• Acute
o Causes – neonates, children, adults
o Management
• Chronic
o Causes – neonates, children, elderly
Appendicitis p 765, p 770 PCCM 105
• Definition
• Incidence
• Causes
• Pathophysiology
• Assessment and common findings
• Management
• Preop care
• Essential health information
Haemorrhoids p 771, p 776 PCCM 124
• Definition
• Causes
• Pathophysiology
• Assessment and common findings p 771 / Clinical features PCCM 124
• Nursing management p 771 / PCCM p 125
• Surgical management
• Post op care
• Essential health information
• External
• Internal
Fissures. Abscesses, fistulas p 772, p 778 PCCM 125
• Definition
• Causes
• Pathophysiology
• Essential patient teaching
Abdominal trauma p 266 (T&E Periods)
• Causes
• Pathophysiology
• Assessment
• Diagnostic
• Common injuries
• Abdominal stabs PCCM p 272
o Clinical features
o Management
• Dangers
• Emergency management
Abdominal compartment syndrome
Jaundice p 785, p 790 PCCM p 115
• Pre hepatic / haemolytic
• Hepatic/ hepatocellular
• Post hepatic / obstructive
Toxic hepatitis p 789, p 794
• Pathophysiology
• Clinical manifestations
• Management
• Essential health information
Poisoning and drug overdose p 58, p 51 PCCM p13
Management (T&E Periods)
• Types of poison
o Paraffin
o Carbon monoxide
o Organophosphate poisoning
Acute pancreatitis p 804, p 809 PCCM p 117
• Definition
• Causes and incidence
• Assessment and common findings p 804, 810 / clinical features PCCM p 117
• Diagnostic tests
o Blood amylase /Urine amylase
• Nursing diagnosis
• Management p 806, 811 /
• PCCM p 117
• Pain relief- nursing care
• Prevention of complications – nursing care
Essential health information
2. Acute Constipation
The onset of acute constipation is sudden and it lasts
for several days.
It’s usually caused by medication, blockage,
dehydration, prolonged activity, or missing a bowel
movement.
With women who are pregnant, it can develop when
the womb is pressed against the intestine.
Swallowing indigestible objects and lead poisoning
are also a cause sometimes, as well as general
anaesthesia, which may affect the bowel muscles a
couple days after surgery.
2018/10/02Compiled by C Settley
2
3. Acute Constipation
The medications below may slow down the faeces passage
through the intestine and provoke acute constipation:
Epilepsy anticonvulsants
Diuretics
Antidepressants
Iron supplements
Calcium-channel blockers, and other heart medications
Morphine, codeine, and other pain medications
Some antacids
Some cold and cough medications that contain dextromethorphan
2018/10/02Compiled by C Settley
3
4. Chronic constipation
Chronic constipation can be defined as the instance of two
or more of the specified below inside an eight week period:
Three bowel movements each week.
One incident of faecal incontinence each week.
Big stools in the rectum or apparent upon examination of
the abdomen.
Withholding behaviour.
Defecation that is painful.
2018/10/02Compiled by C Settley
4
5. Chronic constipation
Normal constipation lasts for a brief period and its symptoms resolve in a
fairly short time.
With chronic constipation, however, the symptoms last for a longer
duration, usually around three or more months and in some cases, years.
It is a long-term condition that can impact a person’s social and work life.
It is generally not relieved with OTC laxatives or lifestyle changes and could
require medical attention.
Although the occasional onset of constipation is common, in some cases,
people will experience chronic constipation, which interferes with their
ability to do daily tasks.
2018/10/02Compiled by C Settley
5
6. Chronic constipation
Chronic constipation treatment will depend on the underlying cause.
The treatment typically starts with lifestyle and diet changes which are
meant for increasing the speed of the stool moving through the intestines.
When simple measures like this fail, laxative tablets are often the next step.
For acute constipation, stimulant laxatives like Dulcolax® tablets are often
used.
Other treatments for acute constipation may also include suppositories &
enemas.
2018/10/02Compiled by C Settley
6
7. Appendicitis
A condition in which the appendix becomes inflamed and filled with pus,
causing pain.
11-30 years more prone to developing
Males are more common affected
2018/10/02Compiled by C Settley
7
8. The appendix
Normally, the appendix sits in the lower right abdomen.
The function of the appendix is unknown.
One theory is that the appendix acts as a storehouse for good
bacteria, “rebooting” the digestive system after diarrheal illnesses.
2018/10/02Compiled by C Settley
8
9. Appendicitis: Causes
A blockage in the lining of the appendix that results in infection is the likely
cause of appendicitis.
The bacteria multiply rapidly, causing the appendix to become inflamed,
swollen and filled with pus.
If not treated promptly, the appendix can rupture.
2018/10/02Compiled by C Settley
9
10. Faecolith: It is a hardening of faeces into lumps of varying size and may occur anywhere in the
intestinal tract but is typically found in the colon. It is also called appendicolith when it occurs in the
appendix and is sometimes concomitant with appendicitis.
Lymphoid hyperplasia is an increase in the number of normal cells (called lymphocytes) that are
contained in lymph nodes.
2018/10/02Compiled by C Settley
10
11. Appendicitis: Pathophysiology
Obstruction of the appendix results in an inflammatory reaction
Leads to oedema and distention
Pressure is applied on the intramural blood vessels
This leads to vascular engorgement (swelling of tissue)
That results in gangrene of the appendix
In addition, the mucosal wall ulcerates, becomes infected and
ruptures
This spreads infection to the peritoneum, hence the associated
peritonitis or abscess formation
2018/10/02Compiled by C Settley
11
13. Assessment
Diagnostic tests
FBC: elevated white cell count above 11 000mm3. neutrophil
count above 75%.
X-rays: Dilated loops of bowel indicating paralytic ileus, air or
fluid levels in case of obstruction and free air consistent with
perforation.
2018/10/02Compiled by C Settley
13
14. Appendicitis: Medical Management
Immediate surgical removal of the appendix through a laparotomy
Drainage of the abscess may be indicated if the complication has
developed
IV therapy should commence surgery to correct fluid and
electrolyte imbalance and to administer AB’s for infection
If appendix has not perforated at the time of the surgery, the
patient’s recovery is usually smooth and the patient is discharged
within 5-7 days or earlier
2018/10/02Compiled by C Settley
14
15. Appendicitis: Nursing Management
Relieve anxiety
Relieve pain
Prevent systematic infection
Correct fluid and electrolyte imbalance
Nutrition
Prepare patient for surgery
2018/10/02Compiled by C Settley
15
17. Haemorrhoids
Swollen and inflamed veins in the rectum and anus
that cause discomfort and bleeding.
2018/10/02Compiled by C Settley
17
18. Haemorrhoids: Symptoms
Painless bleeding during bowel movements —small
amounts of bright red blood on toilet tissue or in the toilet
Itching or irritation in anal region
Pain or discomfort
Swelling around anus
A lump near anus, which may be sensitive or painful (may
be a thrombosed hemorrhoid)
Hemorrhoid symptoms usually depend on the location.
2018/10/02Compiled by C Settley
18
19. Haemorrhoids
Internal hemorrhoids.
These lie inside the rectum. Occasionally, straining can push an internal
hemorrhoid through the anal opening. This is known as a protruding or
prolapsed hemorrhoid and can cause pain and irritation.
External hemorrhoids.
These are under the skin around anus. When irritated, external hemorrhoids can
itch or bleed.
Thrombosed hemorrhoids.
Sometimes blood may pool in an external hemorrhoid and form a clot
(thrombus) that can result in severe pain, swelling, inflammation and a hard
lump near the anus.
2018/10/02Compiled by C Settley
19
20. A venous plexus is a congregation of multiple veins.
2018/10/02Compiled by C Settley
20
21. Haemorrhoids: Causes
Straining during bowel movements
Sitting for long periods of time on the toilet
Chronic diarrhea or constipation
Obesity
Pregnancy
Anal intercourse
Low-fiber diet
Rectal surgery
Loss of muscle tone
Anal intercourse
Heavy lifting
2018/10/02Compiled by C Settley
21
22. Haemorrhoids: Pathophysiology
The covering epithelium is damaged by the hard bowel
movement, and the underlying veins bleed.
With spasm of the sphincter complex elevating pressure, the
internal hemorrhoidal veins can spurt.
Internal hemorrhoids can deposit mucus onto the perianal tissue
with prolapse.
2018/10/02Compiled by C Settley
22
25. Haemorrhoids: Complications
Anemia. Rarely, chronic blood loss from hemorrhoids may cause
anemia, in which you don't have enough healthy red blood cells
to carry oxygen to your cells.
Strangulated hemorrhoid. If the blood supply to an internal
hemorrhoid is cut off, the hemorrhoid may be "strangulated,"
another cause of extreme pain.
2018/10/02Compiled by C Settley
25
26. A: Strangulated internal hemorrhoid;
B: Acutely thrombosed external hemorrhoid.
2018/10/02Compiled by C Settley
26
27. Haemorrhoids: Nursing management
Preventing constipation by eating a high fibre diet
Avoiding prolonged periods of standing/sitting
Warm sitz baths
Inserting soothing anal suppositories
Warm compresses
Anal hygiene
exercise
2018/10/02Compiled by C Settley
27
28. Haemorrhoids: Surgical management
A hemorrhoidectomy.
Indications:
Thrombosis
Prolonged bleeding
Complicated prolapses
Intolerable itching
Discomfort
Intense pain
Post op care:
Support
Pillow
Pain meds
Stool softener
2018/10/02Compiled by C Settley
28
29. Fissures, abscesses & fistulas:
Common problems developed from trauma or infection in the
anorectal area
Fissure: A small tear in the lining of the anus.
Anal fissure may occur when passing hard or large stools.
An anal fissure can cause pain and bleeding during bowel movements.
This condition usually heals on its own in four to six weeks. Common
treatments include dietary fibre and stool softeners, as well as creams to
the affected area.
2018/10/02Compiled by C Settley
29
30. Fissures, abscesses & fistulas:
Common problems developed from trauma or infection in the
anorectal area
Anal abscess: An abscess causes tenderness, swelling, and pain. These
symptoms clear when the abscess is drained. The patient may also
complain of fever, chills, and general weakness or fatigue.
2018/10/02Compiled by C Settley
30
31. Fissures, abscesses & fistulas:
Common problems developed from trauma or infection in the
anorectal area
Anal fistula: An infected tunnel between the skin and the anus.
An anal fistula is an infected tunnel between the skin and the anus, the
muscular opening at the end of the digestive tract. Most anal fistulas are
the result of an infection in an anal gland that spreads to the skin.
Symptoms include pain, swelling and discharge of blood or pus from the
anus.
Surgery is usually required to treat anal fistula.
2018/10/02Compiled by C Settley
31
33. Fissures, abscesses & fistulas:
Summary
Bleeding, pain, or drainage from the anus can occur
with several illnesses, so a physician should always be
consulted.
Often the diagnosis is anal fissure, abscess, or fistula.
These are problems that are usually easy to diagnose
and correct.
A variety of treatments, including surgery, are
available to correct these conditions.
2018/10/02Compiled by C Settley
33
34. Abdominal trauma
Abdominal trauma is an injury to the abdomen.
Signs and symptoms include abdominal pain,
tenderness, rigidity, and bruising of the external
abdomen.
Complications may include blood loss and infection.
Diagnosis may involve ultrasonography, computed
tomography, and peritoneal lavage, and treatment
may involve surgery.
2018/10/02Compiled by C Settley
34
35. Abdominal trauma: Common injuries
Lacerated liver
Injuries to kidney and intestines
Ruptured spleen, liver, stomach, diaphragm & bladder
Dangers:
Peritonitis
Inflammation of the membrane lining the abdominal wall and covering the
abdominal organs.
Shock
Cullen’s sign
superficial oedema and bruising in the subcutaneous fatty tissue around the umbilicus
Abdominal compartment syndrome
A condition caused by abnormally increased pressure within the abdomen.
Gunshots, poly-trauma, stab wounds, haemorrhage
2018/10/02Compiled by C Settley
35
36. Abdominal trauma:
Emergency management
Laparotomy
Clear airway
High Fowlers
Oxygen
Control bleeding
Replace fluid loss
Blood transfusion
Nasogastric tube to decompress the abdomen and stomach
Catheter
Vital signs
2018/10/02Compiled by C Settley
36
37. Jaundice
Jaundice is caused by a build-up of bilirubin, a waste material, in the blood.
Old red blood cells travel to the liver, where they're broken down.
Bilirubin is the yellow pigment formed by the breakdown of these old cells.
Jaundice occurs when your liver doesn't metabolize bilirubin the way it's
supposed to.
An inflamed liver or obstructed bile duct can lead to jaundice, as well as
other underlying conditions.
Symptoms include a yellow colour to the skin and whites of the eyes, dark
urine, and itchiness.
2018/10/02Compiled by C Settley
37
38. Types of Jaundice
Pre hepatic/Haemolytic
Haemolytic jaundice occurs as a result of haemolysis,
or an accelerated breakdown of red blood cells,
leading to an increase in production of bilirubin.
Hepatic/Hepatocellular
Hepatocellular jaundice occurs as a result of liver
disease or injury.
Post hepatic/Obstructive
Obstructive jaundice occurs as a result of an
obstruction in the bile duct.
2018/10/02Compiled by C Settley
38
39. Toxic hepatitis
Toxic hepatitis is an inflammation of the liver in reaction to certain
substances exposed to.
Toxic hepatitis can be caused by alcohol, chemicals, drugs or nutritional
supplements.
In some cases, toxic hepatitis develops within hours or days of exposure to a
toxin.
2018/10/02Compiled by C Settley
39
40. Acute pancreatitis
The pancreas is an organ in the upper abdomen that produces digestive fluids
and the hormone insulin.
Acute pancreatitis means inflammation of the pancreas that develops quickly.
The main symptom is abdominal pain.
It usually settles in a few days but sometimes it becomes severe and very serious.
The most common causes of acute pancreatitis are gallstones and drinking a lot
of alcohol.
2018/10/02Compiled by C Settley
40
41. Acute pancreatitis: Causes
Gallstones
Heavy alcohol use
Drugs such as angiotensin-converting
enzyme (ACE) inhibitors, azathioprine,
furosemide, 6-mercaptopurine,
pentamidine, sulfa drugs, and valproate
Estrogen use in women with high levels
of lipids in the blood
High levels of calcium in the blood
(which may be caused by
hyperparathyroidism)
Viruses such as mumps
High levels of triglycerides in the blood
(hypertriglyceridemia)
Damage to the pancreas caused by
surgery or endoscopy (such as
endoscopic retrograde
cholangiopancreatography [ERCP])
Damage to the pancreas caused by
blunt or penetrating injuries
Cancer of the pancreas, or other
blockages of the pancreatic duct
Hereditary pancreatitis, including a small
percentage of people with cystic fibrosis
or cystic fibrosis genes
Cigarette smoking
Kidney transplantation
Pregnancy (rare)
2018/10/02Compiled by C Settley
41
42. Acute pancreas: Symptoms
Abdominal pain
Coughing, vigorous movement, and deep breathing may worsen the pain. Sitting
upright and leaning forward may provide some relief.
Feeling of wanting to vomit.
Some people, especially those who develop acute pancreatitis because of
heavy alcohol use, may never develop any symptoms other than moderate to
severe pain.
Some people feel terrible. They look sick and are sweaty and have a fast pulse
(100 to 140 beats a minute) and shallow, rapid breathing.
At first, body temperature may be normal, but it may increase in a few hours to
between 100° F and 101° F (37.7° C and 38.3° C).
Blood pressure is usually low and tends to fall when the person stands, causing
light-headedness.
Occasionally, the whites of the eyes (sclera) become yellowish.
2018/10/02Compiled by C Settley
42
43. Poisoning and drug overdose:
Management
Identify the poison
Place in recovery position
Establish or maintain open airway
Assess for signs of breathing
Check pulse and skin colour
Call for help
Transport to hospital
2018/10/02Compiled by C Settley
43