1. Appendix
Appendix : is a small, finger-shaped that projects from colon on the lower right side of abdomen.
Appendicitis: is inflammation of the appendix.

2. Clinical Manifestations
1- Epigastric or per umbilical pain progresses to right lower quadrant pain.
2- Fever.
3- Nausea, and sometimes vomiting.
4- loss of appetite
5- constipation or diarrhea may occur
6- local tenderness with pressure and some rigidity of the lower portion of the right rectus muscle may felt during (Rebound tenderness may be present).
7- If the appendix has ruptured, the pain becomes more diffuse; abdominal distention develops as a result of paralytic ileus.

3. Assessment and laboratory Findings
Diagnosis is based on a complete physical examination
Elevated WBC count with an elevation of the neutrophils,
Abdominal x-ray films,

4. Medical Management
1- Administer antibiotics and IV fluids until surgery is performed.
2- Analgesic agents can be given after diagnosis is made.
3- Surgery (conventional or laparoscopic) is indicated if appendicitis is diagnosed and should be performed as soon as possible to decrease risk of perforation.

5. Complications The major complication of appendicitis is:
perforation of the appendix, which can lead to peritonitis,
abscess formation (collection of purulent material).  

6. Nursing Management
Monitor for abdominal tenderness, fever, vomiting,
Relieving pain,
Assess patient for anorexia, chills and diaphoresis.
replace fluids and electrolytes with intravenous route.
Administer antibiotic agents as prescribed,
Reducing anxiety,
Observe for diarrhea, which may indicate abscess,
optimal nutrition,
Assess for bowel sounds,
Prepare for surgery,

7. Preoperatively prepare patient for surgery
start IV line
administer antibiotic
and insert nasogastric tube (if evidence of paralytic ileus).

8. Postoperatively
place patient in high Fowler’s position
Give analgesic as ordered
administer oral fluids when tolerated
give food as desired on day of surgery (if tolerated).

9. Irritable Bowel Syndrome Irritable bowel syndrome (IBS) is a common functional disorder of GI motility not associated with anatomic changes. It is also known as spastic colon or irritable colon. These disorder occur over a long time, often years. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among patients with IBS.

10. Types of irritable bowel syndrome types:
IBS with constipation (IBS-C) - the patient have stomach pain, discomfort, bloating, infrequent or delayed bowel movements, or hard or lumpy stools.
IBS with diarrhea (IBS-D) - the patient experiences stomach pain, discomfort, an urgent need to go to the toilet, very frequent bowel movements, or watery or loose stools.
IBS with alternating stool pattern (IBS-A) - the patient experiences both constipation and diarrhea.

11. environmental factors, like stress genetic factors
Causes
causes of IBS are still unknown. The factors that appear to play a role include:
dietary factors: that foods rich in carbohydrates, spicy or fatty foods, coffee, and alcohol.
GI Motility Problems
environmental factors, like stress
genetic factors
central nervous system not controlling digestive system properly
digestive organs excessively sensitive to pain. the nerves in gut may be extra sensitive.
Severe infection, can develop after a severe diarrhea (gastroenteritis) caused by bacteria or a virus
Muscle contractions in the intestine, muscles used to move food through the body malfunctioning.

12. Signs and Symptoms Abdominal pain relieved by defecation.
Cramping or bloating that is typically relieved or partially relieved by passing a bowel movement
Excess gas
Abdominal bloating, with or without visible abdominal distention.
Diarrhea or constipation — sometimes alternating of diarrhea and constipation
Mucus in the stool
Depression, anxiety.

13. Risk factors
1. Young. IBS occurs more frequently in patients under age 50.
2. Female. IBS is more common among women. Estrogen
therapy before or after menopause.
3- Family history of IBS. Genes may play a role
4- Mental health problem. Anxiety, depression and psychological stress.

14. Diagnostic Tests History and physical examination.
History and physical examination.
sigmoidoscopy may be done to rule out other disorders.
Stool microscopy and culture (to exclude infectious conditions)
Blood tests: liver function tests, erythrocyte sedimentation rate.
Abdominal ultrasound.

15. Medications Antibiotic drugs.
Antispasmodic medications - reduce abdominal cramping and pain by relaxing the muscles.
laxatives - for patients with constipation.
Antimotility medications - for diarrhea

16. Nursing Management provide patient and family education.
The nurse emphasizes teaching and reinforces good dietary habits.
high-fiber diet; avoiding gas-forming foods; and avoiding fluid intake with meals because it causes abdominal distention.
Adhering to a schedule of regular work and rest periods.
Participating in regular exercise,
Avoiding or minimizing stress-producing situations.
Drinking six to eight glasses of water daily (not at meals) to prevent constipation
Adhering to a regular eating schedule and chewing food slowly and thoroughly.
Avoid Alcohol and cigarette smoking