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Published by: Kathleen Kae Carmona Tan on Mar 02, 2012
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01/15/2013

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is the inflammation of the vermiform appendix and was first described as a pathologic condition by Reginald Fitz in 1886; it is caused

by an obstruction attributed to infection, stricture, fecal mass, foreign body or tumor. Appendicitis can affect either gender at any age, but is most common in male ages 10-30. Appendicitis is the most common disease requiring surgery and one of the most commonly misdiagnosed diseases. Appendectomy, removal of the appendix, is the standard treatment for acute appendicitis, it is important to immediately remove the appendix after the diagnosis to prevent the occurrence of the life-threatening complication of appendix. The most frequent complication of appendicitis is perforation. Perforation of the appendix can lead to a periappendiceal abscess (a collection of infected pus) or diffuse peritonitis (infection of the entire lining of the abdomen and the pelvis). The major reason for appendiceal perforation is delay in diagnosis and treatment. In general, the longer the delay between diagnosis and surgery, the more likely is perforation. The risk of perforation 36 hours after the onset of symptoms is at least 15%. Therefore, once appendicitis is diagnosed, surgery should be done without unnecessary delay.

Gender: A male preponderance exists. runs in certain families. Infections: Gastrointestinal infections such as Amoebiasis. which predisposes it to infection. Seasonal variation: Most cases of appendicitis occur in the winter months between the months of October and May.Risk Factors Age: Appendicitis can occur in all age groups but it is more common between the ages of 11 and 20. Hereditary: A particular position of the appendix. Sometimes appendicitis can occur as a result of: . Mumps.4: 1) and the overall lifetime risk is 8. Having a family history of appendicitis may increase a child's risk for the illness. Coxsackievirus B and Adenovirus can predispose an individual to appendicitis. Bacterial Gastroenteritis. A male child suffering from cystic fibrosis is at a higher risk for developing appendicitis Diet: People whose diet is low in fiber and rich in refined carbohydrates have an increased risk of getting appendicitis. Causes The cause of appendicitis isn't always clear. with a male to female ratio (1.7% for females.6% for males and 6.

Appendicitis may also follow an infection. If not treated promptly. bacteria inside the appendix multiply rapidly. In both cases. Food waste or a hard piece of stool (fecal stone) can block the opening of the cavity that runs the length of your appendix. walk or make other jarring movements Nausea Vomiting Loss of appetite Low-grade fever Constipation . the appendix can rupture. or it may result from other types of inflammation. causing the appendix to become inflamed. Signs and Symptoms Aching pain that begins around your navel and often shifts to your lower right abdomen Pain that becomes sharper over several hours Tenderness that occurs when you apply pressure to your lower right abdomen Sharp pain in your lower right abdomen that occurs when the area is pressed on and then the pressure is quickly released (rebound tenderness) Pain that worsens if you cough.An obstruction. such as a gastrointestinal viral infection. swollen and filled with pus. An infection.

Young children or pregnant women. depending on your age and the position of your appendix. . especially. may have appendicitis pain in different places.Inability to pass gas Diarrhea Abdominal swelling  The location of your pain may vary.

lymph node.Pathophysiology Obstruction of the appendix (by fecalith. foreign objects) Inflammation Increase intraluminal pressure Distention of the Appendix (causes pain) Decrease venous drainage Blood flow and oxygen restriction to the appendix Bacterial Invasion of the Blood wall (causes fever) Necrosis of the appendix . tumour.

Administer antibiotics and intravenous fluids until surgery is performed.Diagnostic Procedure Urinalysis White Blood Cell Count Abdominal X-ray Ultrasound The Alvarado Score for Acute Appendicitis A popular mnemonic used to remember the Alvarado score factors is MANTRELS: Migration to the right iliac fossa Anorexia. Barium enema Computerized (CT) Scan Laparoscopy Tomography . Nausea/Vomiting Tenderness in the right iliac fossa Rebound pain Elevated temperature (fever) Leukocytosis Shift of leukocytes to the left Medical Management Surgery is indicated if appendicitis is diagnosed and should be performed as soon as possible to decrease risk of perforation.

Laparoscopy is a new technique for removing the appendix which involves the use of the laparoscope. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). an incision two to three inches in length is made through the skin and the layers of the abdominal wall over the area of the appendix. The surgeon enters the abdomen and looks for the appendix which usually is in the right lower abdomen. Second is Laparoscopic Method. The appendix may be removed in two ways: First is the open method or through appendectomy. The benefits of the laparoscopic technique include less post-operative pain . through small puncture wounds. cutting the appendix from the colon. During an appendectomy. and sewing over the hole in the colon. The abdominal incision then is closed.Analgesic agents can be given after diagnosis is made. After examining the area around the appendix to be certain that no additional problem is present. If an abscess is present. Surgical Management Surgery is the only treatment for acute appendicitis. the appendix is removed. This is done by freeing the appendix from its mesenteric attachment to the abdomen and colon. the appendix can be removed with special instruments that can be passed into the abdomen. just like the laparoscope. If appendicitis is found. the pus can be drained with drains that pass from the abscess and out through the skin.

(since much of the post-surgery pain comes from incisions) and a speedier return to normal activities. laparoscopy is especially helpful in menstruating women in whom a rupture of an ovarian cyst may mimic appendicitis. and increased leukocyte count) . Preoperatively. For example. fever. and attaining optimum nutrition. Do not administer an enema or laxative (could cause perforation). and insert nasogastric tube (if evidence of paralytic ileus). monitor carefully for signs of intestinal obstruction. tachycardia. give food as desired on day of surgery (if tolerated). administer antibiotic. administer intravenous fluids. administer oral fluids when tolerated. reducing anxiety. If a drain is left in place at the area of the incision. or secondary abscesses (eg. If dehydrated before surgery. secondary hemorrhage. eliminating infection due to potential or actual disruption of the gastrointestinal tract. place patient in semi-fowler’s position. give narcotic analgesic as ordered. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in which the diagnosis of appendicitis is in doubt. Nursing Management Nursing goals include relieving pain. Postoperatively. prepare patient for surgery. maintaining skin integrity. start intravenous line. preventing fluid volume deficit.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Your gallbladder is a small. while others develop many gallstones at the same time. Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Gallbladder attack. just beneath your liver. Risk Factors Being female Being age 60 or older Being an American Indian Being a Mexican-American . Some people develop just one gallstone. Biliary Calculus and Biliary Colic. The gallbladder holds a digestive fluid called bile that's released into your small intestine. Gallstones that don't cause any signs and symptoms typically don't need treatment.Also known as Gallstones. Gallstone attack. Gallstones are common in the United States. People who experience symptoms from their gallstones usually require gallbladder removal surgery. pear-shaped organ on the right side of your abdomen.

Your bile contains too much bilirubin. But if your liver excretes more cholesterol than your bile can dissolve. your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. Certain conditions cause your liver to make too much bilirubin. including liver cirrhosis. the excess cholesterol may form into crystals and eventually into stones. Doctors think gallstones may result when: Your bile contains too much cholesterol. Normally. such as hormone therapy drugs It's not clear what causes gallstones to form. Bilirubin is a chemical that's produced when your body breaks down red blood cells. biliary tract .Being overweight or obese Being pregnant Eating a high-fat diet Eating a high-cholesterol diet Eating a low-fiber diet Having a family history of gallstones Having diabetes Causes Losing weight very quickly Taking some cholesterollowering medications Taking medications that contain estrogen.

If your gallbladder doesn't empty completely or often enough. If a gallstone lodges in a duct and causes a blockage. Seek immediate care if you develop signs and symptoms of a serious gallstone complication. just below your breastbone Back pain between your shoulder blades Pain in your right shoulder Gallstone pain may last several minutes to a few hours. such as: Sudden and rapidly intensifying pain in the upper right portion of your abdomen Sudden and rapidly intensifying pain in the center of your abdomen. Your gallbladder doesn't empty correctly. such as: Abdominal pain so intense that you can't sit still or find a comfortable position . Signs and Symptoms Gallstones may cause no signs or symptoms. signs and symptoms may result. The excess bilirubin contributes to gallstone formation.infections and certain blood disorders. bile may become very concentrated and this contributes to the formation of gallstones.

Yellowing of your skin and the whites of your eyes Clay-colored stools High fever with chills Pathophysiology Diagnostic Procedures Abdominal ultrasound Abdominal CT scan Endoscopic retrograde cholangiopancreatography (ERCP) Gallbladder radionuclide scan Endoscopic ultrasound Magnetic resonance cholangiopancreatography (MRCP) Percutaneous transhepatic cholangiogram (PTCA) Bilirubin Liver function tests Pancreatic enzymes .

this is done less often now. Patients are often sent home from the hospital on the same day as surgery. open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. and the stones may return after treatment ends. and the gallstones may return. which allow for a faster recovery. The chemical rapidly dissolves cholesterol stones. . chemicals are passed into the gallbladder through a catheter. This treatment is not used very often. because it is difficult to perform. ursodiol) may be given in pill form to dissolve cholesterol gallstones. they may take 2 years or longer to work. Surgical Management A technique called laparoscopic cholecystectomy is most commonly used now. Because gallstones often come back in many patients.Medical Management Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA. Rarely. this treatment is not used very often anymore. the chemicals can be toxic. However. LITHOTRIPSY Electrohydraulic shock wave lithotripsy (ESWL) of the gallbladder has also been used for certain patients who cannot have surgery. However. This procedure uses smaller surgical cuts. or the next morning. In the past.

Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to find or treatgallstones in the common bile duct. Nursing Management .

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