Appendectomy Versus Antibiotic Treatment for Acute Appendicitis
28298226 Appendicitis Appendectomy Ppt
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Transcript of 28298226 Appendicitis Appendectomy Ppt
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ThankYou
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APPENDIX a small finger like appendagesabout 10cm long that is attached to the
cecum just below the ileocecal valve.
APPENDICITIS is the inflammation of thevermiform appendix caused by an obstruction
of the intestinal lumen from infection,stricture, fecal mass, foreign body, or tumor.
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ROVSINGS SIGN an indication of acuteappendicitis in which pressure on the left
lower quadrant of the abdomen causes painin the right lower quadrant.
LAPAROSCOPY technique to examine theabdominal cavity with a laparoscope through
one or more small incision in the abdominalwall, usually at the umbilicus.
PERITONITIS inflammation of theperitoneum.
ABSCESS - collection of purulent
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The appendix becomes inflamed andedematous as a result of becoming kinked oroccluded by a fecalith, tumor, or foreignbody.
The inflammatory process increasesintraluminal pressure, initiating aprogressively severe, generalized orperiumbilical pain that become localized to
the right lower quadrant of the abdomenwithin few hour.
The inflamed appendix fills with pus.
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Age Gender
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Periumbilical pain progresses to right lowerquadrant pain and is usually accompanied bya low grade fever and nausea.
Loss of appetite
Rebound tenderness
Rovsings sign
Constipation
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COMPLETE BLOOD COUNT- it demonstrate an elevated WBC count
with an elevation of the neutrophils.
Abdominal x-ray films
Ultrasound
CT scan
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Perforation
Abscess
Peritonitis
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Immediate surgery Administration of IV fluids and antibiotic
- To correct or prevent fluid and electrolyteimbalance, dehydration and sepsis untilsurgery is performed.
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Relieving Pain
Preventing Fluid Volume Deficit
Reducing Anxiety
Eliminating Infection
Maintaining Skin Integrity
Attaining Optimal Nutrition
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Removal of the appendix
Performed as soon as possible to decreasethe risk of perforation
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Laparotomy
Laparoscopy
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Basic Set
Basic Sharps
AP
OS
Babcock
Silk
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During an appendectomy, an incision two tothree inches in length is made through the skinand the layers of the abdominal wall in the areaof the appendix. The surgeon enters theabdomen and looks for the appendix, usuallylocated in the right lower abdomen. Afterexamining the area around the appendix to becertain that no additional problem is present,the appendix is removed.
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This is done by freeing the appendix from itsattachment to the abdomen and to the colon,cutting the appendix from the colon, andsewing the over the hole in the colon. If an
abscess is present, the pus can be drainedwith drains (rubber tubes) that go from theabscess and out through the skin. Theabdominal incision then is closed.
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Newer techniques for removing the appendix
involve the use of the laparoscope. Thelaparoscope is a thin telescope attached to a videocamera that allows the surgeon to inspect theinside of the abdomen through a small puncture
wound (instead of a larger incision). If appendicitisis found, the appendix can be removed with specialinstruments that can be passed into the abdomen,just like the laparoscope, through small puncturewounds.
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The benefits of the laparoscopic techniqueinclude less post-operative pain (since much
of the post-surgery pain comes fromincisions) and a speedier recovery. Anadditional advantage of laparoscopy is that itallows the surgeon to look inside the
abdomen to make a clear diagnosis in casesin which the diagnosis of appendicitis is indoubt. For example, laparoscopy is especiallyhelpful in menstruating women in whom a
rupture of an ovarian cysts may mimicappendicitis.
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If the appendix is not ruptured (perforated) atthe time of surgery, the patient generally issent home from the hospital in one or twodays. Patients whose appendix has perforatedgenerally are sicker than patients withoutperforation. After surgery, their hospital stay
often is prolonged (four to seven days),particularly if peritonitis has occurred.Intravenous antibiotics are given in thehospital to fight infection and assist in
resolving any abscess
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Occasionally, the surgeon may find a normal-appearing appendix and no other cause forthe patient's problem. In this situation, thesurgeon may remove the appendix. Thereasoning in these cases is that it is better toremove a normal-appearing appendix than tomiss and not treat appropriately an early ormild case of appendicitis.
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All diagnostic tests and procedures are
explained to promote cooperation andrelaxation.
The patient is prepared for the type of surgicalprocedures as well as the post operative care.
Measures to prevent postoperative complicationare taught, including coughing, turning, anddeep breathing using splint at the incision site.
I.V fluids or total parenteral nutrition before
surgery maybe ordered to improved fluid andelectrolyte balance and nutritional status.
Intake and output is monitored.
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Preoperative laboratory are obtained.
Bowel cleansing will be initiated 1 to 2 daysbefore surgery for better visualization.
Antibiotics are ordered to decrease the
bacterial growth in the colon. Patient may not have anything by mouth after
midnight the night before surgery. Medicationmay be withheld, if ordered. This will keep the
GI tract clear.
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Position the patient on the OR table Skin preparation
Induction of anesthesia
Procedures done aseptically Closing of the incision
Dressing of the site
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Monitor vital signs for sign of infection andshock such as fever, hypotension andtachycardia.
Monitor I and O for sign of imbalance,dehydration, and shock.
Assess abdomen for increased pain, distention,rigidity, and rebound tenderness because these
may indicate postoperative complications. Evaluate dressing and incision.
Evaluate the passing of flatus or feces.
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Monitor for nausea and vomiting.
Laboratory values are monitored and patient is
evaluated for sign and symptoms of electrolyteimbalances.
Wound drains, I.V, and all other catheter aremonitored and evaluated for signs of
infections. Turning , coughing, deep breathing, and
incentive spirometry are performed every 2hours.
Diet is advanced as ordered.
Administration of medications as ordered
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Patient Education and Health Maintenance
o Instruct patient to avoid heavy lifting for 4 to6 weeks after surgery.
o Instruct patient to report symptoms ofanorexia, nausea, vomiting, fever, abdominalpain, incisional redness and drainagepostoperatively.
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Thank
You