What is 1st managment of appendicites?

SURGICA PROCEDURE

Appendectomy has been the established treatment of acute appendicitis during the last century, regarded as a simple and safe procedure, although hampered with  postoperative complications and increased standard mortality. Modern research has indicated that selected  patients with acute appendicitis can be treated by antibiotic therapy alone

Surgery need not be the first line of treatment for acute uncomplicated appendicitis, researchers from Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, England, reported in the BMJ (British Medical Journal). Often, the use of antibiotics may be a safe and viable alternative, the authors explained.

According to recent studies, however, antibiotic therapy results in fewer problems and complications than surgery for patients with uncomplicated appendicitis. However, the studies have not had compelling enough evidence either way, the researchers wrote.

They gathered data from four randomized, controlled human studies which included900 adults; they had all been diagnosed with uncomplicated acute appendicitis.470 of them were randomly selected to receive antibiotics, while430 had their appendixes removed surgically.

Some recent studies have found fewer problems with antibiotic treatment than surgery when the condition is not complicated.

So Lobo's team evaluated four published studies comparing the approaches. The studies included900 patients. Of those,470 got antibiotics and430 got surgery. Antibiotics were given intravenously and then by mouth.

Their findings:

• Antibiotics were linked with a63% success rate at one year. Other patients had to have surgery.
• Compared to surgery, antibiotic treatment had a39% reduced risk of complications. This was after excluding those who were started on drugs but later needed surgery.
• A fifth of those treated with antibiotics had a return of symptoms and went back to the hospital.  Of these,19% had complicated appendicitis. 
• The length of hospital stay was not different between the antibiotics and surgery groups.

APPROACH CONSIDERATION

Appendectomy remains the only curative treatment of appendicitis, but management of patients with an appendiceal mass can usually be divided into the following3 treatment categories:

• Patients with a phlegmon or a small abscess: After intravenous (IV) antibiotic therapy, an interval appendectomy can be performed4-6 weeks later.
• Patients with a larger well-defined abscess: After percutaneous drainage with IV antibiotics is performed, the patient can be discharged with the catheter in place. Interval appendectomy can be performed after the fistula is closed.
• Patients with a multicompartmental abscess: These patients require early surgical drainage.

Although many controversies exist over the nonoperative management of acute appendicitis, antibiotics have an important role in the treatment of patients with this condition. Antibiotics considered for patients with appendicitis must offer full aerobic and anaerobic coverage. The duration of the administration is closely related to the stage of appendicitis at the time of the diagnosis, considering either intraoperative findings or postoperative evolution. According to several studies, antibiotic prophylaxis should be administered before every appendectomy. When the patient becomes afebrile and the white blood cell (WBC) count normalizes, antibiotic treatment may be stopped.

If all features point to acute appendicitis, you have a grace period of 24 hours to perform the surgery. If not, it is gonna become an apppendicular lump due to adhesions,and so the elective can be done after 6-8 weeks.

Mind you,acute appendicitis is a diagnosis of exclusion and many unecessary appendectomies are being done.

The only way to get a 100% diagnosis is when it perforates.

A high index of suspicion howver is by MRI.

If confirmed appendicites (Abd-UTZ), immediately advise for NPO status. Insert IV cannula G18 collect blood for serology, the doctor may start antibiotics and fluids also. If for surgery, consent must be secured and signed. And follow the rest of doctors order.

Appendicitis is caused by a blockage of the hollow portion of the appendix, Appendicitis commonly presents with right lower abdominal pain, nausea, vomiting, and decreased appetite, The standard 1st treatment for acute appendicitis is surgical removal of the appendix.

prepear for appendectomy

keep patient NPO

antibiotec and iv hydration

Giving IV fluids and antibiotics , and refer to theater

immediately operation and appendectomy  

NPO, IVF and start a strong antibiotic and prepare the patient for appendecectomy

patient should be investigated well be sure of the diagnosis then be put NPO then transferred to surgey either laparoscopic or open appendicectomy

 the patient should be put on NPO,

started in I.V Antibiotics and I.V Hydration

then go to surgery ( appendictomy)