Appendicitis Pathophysiology
Acute Inflammation of the vermiform appendix- the blind pouch attached to the cecum of the colon.
Appendicitis Assessment
Abdominal pain in the epigastric or periumbilical area is the initial symptom of classic appendicitis.
McBurney’s point
Perforation-sudden relief of pain; leads to peritonitis.
Appendicitis Diagnostic Tests
CBC
Ultrasound
MRI
CT-main way to diagnosis
Appendicitis Medical Management
Nonsurgical management includes:
- NPO-possible surgery
- IV fluids
- Semi-fowler’s position-decreases pain/pressure
- Analgesics
- No laxatives or enemas
- No heat-increases inflammation
Surgical Management of Appendicitis
Laparoscopy or laprotomy to rule out appendicitis-non rupture
Preoperative care as for general anesthesia surgeries
Operative procedure-appendectomy
Peritonitis
Life threatening acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum
Primary or secondary peritonitis
Rigid, board like abdomen, abdominal pain, distended abdomen, high fever, tachycardia, dehydration, low urine out put, hiccups (pressure on diaphragm), compromised respiratory status, nausea and vomiting
Non Surgical Management of Peritonitis
IV fluids Broad-spectrum antibiotics Daily weight monitored Fluid volume assessed Nasogastric suctioning NPO status Oxygen Pain management
Inflammatory Bowel Disease (IBS)
Characterized by chronic, recurrent inflammation of intestinal tract.
- periods of remission are interspersed with periods of exacerbation
- exact cause is unknown
- there is no cure
Crohn’s Disease
Familial tendencies
Peaks ages 15-40 years
Unknown autoimmune factors
Nausea and vomiting Abdominal pain and distention Tenderness in RLQ Severe diarrhea Low grade fever Steatorrhea due to decreased bile salt resorption Severe malabsorption
Later signs/symptoms
- weight loss
- dehydration
- electrolyte imbalance
- anemia
Complications
- intra-abdominal abscesses
- intestinal fistula
- peritonitis
- deficiency in fat soluble vitamins
Diverticula
Causes:
- thought to be low fiber
- obesity
- smoking
- sedentary lifestyle
- steroid use
- NSAIDs
- Aspirin
Assessment of Diverticulosis/Diverticulitis
Osis:
- cramping in the lower abdomen
- bloating
- constipation
- diarrhea
Itis:
- pain-lower left abdomen, sudden onset
- fever and chills
- nausea and vomiting
- change in bowel habits
- bleeding
Medical Management of Diverticular Disease
Nutrition: initially with a flare up-clear liquid; then high fiber and low fat to reduce stool volume and transit time.
IV fluids with electrolytes to correct imbalances
Avoidance of any irritating foods and liquids
Cold foods and smoking increase intestinal motility
TPN may be needed
Antibiotics and antispasmodics
Hernia Pathophysiolgoy
Weakness in the abdominal muscle wall through which a segment of bowel or other abdominal structure protrudes.
Classification
- reducible-can stick back in
- Irreducible-cannot replace
- strangulated-stuck with no blood supply
Types of hernia include:
- inguinal
- femoral
- umbilical
- incisional or ventral-abdominal incision
