What is Ochsner-Sherren regimen is used in the management of: and explain in detail?
Ans:B.)Appendicular Mass. Appendix mass is a complication of acute appendicitis, it is an inflammatory mass composed of edematous omentum, small bowel loops, cecum and sometimes sigmoid colon, all walling off an inflamed appendix. It is one of the earliest complications of acute appendicitis and it can be management without immediate operative intervention. Ochsner Sherren regimen is the expectant management giving to a patient with an appendix mass. It is expectant because it is expected that the symptoms and signs the patient presented with will improve during the course of the management and the patient may later be scheduled for elective/interval appendicectomy The aim of the Ochsner Sherren regimen is to treat infection, relieve pain and supplement the fluids and electrolyte over a period of 48-72 hours during which the clinician will expect the condition to have improved The specific treatment given to the patient is as follows 1) Admit 2) Administer maintenance fluids, and potassium in fluid 3) Give vitamin C and B co in the fluids 4) Give antibiotics (against enterobactereocea and anerobes - ciprofloxin and metronidazole) 5) Give analgesics ( paracetamol and pentazocine) 6) Pass nasogastric tube to decompress the stomach and rest the bowel 7) Monitor the urine output as measure of adequacy of the hydration 8) Monitor pulse hourly or two hourly other vital signs 4hourly 9) Measure the mass the diameter of the abdominal mass every 12 hours 10) Check for presence of new symptoms and signs and resolution of the old symptoms and signs ( these include tenderness, distension, skin changes - edema, desquamation of the anterior abdominal wall, this will include a vomit cha to record the quantity and quality of the vomitus) Please note that this regimen is only for appendiceal mass, it should not be employed for other complications of acute appendicitis Other complications of acute appendicitis include Rupture or perforation Abscess formation And rarely poal pyemia and hepatic abscess