chrons@ulcerative

8/4/2019 chrons@ulcerative

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Responses that may indicate appendicitis include

Guarding. Guarding occurs when a person subconsciously tenses the abdominal musclesduring an examination. Voluntary guarding occurs the moment the doctors hand touchesthe abdomen. Involuntary guarding occurs before the doctor actually makes contact.

Rebound tenderness. A doctor tests for rebound tenderness by applying hand pressure toa patients abdomen and then letting go. Pain felt upon the release of the pressure

indicates rebound tenderness. A person may also experience rebound tenderness as painwhen the abdomen is jarredfor example, when a person bumps into something or goesover a bump in a car.

Rovsings sign.A doctor tests for Rovsings sign by applying hand pressure to the lowerleft side of the abdomen. Pain felt on the lower right side of the abdomen upon the releaseof pressure on the left side indicates the presence of Rovsings sign.

Psoas sign. The right Psoas muscle runs over the pelvis near the appendix. Flexing thismuscle will cause abdominal pain if the appendix is inflamed. A doctor can check for thePsoas sign by applying resistance to the right knee as the patient tries to lift the right thigh

while lying down. Obturator sign. The right obturator muscle also runs near the appendix. A doctor test forthe obturator sign by asking the patient to lie down with the right leg bent at the knee.Moving the bent knee left and right requires flexing the obturator muscle and will causeabdominal pain if the appendix is inflamed.


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Pathophysiology(Crohns Disease)

Inflammation of bowel wall

Edema and thickening of mucosa

Formation of granulomas

Ulcers begin to appear (skip

lesions)

Cobblestone appearance

transmural

Inflammation extends in the

peritoneum

-fistulas

-abscess

-Bowel wall thickens and

becomes fibrotic

-intestinal lumen narrows

Disrupted absorption -watery stools

-steatorrhea

-Right lower

quadrant pain

-crampy pains

-tenderness

Precipitating Factor

(unknown)

-consumption of non-

fermental foods

-smoking

-pt. who had appendectomy

Predisposing Factor

-common in adolescent

/ Adults-more common in women and

occurs between the frequently in

older populations (ages 50 & 80)

-geneticfactor


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Pathophysiology (Ulcerative Colitis)

Precipitating Factors (unkown)

-Bacterial origin (E. hystolitica,

C. difficile)

-allergies ang immune

disorders

Predisposing Factor

-highest incidence in Caucasians and

people of Jewish Heritage

-20 and 40 years of age (more common)-below average birth weight who are

born to mothers w/ ulcerative colitis

Superficial mucosa of the colon is inflamed

Crypt abscess formation

-muscle hypertrophy

-fat deposits

Bowel wall shortness

absorptive ability

Desquamation/ shedding of colonic epithelium

Diffuse inflammation

Mucosa becomes edematous

Multiple ulcerations

-Diarrhea (10-20 liquid

stools each day)

-Hypocalcemia and

anemia

Passage of

mucus and pus

Rectal bleeding

Left lower

quadrant pain

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