Health alterations class 23: appendicitis

Most common emergency surgery of childhood (average age 10)

Surgery for acute appendicitis

Acute appendicitis

Obstruction of lumen of appendix from hardened stool or lymph fluid and tissue

Causes pressure increase, get ischemia or ulceration inside.

Can perforate or rupture

Can get peritonitis, loss of extracellular fluid, electrolyte imbalances and Hypovolemia shock

Clinical manifestations of appendicitis

Class first symptoms is periumbilical pain

N/V

Abdominal pain in RLQ

Fever (low with appendicitis, increased if rupture)

Possible anorexia and diarrhea

Elevated WBC

Appendicitis perforation

Can occur within 48 hours of onset of pain

Sudden relief from pain that doesn’t last long

Increased fever

Pain when going over bumps, hopping etc

Complications: major abscess, fistula, peritonitis, partial bowel obstruction

Diagnosis of acute appendicitis

Based on history, physical and signs and symptoms

Pain at McBurney’s point

Elevated WBC

Urinalysis to rule out UTI or ectopic pregnancy

Ultrasound or CT

McBurney’s point

Midway between anterior superior iliac crest and umbilicus

Acute appendicitis will have pain there

Indicators of appendicitis pain for children/infants

Lying in side with knees up to belly, refusing to move right hip

Crying and screaming

Guarding

Management of acute appendicitis before perforation

Rehydration

Prophylactic ABs in case of rupture

Laparoscopic removal of appendix

Post op care of laparoscopic appendectomy

Pain from gas

As they get us gas moves up (pain in shoulders etc)

Get them to move around, swing arms around, burp and fart

Management of ruptured appendix

IV fluid and lytes

ABs

NPO with NG compression and suctioning

Splint with pillow

May have Penrose drain post op

2 forms of IBD

Ulcerative colitis

Crohns disease

Ulcerative colitis

Inflammation of mucosa of colon and rectum

Affects mucosa and submucosa (Serosa still intact)

Edema thus mucous membranes, bleed easy

Mucosa has ulcerations and polyps

Clinical manifestations of UC

Bloody, mucous diarrhea, rectal bleeding. Severe diarrhea

Abdominal cramps, hyperactive bowel sounds

Severe pain with defecation

Anorexia, anemia, fatigue

Ammenhorhea

Main differences of UC and CD

Ulcerative colitis involves colon and rectum, serosa is intact. Polyps

Crohns involves whole GI, serosa not intact

Ulcerative colitis has severe, mucosa and bloody diarrhea and rectal bleeding

Crohns has moderate to severe diarrhea. Rectal bleeding is rare. Can also have anal and perianal lesions, fistulas and strictures

Crohn’s disease

May involve various GI segments and all layers of mucous a of bowel wall

Lesions erode through intestinal wall over time

Ulceration results in adhesions, stiffening of bowel wall, strictures and fistulas between bowel, bladder, vagina or skin

Can get abscesses

Clinical manifestations of CD

Moderate to severe diarrhea Abdominal cramps

Cranky abdominal pain

Severe weight loss and anorexia and growth delay

Rectal bleeding is rare

Common to have anal and perianal lesions. Fistulas and strictures

Amenorhea

Tenesmus

Needing to have a BM after already having one

UC and CD stool chart

Time and appearance/characteristics

Diagnosis of UC and CD

Health history

Physical exam: Abd, perianal and rectal, growth and development

Lab: CBC, stool test

Radiography: upper GI, barium swallow (white poop), abd CT

Endoscopy: sigmoid or colonoscopy (more common) with biopsy

Management of UC and CD

High protein, high calorie meals and vitamin supplements

May need enteral and parenteral nutrition

Meds:anti inflammatory, antidiarrheal, AB, analgesics, corticosteroids

Surgery: when other intervention fails. Parts of bowel removed