Inflammatory Disorders: Appendicitis (Nursing)

00:01 Hi, I'm Dr. Jackie Calhoun.

00:03 And today we're going to talk about pediatric appendicitis.

00:07 So in this lecture, we're going to cover the definition the causes, the epidemiology, or who gets it, the signs and symptoms, which we also call the cues, the diagnosis and the treatment of this condition.

00:21 So first, what is pediatric appendicitis? So, let's talk about what the appendix is first.

00:28 So it's a small attachment located at the base of the ascending colon, which is the first part of the large intestine after the small intestine.

00:36 And it's funny because no one is sure exactly what it does.

00:41 But sometimes it can become inflamed, which is the definition of appendicitis.

00:46 So appendix plus citis, or itis remember, anything with itis at the end of it means inflammation.

00:54 So inflamed appendix is appendicitis.

00:59 And now we're going to talk about what causes it.

01:02 So just like we don't know exactly what the appendix does, we don't know exactly what causes appendicitis.

01:11 There are a few theories.

01:13 One guess is that a piece of hard stool might get stuck in the appendix and kind of shut it off from the rest of the intestine.

01:22 There also could be bacteria that get trapped in there, particularly if there was that hard stool, blocking it.

01:29 But whatever the cause the end result is appendiceal inflammation or appendicitis.

01:36 Sometimes that inflamed appendix can rupture or perforate.

01:41 And this is a much more serious condition than regular appendicitis.

01:46 So what kind of kids get appendicitis? Generally, the older a child is, the more likely they are to get appendicitis.

01:55 So infants or babies rarely develop it.

01:58 It's like something we hardly even think about in that age group.

02:02 And then, as children get older, particularly when they're school age, so kind of like five, six years old and older, that's when they it starts to become something that you think about in kids, and then adolescents and young adults.

02:18 In kids this is when it's the most common.

02:23 So, lets talk about the signs and symptoms or the cues of appendicitis.

02:26 So how can we tell if a kid has appendicitis.

02:30 The first sign is usually pain that begins near the umbilicus or the belly button.

02:37 And then this pain actually then moves from the middle of the abdomen down to the right lower abdomen, kind of over where the appendix is located.

02:48 And then finally, as it progresses, that pain is felt throughout the entire abdomen.

02:54 After that pain has developed and changed the patient may become listless or irritable and listless and kind of mean like, they seem they're not quite there, not as interactive with their environment.

03:08 They're not responding the way you would expect them to or not really responding at all.

03:12 And irritability, we all know. They're a little they're grumpier.

03:15 They're reacting negatively to things that you wouldn't expect them to if they felt fine.

03:21 After at that list, is this an irritability.

03:25 There, the patient likely will have a decreased appetite.

03:29 We all know that when your belly hurts, you don't want to eat.

03:32 This can also be accompanied by nausea or vomiting.

03:37 And they may also have a low grade fever.

03:41 It's important to note that all of these symptoms seem very similar to viral gastroenteritis.

03:48 So if a child has a virus that's causing them to throw up.

03:52 But these symptoms happen in a different order in patients that have appendicitis than in those who have viral gastroenteritis.

03:59 than in those who have viral gastroenteritis.

04:00 So patients that have appendicitis, they start with that pain and end with a fever.

04:05 And when someone has a viral gastroenteritis, they start with the fever and the nausea and vomiting kind of end with the pain.

04:13 So how is appendicitis diagnosed? It's important before we get into this section to know that this diagnosis can be really challenging.

04:25 The symptoms like we just talked about can be similar to other diseases and really common diseases like viral gastroenteritis.

04:33 And so it can take us a while to get to appendicitis that diagnosis because we have to work through other things.

04:41 If a patient is suspected of having it of having appendicitis, we'll often start with blood labs.

04:47 So we often draw serum electrolytes, and then a complete blood count.

04:53 The serum electrolytes show if a patient is dehydrated, particularly if they've been having a lot of nausea and vomiting.

05:00 And then the complete blood count can help us rule out an infection.

05:06 The imaging study of choice for appendicitis is an abdominal ultrasound.

05:12 But it can be hard to find the appendix on this.

05:15 So sometimes a patient may have to have an abdominal CAT scan or CT scan, or an MRI.

05:23 The ultrasound is nice because there's no radiation.

05:26 And the ultrasound machine is taken to a patient's bedside, whether they're in the emergency room or in the hospital and the patient doesn't have to go anywhere else.

05:37 But the CT scan shows a lot more detail.

05:41 But it has a lot of radiation that is associated with it too.

05:44 Lastly, if we go through all of those things, especially the imaging.

05:49 And we still don't know if this patient has appendicitis or not, there may be some exploratory surgery where the surgeons will actually come in and physically try to look at the appendix in surgery to see if it looks like it is inflamed or not.

06:05 So if an appendix needs to be removed, which it doesn't always we'll talk about that.

06:11 It's done with a laparoscopic appendectomy.

06:15 So this is where either they go into look at it, like we just said, and they're trying to see if it's inflamed, or if they actually have determined it needs to come out.

06:23 There's usually three incisions and there's different probes that you can see here, one to kind of look and the other probes are used to actually remove that appendix and the incisions are small.