Acute Appendicitis
a) What are the clinical features of acute appendicitis?
b) What is the immediate Preoperative Management?
c) Draw out a nursing care plan for the first 48 hours post-operative period.
Definition
Inflammation of the vermiform appendix is called appendicitis
Aetiology
Appendicitis is the most common cause of acute abdomen in young adults
Most frequently performed urgent abdominal operation
Commonin childhood and early adult life : peak between 10 -25 yrs
Causes : luminal obstruction by a faecolith or a stricture or a tumor leading to proliferation of bacteria
Pathology
Obstruction → proliferation of bacteria → inflammation of the mucosa → transmural spread → serosal layer involved → gathering of omentum and intestines near the appendix → mass formation.
May form fluid/pus around
May spread to the general peritoneal cavity → peritonitis.
Perforation of appendix may occur → pneumoperitoneum
Clinical Features
Early stage : only a colicky abdominal pain in the preumbilical region
Nausea and vomiting
Aversion to food
Anorexia
H/O such episodes previously
Progressive inflammation involves the parietal peritoneum and more intense, constant and more intense pain
coughing or sudden movement exacerbates the RIF pain
Mild fever
Tenderness in RIF
Pain in the RIF on palpation of the LIF - Rovsing's Sign
Muscle guarding first localised to RIF and when peritonitis sets in whole abdomen is rigid
If the pain is increased when the palpating hand is lifte off the abdomen - Rebound Tenderness - denotes ganrenous changes in the appendix
Retrocacal appendix - rigidity is absent, tenderness even on deep palpation absent
Pelvic - diarrhoea, absence of rigidity, PR examination elicits tenderness in the retrovesical pouch or Douglas Pouch, involment of the bladder - increased frequency of micturition
Post ileal - diarrhoea, marked retching
Differential Diagnosis
A.G.E. (Acute Gastro Enteritis)
mesenteric lymphadenitis
Meckel's diverticulitis
Intussusception
Purpura
Terminal ileitis
Ureteric colic
Right sided acute pyelonephritis
Perforated peptic ulcer
Testicular torsion
Acute pancreatitis
Salpingitis
Rupture of ovarian follicle with bleeding
Torsion of ovarian cyst
Ectopic pregnancy
Investigations
TC, DC, ESR, Peripheral Smear
Urine analysis
X-ray abdomen including diaphragms
USGM abdomen and pelvis
Blood sugar, Serum urea, electrolytes
Pregnancy test
Treatment
IV fluids to correct dehydration and electrolyte imbalance
Pain relief
Antibiotics and metronidazole
Appendicectomy
Preoperative Management
Do the investigations
Relieve pain by analgesics and antispasmodics
Start antibiotics
Start IV fluids
Position of Comfort
Prepare the parts for surgery
NO ENEMA (enema - bowel movements → spreading of infection which is localized.
Post operative Management
Keep air way clear and monitor breathing
6 hrly PTR
Pain relief
Antibiotics
Nil orally until bowel sound are restored
Oral feeds started with small rations of liquids and gradually increased to solid diet
Wound care
Suture removal on 7-10th day
