28298226 Appendicitis Appendectomy Ppt

8/3/2019 28298226 Appendicitis Appendectomy Ppt

1/29


2/29

ThankYou


3/29

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.


4/29

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


5/29


6/29

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.


7/29

Age Gender


8/29

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


9/29

COMPLETE BLOOD COUNT- it demonstrate an elevated WBC count

with an elevation of the neutrophils.

Abdominal x-ray films

Ultrasound

CT scan


10/29

Perforation

Abscess

Peritonitis


11/29

Immediate surgery Administration of IV fluids and antibiotic

- To correct or prevent fluid and electrolyteimbalance, dehydration and sepsis untilsurgery is performed.


12/29

Relieving Pain

Preventing Fluid Volume Deficit

Reducing Anxiety

Eliminating Infection

Maintaining Skin Integrity

Attaining Optimal Nutrition


13/29


14/29

Removal of the appendix

Performed as soon as possible to decreasethe risk of perforation


15/29

Laparotomy

Laparoscopy


16/29

Basic Set

Basic Sharps

AP

OS

Babcock

Silk


17/29

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.


18/29

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.


19/29

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.


20/29

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.


21/29

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


22/29

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.


23/29

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.


24/29

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.


25/29

Position the patient on the OR table Skin preparation

Induction of anesthesia

Procedures done aseptically Closing of the incision

Dressing of the site


26/29

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.


27/29

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


28/29

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.


29/29

Thank

You

28298226 Appendicitis Appendectomy Ppt

Documents

Transcript of 28298226 Appendicitis Appendectomy Ppt