Appendicitis.

Inflammation of the vermiform appendix is a common cause of acute abdominal pain. Most common reason for emergency abdominal surgery.

Appendicitis

Perforation, peritonitis, and abscess are possible complications of acute appendicitis. Perforation is manifested by increased pain and a fever. An inflamed appendix can perforate within 24 hours so rapid diagnosis and treatment are important.

Complications.

Higher fiber intake is common, encouraging a diet high in fiber and low in animal fats.

Health Promotion.

24 to 48 hours. Which can lead to tissue perforation leading to bacterial peritonitis.

How quickly can tissue necrosis and gangrene occur?

It falls.

If sepsis is present does BP fall or increase?

Cephalosporin, cefotaxime, ceftazidime. The antibiotic is repeated during surgery and continued for at least 48 hours post op.

Medications.

Cephalosporin, cefotaxime (claforan), ceftazidime (fortaz) ceftriaxone (rocephin)

Meds.

Increased pain and a high fever.

Perforation is manifested by what symptoms?

Assessing patient for signs of a ruptured appendix is the main priority, then beginning antibiotics, prevention of dehydration and maintaining fluids and electrolytes. Managing patients pre-op and post-op issues.

Priorities of Care.

Appendectomy. 1- direct visualization, 2. post op surgery heals faster, 3. post op complications are infrequent, 4. Recovery is faster. Lapartomy- is normally performed if the appendix ruptured.

Surgery.

With appendicitis the total WBC is 10,000 or 20,000

Total WBC count?

If the appendix ruptures or perforates the infected contents spill into the abdominal cavity.

What causes peritonitis?

Sudden relief of preoperative pain may signal rupture of the distended and edematous appendix. Patients pain provides important clues about the diagnosis and possible complications such as rupture of the appendix or peritonitis. Asses patient 30m after giving pain medications

Acute pain for Appendicitis.

Abdominal ultrasound is the most effective, Abdominal x-rays, IV pyelogram, urinalysis and a pelvic examination. In addition a WBC count with differential is obtained.

Diagnosis

It serves as a reservoir for beneficial intestinal bacteria. Obstruction is most often caused by fecal matter, stones or a foreign body, inflammation, tumor, parasites or edema of the lymphoid tissue. Pressure within the appendix increases cutting blood supply, this leads to ulceration, edema and infection. Within 24 to 36 hours, tissue necrosis and gangrene result leading to perforation if treatment is not initiated.

Pathophysiology.

peritonitis and perforation.

Pre op complications?

Keep patient NPO, do not administer enemas or laxatives, it could perforate the appendix. No heat should be applied to abdomen. This could increase blood circulation to that area and cause perforation.

Precautions to take for suspected appendicitis?

Tachycardia and rapid shallow breaths may indicate perforation of the appendix with resulting peritonitis. Fever may develop as well, and the blood pressure may fall resulting in sepsis. No heat should be applied to the abdomen, keep patient with suspected appendicitis NPO and do not administer laxatives or enemas. Laxatives or enemas may cause perforation of the appendix. Swelling of the wound, increased abdominal girth or an increase in pain may indicate infection or peritonitis. Maintain intravenous infusion until oral intake is adequate.

Symptoms

Improper wound care, risk of infection, abscess and possible peritonitis.

Post op complications of an appendectomy?

Increasing pain, boardlike abdomen and abdominal distention.

What physical characteristic may indicate a developing peritonitis?

tachycardia, shallow breaths and fever.

What physical manifestations could indicate perforation?

On palpation, localized and rebound tenderness are noted at McBurney's point.

Where do you generally palpate?

Continuous mild or upper abdominal pain is the initial characteristic manifestation of acute appendicitis. During the first 4 hours the pain intensifies and localized in the RLQ of the abdomen. This pain is aggravated by moving, walking and coughing. Extension or internal rotation of the right hip increases the pain. Low grade fever, anorexia, nausea, and vomiting are often present. Pain and local tenderness may be less acute in older adults, delaying the diagnosis.

Manifestations.