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Process of Appendix Removal

Info: 1495 words (6 pages) Nursing Essay
Published: 11th Feb 2020

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  • Natalija Miller

 

Process Description of Appendix Removal

Appendectomy:

The appendix itself is a small, finger-like projection off the large intestine. Appendicitis is the inflammation of the appendix due to a block in the opening to the colon, or by an infection (US National Library of Medicine, 2014). An appendectomy then, is the surgical procedure done to remove the appendix, usually in cases where acute appendicitis is present. The procedure is considered highly recommended in cases where appendicitis may be suspected to reduce the possibility of a life-threatening infection due to an appendix rupture (Johns Hopkins Medicine).

Causes of Appendicitis:

Appendicitis is considered to have multiple causes, including those that involve stools, mucus, bacteria and other organisms like parasites. These cause the appendix to swell, leading to irritation and inflammation. If the appendix then ruptures, those stools, bacteria, etc., then leak into the abdomen and could cause a serious infection. Inflammation of the abdomen due to bacterial infection is known as peritonitis. Antibiotics, further surgery and/or (in some cases) blood transfusions maybe used to treat this condition (Mayo Clinic, 2011).

Diagnosis of Appendicitis:

Generally, the physician will first inspect the abdomen and evaluate signs and symptoms. Often a light pressure is applied to any areas of pain, and then relieved quickly. Pressing down on the site and letting go quickly should be considerably more painful or discomforting in cases where appendicitis is present. Doctors will often look for what is termed, “guarding” – the tendency to tighten the abdominal muscles due to the increase in pressure against the inflamed area. Other helpful diagnostic testing may occur to confirm appendicitis (ultrasound, white blood cell count, etc.), or to simply rule other complications out (urine testing for kidney stones) (Mayo Clinic, 2014). It is important to note, however, that there are no tests to completely confirm the existence of appendicitis.

Symptoms of Appendicitis:

Certain areas and intensities of pain are considered to be more symptomatic than others. It is important to report any of the following to a physician:

  • Pain of the lower right abdomen or pain that travelled there from the midsection.
  • Progressive pain (increase in severity as time progresses).
  • Heightened pain with touch, coughing/sneezing, or certain movements.
  • Nausea and vomiting.
  • Lack of appetite or desire to consume food.
  • Fever/chills.
  • Constipation/Diarrhea

Laxatives and other bowel regulating methods are exceptionally dangerous in cases of appendicitis due to their contribution to the risk of rupture. Pain medications should also be avoided to ensure that other sites of pain are not overlooked, preventing a physician from concluding a definitive diagnosis (Johns Hopkins Medicine).

Appendectomy Variations:

Open Appendectomy:

This is a method where an incision will be made in the lower right abdomen – generally no more than 3 inches in diameter – by which the physician can locate and extract the appendix.

Laparoscopic Appendectomy:

This is performed through several small incisions and a tube-shaped camera (laparoscope) used to locate the appendix for removal. The laparoscope is hooked-up to a monitor for the surgeon to view during the procedure. This method is not only considered to result in less scarring (shown in Figure 1 below), but also lessen the amount of pain surgery results in, decrease length of hospital care, shorten recovery period, and lower infection rates (Johns Hopkins Medicine).

Figure 1: Laparoscopic Appendectomy incision site

Possible Risks:

There are risks associated with the procedure, which include:

  • Infected incision site.
  • Peritonitis.
  • Obstructed bowels (Johns Hopkins Medicine).
  • Possible bleeding
  • Reactions to anesthesia
  • Pus build-up (US National Library of Medicine, 2014).

Other risks may be possible depending on specific medical conditions – report to the physician along with any concerns about the procedure (Johns Hopkins Medicine).

Procedure:

Before:

The details of the procedure will be extensively described, as which point permission to perform said procedure will be requested. A list of medications or medical concerns will be collected, and a sedative or anesthesia will be given to induce a relaxed state, allowing the operation to begin.

During:

  • All clothing and jewlery will be removed and a gown will be provided to change into.
  • An intravenous (IV) line will be placed in the arm, wrist or hand.
  • Physicians will request a supine position of the operating table (laying on back).
  • An anesthesiologist will monitor all vital signs during the appendectomy.

Open Appendectomy:

Through the incision in the lower right quadrant, the abdominal cavity will be opened by separating the abdominal muscles, and the appendix will be removed through a process involving sutures (a series of stitches). In the case of a rupture, the cavity will be rinsed thoroughly with saline and drained. The incision will then be cleansed with an antiseptic to reduce the risk of infection.

Laparoscopic Appendectomy:

A number of incisions will be made for the laparoscope and the instruments needed to extract the appendix. The abdominal cavity will be inflated with carbon dioxide through one of the incisions to allow for a clearer visual. Once the appendix is located it is tied off with sutures and removed. At the end of both methods, the appendix is examined in a laboratory setting, the incisions will be sealed and the wounds will be dressed with a sterile gauze (Johns Hopkins Medicine).

Returning to Daily Living:

After the procedure, it is recommended that walking take place within a few hours or the following day. Pain medication may be administered to provide a more comforting environment. It is important to progressively increase the solidity of foods to ensure that the body can still consistently regulate itself. Once discharged (usually after a day or two), the incision site must be kept clean and dry (US National Library of Medicine, 2014). Avoid any strenuous activities until the follow –up (2-3 weeks after surgery), for a physician’s recommendations.

It is extremely important to notify a physician if any of the following problems arise:

  • Lasting fever of over 101 degrees Fahrenheit.
  • Any irritation at incision sites.
  • Inability and/or lack of desire to consume fluids.
  • Continuous coughing, shortness of breath and/or trouble breathing.
  • Inability to have bowel movements (Johns Hopkins Medicine).

Recovery to the point where normal, everyday activities can resume will generally take place between 2-4 weeks after being discharged (US National Library of Medicine, 2014).

References

The Johns Hopkins Hospital and Health System. (n.d.). Appendectomy. Retrieved October 26, 2014, from http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/appendectomy_92,P07686/

Mayo Clinic. (2014, August 20). Appendicitis. Retrieved October 26, 2014, from http://www.mayoclinic.org/diseases-conditions/appendicitis/basics/tests-diagnosis/con-20023582

Mayo Clinic. (2011, July 9). Peritonitis. Retrieved October 26, 2014, from http://www.mayoclinic.org/diseases-conditions/peritonitis/basics/treatment/con-20032165

U.S National Library of Medicine. (2014, October 9). Appendectomy: MedlinePlus Medical Encyclopedia. Retrieved October 26, 2014, from http://www.nlm.nih.gov/medlineplus/ency/article/002921.htm

 

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