Appendicitis, as defined by KidsHealth.org, occurs when the appendix becomes inflamed and fills with pus. The appendix, a finger-shaped organ attached to the large intestine on the lower right side of the abdomen, normally opens into the large intestine. Unfortunately, this opening can become blocked, typically with stool, resulting in the inflammation and infection associated with appendicitis. Children suspected to have appendicitis require immediate medical attention. The treatment for appendicitis is the surgical removal of the appendix called an appendectomy. Quick assessment and treatment of a child with appendicitis is crucial as the condition can deteriorate quickly, resulting in rupture of the appendix and peritonitis (an infection of the abdominal lining following the rupture of the appendix) which can lead to death. (See References 1)
Initial Symptoms
Initially, pediatric appendicitis presents as pain and tenderness around the child's navel. This pain will then descend to the right lower side of the abdomen. In addition, children in the early stages of appendicitis may develop a low-grade fever, vomiting and diarrhea. According to Whaley and Wong's, "Nursing Care of Infants and Children," the most significant sign of early pediatric appendicitis is a marked change in the child's behavior. Many children will lie on their sides with their knees flexed up to their abdomen. They will also appear rigid and will try to move as little as possible.
Common Symptoms
In addition to the initial symptoms, other common symptoms of appendicitis include a loss of appetite, tenderness when pressure is applied to the lower right side of the abdomen, an increase in pain during coughing or walking, constipation and abdominal swelling. If left untreated, the appendix may rupture within 24 to 72 hours after a child starts having symptoms
Symptoms Associated With Ruptured Appendix
Once the appendix has ruptured, children can rapidly develop peritonitis. These children will typically present with the common symptoms of appendicitis as well as additional symptoms consistent with a diagnosis of peritonitis. These symptoms include progressive abdominal distention, high-grade fever, tachycardia--increased heart rate, rapid shallow breathing, pallor, chills, irritability and restlessness. In addition, one of the classic signs of peritonitis is a sudden relief of pain immediately after the rupture of the appendix followed by an increase in pain far worse than that felt previously. At this point, the pain can also spread across the entire abdomen.
Signs of Appendicitis
Aside from the symptoms of pediatric appendicitis, doctors and nurses will look for several classic signs during assessment. The most common of these is rebound tenderness, defined by Whaley and Wong as sudden pain at the point of tenderness elicited by pressing firmly over a part of the abdomen distal to the area of tenderness.
Other signs include Rovsing sign, Psoas sign and Obturator sign. Rovsing sign occurs when pain is felt on the lower right side of the child's abdomen as pressure is put on the lower left side of the abdomen. Psoas sign is assessed by having the child flex his right hip, bringing his leg up and in toward the body, as if assuming the fetal position. As the hip is flexed, the child will notice a decrease in pain. Once the leg is straightened out, the pain will resume. Obturator sign is when pain is felt during inward rotation of the flexed thigh.
Considerations
Although lower right-sided abdominal pain is the most common symptom of pediatric appendicitis, not all children will present with this type of pain. According to MayoClinic.com, the location of appendicitis pain may vary and younger children may experience pain in different areas. In addition, several other conditions, such as urinary tract infections, constipation and intussusception, all have similar symptoms to appendicitis. Because of this, it is important that any complaints of abdominal pain be taken seriously and that children with any of these signs and symptoms receive immediate medical care.
References
- "Nursing Care of Infants and Children"; Lucille F. Whaley R.N., Ed.D. and Donna Wong R.N. M.N.; 1991
- MayoClinic.com: Appendicitis
- KidsHealth from Nemours: Appendicitis
- Merck Manuals Online Medical Library: Appendicitis
