Appendicits

Appendicits

1. Signs & Symptoms

   • Periumbilical pain, anorexia, naseau & Vomiting
   • Diagnostics
     • Differential WBC
       • Increased Neutrophils (more than 75% in later stages)
       • Reveals Leukocytosis
     • Urinalysis
       • rule out Genitourinary conditions that mimic similar symptoms
       • May reveal (hematuria, pyuria) usually normal in appendicits
     • Abdominal X-ray examination
       • Fecalith
         • accumulated feces
       • Localized air fluid levels
       • Increased Soft Tissue Density in RLQ
       • Indications of Localized Ileus
       • If Perforation, the presence of free air noted
     • Abdominal CT
       • 95% accuracy, performed before laporotomy
     • IV pyelogram
       • R/O ureteral stone or pyelitis
     • Abdominal Ultrasound
       • conditions that mimic crohns, diverticulitis & Gastroenteritis
   • Palpation of the Abdomen
   • Early
     • Contralateral tenderness (side on the opposite of palpation)
   • Later
     • Somatic Tenderness (Sharp well-localized/continuous)
       • stretching of swollen liver
     • Palpable tender mass may be felt in peritoneal pouch (if appendix lies in the pelvis area)
   • RLQ pain
     • Mcburney's Point
   • Rebound Tenderness
   • Guarding RLQ
     • Sit still w/ Right leg flexed
   • Rigidity & Muscles Spasms
   • Tachycardia
   • Low grade fever
   • Pain elicited w/ rectal examination
   • Older adult report less severe pain, slight fever and discomfort in right iiliac fossa.

2. inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum.

3. Appendicitis with Perforation Signs

   • pain,pain,pain then STOP?
     • Peritonitis
       • Fetal Position
   • Temp. increases more than 101.4F
   • Generalized abd. Rigidity & Abd. DIstended
   • Pt. Rigid with flexed knees
   • Tender palpable mass
   • Increased generalized pain, Recurrent vomiting

4. Most Common age 10-30yrs old

5. Risk

   • Peritonitis
   • preforation
   • gangrene

6. Interventions

   • Immediate surgery Laporoscopically (Antibiotics & fluid resuscitation given prior)
   • Ruptured & evidence of abscess/peritonitis/abscess: parental fluids & antibiotic therapy is given 6-8hrs before appendectomy to prevent dehydration & sepsis
   • NPO status if appendicitis is suspected (prepare for surgery)
   • encourage ambulation 1st day after surgery
   • Laxative & Enemas increase risk for Perforation of the appendix
   • NO HEAT risk for infection