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Appendicitis

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Information about Appendicitis
Health & Medicine

Published on November 24, 2008

Author: txnurse

Source: slideshare.net

Description

A brief but concise visual presentation on one of the most common gastrointestinal disorders - appendicitis.
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APPENDICITIS Maria G. Nelson

WHAT IS AN APPENDIX? Small, tube-like structure attached to the 1 st part of the large intestine (colon) Located in the lower right portion of the abdomen Has no known function Removal of the appendix appears to cause no change in digestive function

Small, tube-like structure attached to the 1 st part of the large intestine (colon)

Located in the lower right portion of the abdomen

Has no known function

Removal of the appendix appears to cause no change in digestive function

WHAT IS APPENDICITIS Inflammation of the appendix No effective medical therapy, and is considered a medical emergency Patients recover without difficulty if treated promptly If treatment is delayed, it can burst, causing infection and even death Most common acute surgical emergency of the abdomen Anyone can get it, but occurs most often between ages 10-30

Inflammation of the appendix

No effective medical therapy, and is considered a medical emergency

Patients recover without difficulty if treated promptly

If treatment is delayed, it can burst, causing infection and even death

Most common acute surgical emergency of the abdomen

Anyone can get it, but occurs most often between ages 10-30

APPENDICITIS

CAUSES OF APPENDICITIS Relates to blockage of the inside of the appendix, known as the lumen Blockage leads to increased pressure, impaired blood flow and inflammation If blockage is not treated, gangrene and rupture (breaking or tearing) of the appendix could result Bacterial or viral infections in the digestive tract which can lead to swelling of lymph nodes, which squeeze the appendix and cause obstruction Swelling known as lymphoid hyperplasia

Relates to blockage of the inside of the appendix, known as the lumen

Blockage leads to increased pressure, impaired blood flow and inflammation

If blockage is not treated, gangrene and rupture (breaking or tearing) of the appendix could result

Bacterial or viral infections in the digestive tract which can lead to swelling of lymph nodes, which squeeze the appendix and cause obstruction

Swelling known as lymphoid hyperplasia

CAUSES OF APPENDICITIS Traumatic injury to the abdomen Feces blocks the inside of appendix Genetics Genetic variant that predisposes a person to obstruction of the appendiceal lumen

Traumatic injury to the abdomen

Feces blocks the inside of appendix

Genetics

Genetic variant that predisposes a person to obstruction of the appendiceal lumen

SYMPTOMS Pain in the abdomen, 1 st around the belly button, then moving to the lower right area Loss of appetite Nausea Vomiting Constipation or diarrhea Inability to pass gas Low fever that begins after other symptoms Abdominal swelling

Pain in the abdomen, 1 st around the belly button, then moving to the lower right area

Loss of appetite

Nausea

Vomiting

Constipation or diarrhea

Inability to pass gas

Low fever that begins after other symptoms

Abdominal swelling

PEOPLE WITH SPECIAL CONCERNS People who use immunosuppressive therapy such as steroids People who have received a transplanted organ People infected with the HIV virus People with diabetes People who have cancer or who are receiving chemotherapy Obese people Pregnant women Infants and young children Elderly

People who use immunosuppressive therapy such as steroids

People who have received a transplanted organ

People infected with the HIV virus

People with diabetes

People who have cancer or who are receiving chemotherapy

Obese people

Pregnant women

Infants and young children

Elderly

DIAGNOSIS & TREATMENT Medical history and physical examination Laboratory tests WBC count and differential Mild to moderate elevation 10,000-18,000 mm3 with left shift is consistent with appendicitis Imaging tests Ultrasound of the lower abdomen Abdominal computed tomography (CT scans) - may be used when symptoms are recurrent or prolonged. Check allergies and renal function if contrast dye is used

Medical history and physical examination

Laboratory tests

WBC count and differential

Mild to moderate elevation 10,000-18,000 mm3 with left shift is consistent with appendicitis

Imaging tests

Ultrasound of the lower abdomen

Abdominal computed tomography (CT scans) - may be used when symptoms are recurrent or prolonged.

Check allergies and renal function if contrast dye is used

TREATMENT Surgery Standard small incision in the right lower part of the abdomen 3-4 incisions using a laparoscope Antibiotics and other treatment If symptoms have a nonsurgical or medically treatable cause IV antibiotics and IV fluids Draining the abscess and leaving the drain in the abscess cavity Appendectomy may be scheduled after the abscess is drained

Surgery

Standard small incision in the right lower part of the abdomen

3-4 incisions using a laparoscope

Antibiotics and other treatment

If symptoms have a nonsurgical or medically treatable cause

IV antibiotics and IV fluids

Draining the abscess and leaving the drain in the abscess cavity

Appendectomy may be scheduled after the abscess is drained

NURSING MANAGEMENT Pre – Operative NPO status upon admission Administer IV fluids as prescribed Semi-Fowler’s position to contain abdominal drainage in the lower abdomen Avoid laxatives/enemas or application of heat that could cause perforation Post – Operative Administer opioid analgesia (morphine sulfate) Administer IV antibiotics as ordered (surgical prophylaxis, perforation) For peritonitis, monitor NG tube drainage For perforation or abscess, monitor surgical drains.

Pre – Operative

NPO status upon admission

Administer IV fluids as prescribed

Semi-Fowler’s position to contain abdominal drainage in the lower abdomen

Avoid laxatives/enemas or application of heat that could cause perforation

Post – Operative

Administer opioid analgesia (morphine sulfate)

Administer IV antibiotics as ordered (surgical prophylaxis, perforation)

For peritonitis, monitor NG tube drainage

For perforation or abscess, monitor surgical drains.

COMPLICATIONS Peritonitis due to perforation – perforation is a life-threatening emergency! Risk of perforation greatest 48 hours following onset of appendicitis pain. Carefully assess the client for: Fever of 38.2 (101 F) or higher Acute ill appearance Board-like abdomen

Peritonitis due to perforation – perforation is a life-threatening emergency!

Risk of perforation greatest 48 hours following onset of appendicitis pain.

Carefully assess the client for:

Fever of 38.2 (101 F) or higher

Acute ill appearance

Board-like abdomen

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