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US Army Medical the Gastrointestinal System Ed.100

US Army Medical the Gastrointestinal System Ed.100


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Published by Space_Hulker
US Army Medical the Gastrointestinal System Ed.100
US Army Medical the Gastrointestinal System Ed.100

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Published by: Space_Hulker on Mar 03, 2009
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a. Definition. Appendicitis is the inflammation of the vermiform appendix. The
appendix, a narrow, blind tube located at the tip of the cecum, becomes inflamed.

b. Etiology. An obstruction occurs, and the contents of the appendix cannot
empty normally. The obstruction may be a fecalith (a hardened piece of stool),
inflammation, a foreign body, or a tumor. The intestinal contents locked in the appendix
are full of bacteria. Prolonged contact of this bacteria with the tissues of the appendix
often produces infection. Infection of the appendix occurs quickly followed by
inflammation. Perforation occurs if inflammation weakens the appendix tissues.
Perforation is a dangerous complication because if the intestinal contents spill into the
peritoneal cavity, the result can be generalized peritonitis or an abscess.

c. Signs and Symptoms. Appendicitis seems to be more common among
adolescents and young adults, but this disorder can occur at any age. The most
common initial symptom is an attack of severe abdominal pain. Signs and symptoms
progress in this manner:

(1) At first, pain is generalized in the abdominal area. Later, the pain
becomes concentrated in the right, lower quadrant of the abdomen. The most severe
pain is usually midway between the umbilicus and the right iliac crest at a point called
McBurney's point.

(2) Next, loss of appetite, moderate feeling of being sick, slight fever (up to

102ºF) and mild nausea.

(3) Vomiting, if it occurs, appears next.

(4) Eventually (from 2 to 12 hours), pain shifts to the right side localizing in

the right lower quadrant.

(5) Pain persists as a steady soreness made worse by walking or coughing.
The patient finds that he is most comfortable lying still and drawing the right leg up to
relieve tension on the abdominal muscles.

(6) Constipation usually, but sometimes diarrhea.

(7) Rectal tenderness.

(8) Bowel sounds are diminished or absent.

NOTE: Ninety-five percent of appendicitis cases have a tendency to become
progressively worse and develop the complication of perforation.



d. Diagnosis.

(1) The patient can usually point to the location of pain. If the patient is
asked to cough, the main point of pain will be one-third the distance from the anterior
iliac crest to the umbilicus.

(2) Since perforation rarely occurs during the first eight hours of signs and
symptoms, it is generally safe to observe for diagnosis during this time.

(3) There is a moderate increase in the number of leukocytes in the blood
(leukocytosis--10 to 20 thousand) with an increase in white blood cells, specifically the

e. Treatment.

(1) Before surgical facilities are available, have the patient follow this


(a) Bed rest in the semi-Fowler's position.

(b) Nothing by mouth. Give intravenous fluids as necessary, and keep
an accurate record of the patient's fluid intake and output.

(c) Ice bag to the abdomen. DO NOT apply heat to the appendix


(d) Prophylactic antibiotics or analgesics may be given at the discretion

of the surgeon.

(e) DO NOT give laxatives or enemas.

(2) When surgical facilities are available, the appendix should be removed.

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