Appendicitis

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

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  • Appendicitis

    1. 1. APPENDICITIS Maria G. Nelson
    2. 2. WHAT IS AN APPENDIX? <ul><li>Small, tube-like structure attached to the 1 st part of the large intestine (colon) </li></ul><ul><li>Located in the lower right portion of the abdomen </li></ul><ul><li>Has no known function </li></ul><ul><li>Removal of the appendix appears to cause no change in digestive function </li></ul>
    3. 3. WHAT IS APPENDICITIS <ul><li>Inflammation of the appendix </li></ul><ul><li>No effective medical therapy, and is considered a medical emergency </li></ul><ul><li>Patients recover without difficulty if treated promptly </li></ul><ul><li>If treatment is delayed, it can burst, causing infection and even death </li></ul><ul><li>Most common acute surgical emergency of the abdomen </li></ul><ul><li>Anyone can get it, but occurs most often between ages 10-30 </li></ul>
    4. 4. APPENDICITIS
    5. 5. CAUSES OF APPENDICITIS <ul><li>Relates to blockage of the inside of the appendix, known as the lumen </li></ul><ul><ul><li>Blockage leads to increased pressure, impaired blood flow and inflammation </li></ul></ul><ul><ul><li>If blockage is not treated, gangrene and rupture (breaking or tearing) of the appendix could result </li></ul></ul><ul><li>Bacterial or viral infections in the digestive tract which can lead to swelling of lymph nodes, which squeeze the appendix and cause obstruction </li></ul><ul><ul><li>Swelling known as lymphoid hyperplasia </li></ul></ul>
    6. 6. CAUSES OF APPENDICITIS <ul><li>Traumatic injury to the abdomen </li></ul><ul><li>Feces blocks the inside of appendix </li></ul><ul><li>Genetics </li></ul><ul><ul><li>Genetic variant that predisposes a person to obstruction of the appendiceal lumen </li></ul></ul>
    7. 7. SYMPTOMS <ul><li>Pain in the abdomen, 1 st around the belly button, then moving to the lower right area </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Constipation or diarrhea </li></ul><ul><li>Inability to pass gas </li></ul><ul><li>Low fever that begins after other symptoms </li></ul><ul><li>Abdominal swelling </li></ul>
    8. 8. PEOPLE WITH SPECIAL CONCERNS <ul><li>People who use immunosuppressive therapy such as steroids </li></ul><ul><li>People who have received a transplanted organ </li></ul><ul><li>People infected with the HIV virus </li></ul><ul><li>People with diabetes </li></ul><ul><li>People who have cancer or who are receiving chemotherapy </li></ul><ul><li>Obese people </li></ul><ul><li>Pregnant women </li></ul><ul><li>Infants and young children </li></ul><ul><li>Elderly </li></ul>
    9. 9. DIAGNOSIS & TREATMENT <ul><li>Medical history and physical examination </li></ul><ul><li>Laboratory tests </li></ul><ul><ul><li>WBC count and differential </li></ul></ul><ul><ul><li>Mild to moderate elevation 10,000-18,000 mm3 with left shift is consistent with appendicitis </li></ul></ul><ul><li>Imaging tests </li></ul><ul><ul><li>Ultrasound of the lower abdomen </li></ul></ul><ul><ul><li>Abdominal computed tomography (CT scans) - may be used when symptoms are recurrent or prolonged. </li></ul></ul><ul><ul><li>Check allergies and renal function if contrast dye is used </li></ul></ul>
    10. 10. TREATMENT <ul><li>Surgery </li></ul><ul><ul><li>Standard small incision in the right lower part of the abdomen </li></ul></ul><ul><ul><li>3-4 incisions using a laparoscope </li></ul></ul><ul><li>Antibiotics and other treatment </li></ul><ul><ul><li>If symptoms have a nonsurgical or medically treatable cause </li></ul></ul><ul><ul><li>IV antibiotics and IV fluids </li></ul></ul><ul><ul><li>Draining the abscess and leaving the drain in the abscess cavity </li></ul></ul><ul><ul><li>Appendectomy may be scheduled after the abscess is drained </li></ul></ul>
    11. 11. NURSING MANAGEMENT <ul><li>Pre – Operative </li></ul><ul><ul><li>NPO status upon admission </li></ul></ul><ul><ul><li>Administer IV fluids as prescribed </li></ul></ul><ul><ul><li>Semi-Fowler’s position to contain abdominal drainage in the lower abdomen </li></ul></ul><ul><ul><li>Avoid laxatives/enemas or application of heat that could cause perforation </li></ul></ul><ul><li>Post – Operative </li></ul><ul><ul><li>Administer opioid analgesia (morphine sulfate) </li></ul></ul><ul><ul><li>Administer IV antibiotics as ordered (surgical prophylaxis, perforation) </li></ul></ul><ul><ul><li>For peritonitis, monitor NG tube drainage </li></ul></ul><ul><ul><li>For perforation or abscess, monitor surgical drains. </li></ul></ul>
    12. 12. COMPLICATIONS <ul><li>Peritonitis due to perforation – perforation is a life-threatening emergency! </li></ul><ul><ul><li>Risk of perforation greatest 48 hours following onset of appendicitis pain. </li></ul></ul><ul><li>Carefully assess the client for: </li></ul><ul><ul><li>Fever of 38.2 (101 F) or higher </li></ul></ul><ul><ul><li>Acute ill appearance </li></ul></ul><ul><ul><li>Board-like abdomen </li></ul></ul>

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