Responses that may indicate appendicitis include Guarding.

. Guarding occurs when a person subconsciously tenses the abdominal muscles during an examination. Voluntary guarding occurs the moment the doctors hand touches the abdomen. Involuntary guarding occurs before the doctor actually makes contact. Rebound tenderness. A doctor tests for rebound tenderness by applying hand pressure to a 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 pain when the abdomen is jarredfor example, when a person bumps into something or goes over a bump in a car. Rovsings sign. A doctor tests for Rovsings sign by applying hand pressure to the lower left side of the abdomen. Pain felt on the lower right side of the abdomen upon the release of 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 this muscle will cause abdominal pain if the appendix is inflamed. A doctor can check for the Psoas 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 for the 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 cause abdominal pain if the appendix is inflamed.

Pathophysiology (Crohns Disease)

Precipitating Factor (unknown) -consumption of nonfermental 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

Inflammation of bowel wall

-Right lower quadrant pain

Edema and thickening of mucosa

Formation of granulomas

-crampy pains -tenderness

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 -watery stools -steatorrhea

Disrupted absorption

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

Left lower quadrant pain

Desquamation/ shedding of colonic epithelium

Diffuse inflammation

Mucosa becomes edematous Rectal bleeding

Multiple ulcerations Crypt abscess formation

Passage of mucus and pus

-muscle hypertrophy -fat deposits

Bowel wall shortness -Diarrhea (10-20 liquid stools each day) -Hypocalcemia and anemia

absorptive ability