Appendicitis PDF

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Appendicitis Anatomy and physiology of appendix The appendix is a slender, worm-shaped pouch, averaging 5-10cm in length that protrudes from the top of the colon in the lower right abdomen. Blood & nerve supply: Blood supply by -Appendix artery from ileocolic artery. Blood return by -Appendix vein Nerve supply by -Sympathetic nerve. Definition: “It is inflammation of the vermiform appendix” Incidence: - Occurs mainly in 10 to 30 year of age. Etiology:     

Obstruction (accumulated feces in lumen) Tumor Foreign bodies King-King of appendix (Twisting) Swelling of the bowel wall

Types of appendicitis There are 2 basic types of appendicitis  

Chronic appendicitis Acute appendicitis

Pathophysiology:

Clinical manifestation: Subjective sign & symptoms        

Epigastric pain spread to right lower quadrant. Malaise Anorexia Vomiting Moderate leukocytosis ( leukocyte in blood) Rebound tenderness Constipation ‘ Diarrhea

Objective sign & symptoms     

Pain at McBurney’s point.(between umbilical & iliac crest) Rovsing’s sign: (pain in the right lower quadrant upon palpation of the left lower quadrant) Obturator sign: (pain on internal and external rotation of the hip) Psoas sign : (pain on active elevation of the legs) Tachycardia

 

Tachypnoea Low grade fever

Diagnostic evaluation:       

History Physical examination WBC count Urinalysis Abdominal x-ray CT Scan USG

Management: Medical management       

Bed rest NPO I/V fluid Antibiotic eg. Ampicillin, Sulbactam, Gentamycin Antipyretic Antiemetic Analgesic

Surgical management: 

Appendectomy: General anesthesia is usually given, and the appendix is removed through a 4-inch incision or by laparoscopy. If you have peritonitis, the abdomen is also irrigated and drained of pus

Complication:    

Abdomen abscess Perforation Peritonitis Infection

Nursing management:

Pre-operative  

Pain R/t inflamed appendix. Fluid volume deficit R/T vomiting.

Post-operative  

Risk for infection R/T Perforation. Altered nutrition less then body requirement R/t less intake of food....