Disorders of the Gastrointestinal System, 2nd Edition
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Appendicitis Appendicitis is the most common dis- ease requiring emergency surgery, with an estimated 5%–9% of the population experiencing appendicitis at some point (National Institute of Diabetes and Diges- tive and Kidney Diseases [NIDDK], 2021). Appendicitis results from inflammation caused by obstruction of the appendix lumen (the inside of the appendix), infec- tion, stricture, fecal mass, or inflammatory bowel disease. Signs and symptoms of appendicitis in- clude the following (Martin, 2022). ● Abdominal pain: ○ Tenderness at McBurney’s point: This point is about 1.5 to 2 inches above the iliac crest on the anterior right side. ○ Rovsing’s sign: Pain occurs in the right lower quadrant when the left lower abdomen is pressed. This indicates peritoneal irritation. ○ Psoas sign: Pain in the right lower quadrant occurs when the right hip is passively extended. ● Rebound tenderness is common. It is elicited when the nurse or provider removes pressure from the abdomen rather than when pressure is applied, as in palpation. In other words, the nurse applies gentle pressure during palpation, and rebound tenderness is present when that pressure is released and pain occurs. ● Nausea or vomiting. ● Low-grade fever. ● Elevated white blood cell (WBC) count with many immature cells. CT scan, MRI, abdominal x-ray, or ab - dominal sonography may be useful in visualizing the appendix. Diagnosis is based on patient history and diagnostic test results (Martin, 2022).
| NURSING CONSIDERATION
Factors necessary for vitamin B12 ab- sorption are found in gastric secre- tions. Lifelong replacement vitamin B12 and iron supplements are neces- sary for patients who have had gas- trectomies (MSKCC, 2022a).
OTHER GI DISORDERS
CASE STUDY 5 Daniel is a 22-year-old college senior. He and a group of friends are studying for fi - nal exams when he begins complaining of nausea and pain in the right lower ab- domen. Daniel’s friends are not very sym- pathetic. One of them comments, “You really overdid it last night! I have never seen you drink so much beer at one par- ty!” The pain worsens as their study ses- sion progresses, and Daniel is doubled over in pain. His friends decide to take him to the campus health center. The nurse on duty listens to Daniel’s complaints and finds rebound tender - ness over his right lower abdomen. She arranges for Daniel to be immediately transferred to the local hospital. Daniel has appendicitis. Question All of the following are examples of classic signs of appendicitis EXCEPT: a. Homan’s sign. b. Rebound tenderness at McBurney’s point. c. Rovsing’s sign. d. Psoas sign. Answer/Rationale: The correct answer is a. Homan’s sign is often used in the diagnosis of deep venous thrombosis of the leg. Rebound tenderness at McBurney’s point, Rovsing’s sign, and Psoas sign indicate a risk of appendicitis.
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