, pain management.
Lifespan & Cultural Considerations: - Answer--Uncommon for children age 4 and under
to have appendicitis, but when they do it progresses to rupture because they can't tell
parents how they feel. Common symptoms would be listlessness, inconsolability,
vomiting, distended abdomen. Its low on the diagnostic priority for kids so the delay in
diagnosis and an increase in rupture, complications, and death in infant population.
-Older adults are likely to present with confusion.
Collaboration: - Answer-Acutely inflamed appendix can perforate within 24 hours, so
rapid diagnosis and treatment are important. Client admitted to the hospital and
intravenous fluids are initiated, oral foods and fluids are withheld until a diagnosis is
confirmed.
Diagnostic Tests: - Answer--Abdominal ultrasound is the most effective test for
diagnosing acute appendicitis.
-Abdominal X-rays, intravenous pyelogram, urinalysis, and pelvic exam, WBC with
differential.
Surgery: - Answer--Appendectomy is the surgical removal of the appendix. Can either
laparoscopic approach (insertion of an endoscope to view abdominal contents) or
laparotomy (surgical opening of the abdomen) is used for appendectomy.
-Laparoscopic advantages are direct visualizations to allow diagnosis without
laparotomy, postop hospitalization is short, postop complications are infrequent,
recovery and resumption of normal activities are rapid.
-Laparotomy used when the appendix has ruptured. Allows removal of contaminations
from the peritoneal cavity by irrigation with NS.
Pharmacologic Therapy: - Answer--Prior to surgery intravenous fluids are given to
restore or maintain vascular volume and prevent electrolyte imbalance.
-Anitibiotics initiated prior to surgery. Administered during surgery and continued for at
least 48 hours postop.
QUESTIONS WITH CORRECT ANSWERS
Perforated Appendicitis: - Answer-Gross perforation and contamination of the peritoneal
cavity.
Etiology: - Answer-Almost always caused by an obstruction in the appendiceal lumen,
this obstruction often caused by a hard mass of feces. Other obstructive causes are
calculus, parasites, edema of lymphoid tissue, tumor, or a foreign body. Continued
secretion of mucus following obstruction increases pressure causing ischemia,
inflammation, cellular death, and ulceration.
Risk Factors: - Answer-Adolescent males at greatest risk! Individuals diet whose low in
fiber or high in carbs can develop feces masses.
Prevention: - Answer-Eat foods high in fiber such as fresh fruits and veggies. Staying
hydrated!
Clinical Manifestations: - Answer--Initial symptoms are continuous, mild, generalized or
upper abdominal pain.
-Over next four hours pain intensifies and localizes in the right lower quadrant.
-Pain is aggravated by moving, walking, or coughing. On palpation, localized and
rebound tenderness are noted at McBurneys point. [Rebound tenderness is a relief of
pain with direct palpation, followed by pain on release of pressure]
-Extension or internal rotation of right hip increases pain.
-Low grade fever, anorexia, nausea, vomiting.
cont... - Answer--Older adults don't show acute pain or local tenderness so the
diagnosis is delayed making the course of acute appendicitis more virulent increasing
the mortality rate.
-Pregnant women may get right lower quadrant pain, periumbilical, or right subcostal
(under rib) pain due to displacement of appendix.
-Perforation is manifested by increased pain & a high fever.
-Chronic appendicitis characterized by chronic abdominal pain and recurrent acute
attacks at intervals of several months or more.
, Peritonitis resulting from appendix rupture with bowel contents leaking into the
abdominal cavity: - Answer-*High fever, acute severe abdominal pain, abdominal
distention, can result in death.
*Removal of the appendix, antibiotics, fluid restoration, maintain VS.
Chronic Appendicitis: - Answer-*Chronic recurrent abdominal pain over several months.
*appendectomy, pain management.
Lifespan & Cultural Considerations: - Answer--Uncommon for children age 4 and under
to have appendicitis, but when they do it progresses to rupture because they can't tell
parents how they feel. Common symptoms would be listlessness, inconsolability,
vomiting, distended abdomen. Its low on the diagnostic priority for kids so the delay in
diagnosis and an increase in rupture, complications, and death in infant population.
-Older adults are likely to present with confusion.
Collaboration: - Answer-Acutely inflamed appendix can perforate within 24 hours, so
rapid diagnosis and treatment are important. Client admitted to the hospital and
intravenous fluids are initiated, oral foods and fluids are withheld until a diagnosis is
confirmed.
Diagnostic Tests: - Answer--Abdominal ultrasound is the most effective test for
diagnosing acute appendicitis.
-Abdominal X-rays, intravenous pyelogram, urinalysis, and pelvic exam, WBC with
differential.
Surgery: - Answer--Appendectomy is the surgical removal of the appendix. Can either
laparoscopic approach (insertion of an endoscope to view abdominal contents) or
laparotomy (surgical opening of the abdomen) is used for appendectomy.
-Laparoscopic advantages are direct visualizations to allow diagnosis without
laparotomy, postop hospitalization is short, postop complications are infrequent,
recovery and resumption of normal activities are rapid.
-Laparotomy used when the appendix has ruptured. Allows removal of contaminations
from the peritoneal cavity by irrigation with NS.
Pharmacologic Therapy: - Answer--Prior to surgery intravenous fluids are given to
restore or maintain vascular volume and prevent electrolyte imbalance.
-Anitibiotics initiated prior to surgery. Administered during surgery and continued for at
least 48 hours postop.
