ANATOMY AND PHYSIOLOGY OF ORGAN INVOLVED The appendix is a closed-ended, narrow tube up to several inches in length that attaches

to the cecum , the first part of the colon, like a worm. The anatomical name for the appendix is vermiform appendix which means worm-like appendage. It's pencil-thin and normally about 4 inches (7 cm) long. The appendix is usually located in the right iliac region, just below the ileocecal valve (designated McBurney's point) and can be found at the midpoint of a straight line drawn from the umbilicus to the right anterior iliac crest. The inner lining of the appendix produces a small amount of mucus that flows through the open center of the appendix and into the cecum. The wall of the appendix contains lymphatic tissue that is part of the immune system for making antibodies. During the first few years of life, the appendix functions as a part of the immune system, it helps make immunogobulins. But after this time period, the appendix stops functioning. However, immunoglobulins are made in many parts of the body, thus, removing the appendix does not seem to result in problems with the immune system. Like the rest of the colon, the wall of the appendix also contains a layer of muscle, but the muscle is poorly developed.

Pathophysiology of Appendicitis Episodes of Constipation Low Fiber Diet Occlusion of Appendix by Fecalith Decreased flow/drainage of mucosal secetions Increased ILP in the appendix Vasocongestion Decreased blood supply in the appendix Decreased O2 supply in the appendix Appendix starts to be necrotic; Bacteria invade the appendix Disruption of Cell Membrane of Appendix Start of Inflammatory Process Release of Chemical Mediators Activation of the Vomiting Neutrophils to area Center in the Medulla ---> Histamine, Prostaglandin, Stimulation of Vagus Suppression of Pus Formation Leukotrienes, Bradykinin Nerve Sympathetic (phagocytized bacteria GI Function and dead cells) Swelling of Appendix ruptures) ---> Prostaglandin, Bradykinin Pain in the RLQ of Abdomen Acute Pain ---> Interleukin-1 Increased WBC Risk for Infection (if appendix Nausea & Vomiting Risk for Deficient Fluid Volume Anorexia

Risk for Imbalanced Nutrition less than body requirements

Inflammation of Appendix (Appendicitis) Appendectomy

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Tissue Trauma Nociceptors on the Dermis Send Impulse to CNS

Open Wound Disruption of Cell Membrane Impaired Tissue Risk for Start of Inflammatory Integrity Infection Process

Release of Prostaglandin/ Bradykinin

Pain on Surgical Site Activity Intolerance