appendicitisbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb.pptx

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1. APPENDICITIS

2. I ntroduction The Appendix is:- A small, finger-like appendage about 8 to 10 cm long Attached to the cecum just below the ileo-cecal valve Fills with food and empties regularly into the cecum appendix is prone to obstruction and is particularly vulnerable to infection Because it empties inefficiently and its lumen is small

3. Definition Appendicitis- is an inflammation of the vermiform appendix pathophysiology Obstruction of the lumen by: A fecalith (accumulated feces ) Foreign bodies Worms (e.g., Pinworms, ascaris ) Intramural thickening caused by lymphoid hyperplasia Tumours of the cecum or appendix

4. The inflammatory process increases intra luminal pressure initiating progressively sever, generalized peri umbilical pain that became localized to the right lower quadrant of the abdomen with in a few hours . Finally the inflamed appendix fills with pus

5. Clinical Manifestations Vague epigastric or peri -umbilical pain Progressing to RLQ May be accompanied by: A low-grade fever Nausea and vomiting Loss of appetite Local tenderness is elicited at McBurney’s point when pressure is applied Guarding the abdominal area by lying still with the right leg flexed at the knee

6. McBurney’s point and test of Rovsing’s sign

7. Possible signs of Appendicitis Rovising sign &Rebound tenderness applying pressure to the right lower quadrant then release quickly the pateint exepreinces sever pain when the pressure relased If the appendix curls around behind the cecum , pain and tenderness may be felt in the lumbar region

8. b. referred rebound tenderness Press deeply and evenly in the left lower quadrant Then quickly withdraw your fingers Pain in the right lower quadrant during left-sided pressure

9. . c. Positive Psoas Sign Psoas Sign: 2 methods 1st Method Place your hand just above the patient’s right knee Ask the patient to raise that thigh against your hand (extending right thigh) 2nd Method Ask the patient to turn onto the left side Then extend the patient’s right leg at the hip Flexion of the leg at the hip makes the psoas muscle contract; extension stretches it

10. . d. Positive Obturator Sign Flex the patient’s right thigh at the hip, with the knee bent, and rotate the leg internally at the hip This maneuver stretches the internal obturator muscle

11. C/M The extent of tenderness depends on the location of the inflamed appendix Pain on defecation suggests that the tip of the appendix is resting against the rectum. Pain in urination suggest that the tip is near to the bladder If tip is in the pelvis can be elicited only on rectal examination.

12. Acute Complications a. Perforation The most common and generally occurs 24 hours after the onset of pain b . Peritonitis c. Abscess

13. Diagnosis History Complete physical examination Lab tests CBC—increased WBCs (neutrophils >75%) Serum electrolyte profile Abdominal x-ray films, ultrasound studies, and CT scan

14. Medical M anagement Surgery is indicated if appendicitis is diagnosed Antibiotics and intravenous fluids To correct or prevent fluid and electrolyte imbalance and dehydration , until surgery is performed Used for 6 to 8 hrs before the appendectomy If the appendix has ruptured and there is evidence of peritonitis or an abscess Analgesics after diagnosis Appendectomy

15. Nursing Management Patient preparation for surgery IV infusion to replace fluid loss and promote adequate renal function Antibiotic therapy to prevent infection Enema is not administered because risk of perforation Avoid self-treatment like the use of laxatives and enema to prevent perforation Cold compress to the RLQ to decrease blood flow to the area and impend the inflammatory process Heat is never used because it may cause the appendix to rupture

16. Postoperative care Placing the patient in a semi-Fowler position Opioid , usually morphine sulfate Oral fluids as tolerated Food is provided as desired and tolerated on the day of surgery Ambulation begins the day of surgery or the first postoperative day Discharge on the first or second postoperative day Normal activities are resumed 2 to 3 weeks after surger

17. Thank you