appendicitis management

Apr 15th, 2015
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THE ACUTE ABDOMEN/APPENDICITISMBChB VIAcute abdomenSudden onset of severe and worseningabdominal pain whose treatment may includeemergency surgerySeverity of pain not = seriousnessPainTime and mode of onset?LocationCharacterAssociated symptomsAnatomyAnatomy of painVisceral peritoneum (mesoderm)Innervation :AutonomicPain dull crampy, poorly localised,Sensitive to Distension stretching & contraction vsresistance Ischemia, inflammationParietal peritoneum ()Nausea and vomiting diaphoresisInnervation : Entirely somatic, from spinal nervesPain: sharp severe & localised,Rigdity and tendernessMigration to somatic pain indicates surgicalprogressionPathology of painObstruction Colic:Inflammation Mildpain til it becomes transmuralPerforation Buildscyclical, nauseatingto a crescendo then becomes somatic/diffuseTorsion Severe,suddenIschemia Painout of proportionEvaluationMost important instrument: the chairAttitudeFacial expressionAbdomical contourOnset?Course?Prodrome?Vomiting/nauseaReferred painDiarrhea/last bowel movementPast drugs: steroids; DMLMPExaminationGeneral assesmentVital signsAttitudePositionHernial orificesChest auscultationExamine incisions and stomasLabs esp routine

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