Appendicitis

Diagram Description automatically generated. Appendicitis.

Outlines. Case scenario. Assessment ( Health history& Physical examination). Introduction about Appendicitis. Etiology. Anatomy & Physiology. Pathophysiology. S/S. Risk factors and Complications. Diagnostic tests. Medical management. Nursing management..

Case Scenario. A 10 years old patient with his parents , Attended ER at University of Sharjah hospital on 3 rd of April 2022 complaining of vomiting for 1 day 4-5 times per day, moderate amount non-bilious, non-projectile and contains food particles. Examined by Dr. S.A who indicated that he has positive rebound tenderness. And with further examination, they detected the inflammation The patient did appendectomy because he had a perforated acute appendicitis Pain: 5 on a numeric pain scale. Stable vital signs..

Health history. History of present illness: - Gastritis . Past health history: - - Past Surgical History: - - Family history: - His father had the same problem and did an appendectomy..

Physical examination. Review of systems: - All systems are normal and nothing abnormal detected except of: - gastrointestinal system. Gastrointestinal system: - soft abdomen with tenderness and positive rebound tenderness. Vital signs: - Temperature: - 36.6 °C. (Route: - Tympanic.). - Pulse: - 79 bpm. RR: - 18 bpm. - BP: - 103/62 mmHg. SpO2: - 97%..

Introduction about Appendicitis. Definition: - Appendicitis is inflammation of appendix..

Etiology. Appendicitis can have more than one cause, and in many cases the cause is not clear. Possible causes include: - Blockage of the opening inside the appendix. Enlarged tissue in the wall of the appendix, caused by infection in the gastrointestinal (GI) tract or elsewhere in the body. Inflammatory bowel disease. Stool, parasites, or growths that can clog your appendiceal lumen. Trauma to your abdomen..

Anatomy & Physiology. The appendix is a wormlike extension of the cecum. The appendix has no known function in the body, but it can become diseased, One theory said that the appendix acts as a storehouse for good bacteria, “rebooting” the digestive system after diarrheal illnesses. The average length of the appendix is 8-10 cm (Range: 2-20 cm). it appears during the fifth month of gestation. Like the rest of the colon, the wall of the appendix also contains a layer of muscle, but the muscles are poorly developed..

Pathophysiology. Appendicitis is thought to result from obstruction of the appendiceal lumen. Normal stool, Fecalith (a hard mass of fecal matter), or lymphoid hyperplasia are the main causes of obstruction. Once obstructed, there is reduced blood flow to the tissue and bacteria is able to multiply. Due to the lumen being obstructed, the pressure within the appendix increases and this reduces venous drainage, resulting in ischemia. At this stage, the appendix is at risk of perforating. It takes around 72hrs for perforation to occur from when the appendix becomes obstructed. Once the appendix perforates, bacteria and inflammatory cells are released into the surrounding structures. This then causes inflammation of the peritoneum..

Signs & Symptoms. The most common symptom is pain in the abdomen. If a person has appendicitis, he’ll most often have pain in his abdomen that: - Begins near umbilicus and then moves to the RLQ. Gets worse in a matter of hours. Gets worse when moving around, take deep breaths, cough, or sneeze. Is severe and often described as different from any pain felt before. Other symptoms of appendicitis may include: - Loss of appetite. Vomiting. Constipation or diarrhea. Inability to pass gas. Low-grade fever. Swelling in the abdomen..

Risk factors. Age: Appendicitis most often affects people between the ages of 15 and 30 years old. Sex: Appendicitis is more common in males than females. Family history: People who have a family history of appendicitis are at heightened risk of developing it..

Complications. Appendicitis can cause serious complications. Like: - Pocket of pus known as an abscess to form in your appendix. This abscess may leak pus and bacteria into your abdominal cavity. Ruptured appendix. If your appendix ruptures, it can spill fecal matter and bacteria into your abdominal cavity. If bacteria spill into your abdominal cavity, it can cause the lining of your abdominal cavity to become infected and inflamed. This is known as peritonitis, and it can be very serious, even fatal. Bacterial infections can also affect other organs in your abdomen. For example, bacteria from a ruptured abscess or appendix may enter your bladder or colon. It may also travel through your bloodstream to other parts of your body..

Diagnostic tests. Blood test: - to check for signs of infection. A high white blood cell count is a sign of an infection. Urine test: - to rule out a urinary tract infection. Imaging tests: - such as an abdominal ultrasound or CT scan , to view the inside of your abdomen. Imaging tests are often used to help confirm a diagnosis, if a physical exam and/or blood test show possible appendicitis..

Diagnostic tests. Our case Blood test results: -.

Diagnostic tests. CT scan & U/S images : - ( Not real just an example).

Medical management. Doctors typically treat appendicitis with surgery to remove the appendix. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst. The surgery name is: - Appendectomy. And there is two type of appendectomy. Include: - Laparoscopic surgery: - During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Open surgery: - Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen. After surgery, most patients completely recover from appendicitis and don’t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery..

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Medical management. Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed..

Medications. Medication for Appendicitis such as: - Unasyn (ampicillin and sulbactam): -.

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Medications. Flagyl (metronidazole).. Drug name route dose frequency classification action indication Side effects Flagyl (metronidazole) IV 500mg q8hr antibiotics (nitroimidazoles) stopping the growth of certain bacteria and parasites. to treat a wide variety of infections. Dizziness, headache, loss of appetite, diarrhea, constipation, or metallic taste.

Flagyl@ métronidazole in ml.

Medications. Cefuroxime.. Drug name route dose frequency classification action indication Side effects Cefuroxime. IV 750mg q12hr antibiotics fighting bacteria in your body. to treat many kinds of bacterial infections, including life-threatening forms. severe stomach pain, diarrhea, Jaundice, skin rash, bruising, or numbness ..

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Nursing management. Stethoscope.

Nursing management. Nursing diagnosis: - Acute pain R/T post-op AEB pain score (5/10). Implementation and rationale: -.

Nursing management. Nursing diagnosis: - Impaired skin integrity R/T surgical incision AEB patient says he has pain in place of surgery and objective: open wound, visible surgical incision, post-operative. Implementation and rationale: -.

Nursing management. Nursing diagnosis: - Risk for Infection R/T surgical incision. Implementation and rationale: -.

References. https://www.drugs.com/mtm/cefuroxime.html https://reference.medscape.com/drug/unasyn-ampicillin-sulbactam-342476 https://www.webmd.com/drugs/2/drug-7644/flagyl-oral/details https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-020-01108-5 https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/appendicitis https://www.healthline.com/health/appendicitis#prevention https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis/treatment.

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