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32 Cards in this Set
- Front
- Back
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What are the associated symptoms in the acute abdomen? |
1) nausia, vomiting, anorexia (appendicitis, bilary tract diseaase, gastritis, high intestional obstruction, pancreatitis. 2) Diarrhoes (inflammatory process (gastroenteritis, ulcerative colitis)) 3) Constapation (Dehydration, obstruction, medication-induced decreased intestinoal motility (codeine, morphine)) 4) Change in stool colour (Biliary tract obstruction (clay-coloured stools), lower intestinal bleeding (black, tarry stools) 5) Chills and fever (appendicitis, bacterial infection, choleystitis, pyelonephritis) |
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What is Ascites/hydroperitineum? And what is it genrally caused by? |
Its the accumulation of fluid in the peritoneal cavity causing abdominal swelling. Its sgenrelly caused by - cirrhosis (disease of liver) - Portal hypertension - Poor excretion of sodium and water by the kidneys - Infections (TB) - Ovrian and hepatic cancers - Obstruction to the drainage of lymph from the abdomen. |
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What can ascites lead to? |
Can lead to spontanious bacterial peritonitis (SBP). Spontanious bacterial peritonitis has a high mortality rate. |
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What is dysphagia and what are the three types? |
It is difficulty swallowing (deglutination) 1) Oral 2) Pharyngeal 3) Oesophageal - transport dysphagia . If chocking - remove foreign object and general management. It pt not choking byt mortility of the food bolus has been impared, trasnport to a suitable ED for further treatment. |
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What are bowel obstructions and are some things that it may be caused by? |
Occulsion of the interstinal lumen that results in blockge of normal flow of intestional contents. Could be caused by: - adhesions, hernia, neoplasms (abnormal groweth of tissue in a part of the body) , inflamatory bowel disease, foreign bodies, diverticulitis, abscessess (swolen area containing an accumulation of pus). |
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What types of hernial are there? Hint: LOTS |
- umbilical - epigastric - incisional - spigelian - diaphragmatic - obturator - hiatus - femoral . For cumfort, lay supline with need raised to take pressure off the bowels. |
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What is gastroenteritis? |
Its inflammation of the stomach and intestines, typicall from a bacterial toxin or viral infection. Causing: nausea, vomiting, adbominal cramping, diarrhoea, pain, lethargy, malaise and fever. It can last from one day up to three weeks. It can be caused by viruses, bacteria and protozoa. Treatment is to replace the fluid and electrolyte losses (orally if vomiting is not present) Administer 4mg/2ml or ondansetron. |
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What is haemetamesis? |
Defined as the vomiting of blood from upper gastrointestinal bleeding. - peptic ulceration and perforation - NSAIDs - gastric or duodenal ulcers - reflux oesophagitis - mallory-weiss tear (repeated, often violent vomiting (extreem cases of morning sickness often during the first trimester of pregnancy)) - oesophageal varices - alchole abuse - portal hypertension - Oesophagitis - a history of aortic surgery |
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What is biliary tract disease? |
Biary disease encompasses a wide spectrum of disorers caused by abnormalities in bile composition, bilary anatomy or function. The liver determines the chemical conposition of bile, and this may be subsequently modified by the gallbladder and biliary epithelium. |
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What does the gall bladder do and where is it located? |
Its sack located under the liver and stores and concentrated bile produced in the liver. The bile aids in the digestion of fat, and is released from the gallbladder into the upper small insectine (dueodunum) in response to food (espically fats) |
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What are the different types of biliary tract diseases? |
Biliary = relating to bile or the bile duct . Cholecystitis (inflamtion of the gall bladder) Gallstones (cholelithiasis) Chronic asalculous gallbladder disease - in which the natural movements needed to empty the gallbladder do not work well. Gangrene or abscesses Growth tissue (polyps) in the gallbladder Defects of the gallbladder that are present at birth (congenital) Tumors of the fallbladder and bile ducts. |
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What is cholelithiasis? |
Stones in the gallbladder. It is the most common disorder of the biliary system and it has een estimated that 8-10% of all adults in the US have this condition. Predisposing factors include: gender, age, oestrogen Rx, sedentary lifestyle, family history and obesity. |
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What is the management for choleithiasis? |
Provide relief from vomiting. Nsogastric tube - reduces distension and eliminates gastric juices. Maintain fluid and electrolyte balance. Monitor drug therapy - administer broad spectrum anti-biotics. Pain relief - morphine may cause spasms of the spincter of oddi and therefore may exacerbate the condition. USE FENTANYL. |
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Tell me about cholecystitis? |
- inflamation of the gall bladder - commonly associated with gallstones (choleithiasis) - more common in 30-50yoF - nausia, vomiting, RUQ pain, tenderness and fever. - attacks triggered by ingestion of fatty foods. |
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What can cause cholecystitis? |
cholelithiasis chronic cholesyctitis bacterial infection acalculus cholecystitis Burns, sepsis and diabetes. Multiple organ failure. |
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What is the presontation of cholecystitis? |
- Epigastric pain after eating - Pain localised to the RUQ because of somatic sencory nerves. - Murphys sign - cant take a deep inspiration when the assessors fingers are pressed below the hepatic margin. - Pain beging 2-4 hours after eating fried or fatty foods and presist more than 4-6 hours. - nausia, vomiting and anorexia. - Low-grade fever - Jaundice and weight loss. |
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What is pancreatitis? |
Its an acute inflammation process of the pancres with associated escape of the pancreatic enzymes into sourrounding tissue. The primary aetological factors are alcoholisn and biliary tract disease. may be a complicatio of viral or bacterial disease, peptic ulcer, trauma. Major-bilary stones, alchole use/abuse. Minor age:55-65 yrs. for biliary pancreatitis (45-55yrs - for alchole related) Trauma, infectious disease, drun toxivities, chronic diseases (inflammatory diseases) |
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What is the pathophysology of acute pancreatitis? |
- triggering mechnism not exactly understood. - pancreatic enzymes that escape into the sourrounding tissues due to compromised pancreatic function seem to be the primary cause. - when the pancreas becomes damaged or the ducts become blocked, the trypsin inhibitor accumulates and activates the pancreatic secretions that escape into the sorrounding tissue, resulting in inflammation, thereby causing acute pancreatitis. . ACUTE PANCREATITIS = ENZYMES ESCAPE
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What is the presontation of pancreatitis? |
Pain - strady nd severe in nature; located in the epigastric or umbilical region; may rediate to the back. Worsened by lying supine; may be lessened b flexed knee, curved-back position. Vomiting - varies in severity, but is usially protracted, worsened by ingestion of food or fluid. Does not relieve the pain. Usually accompanied by nausea. Fever - rarely exceeds 39C Abdominal findings - rigidity, tenderness, guarding, distended, decreased or absent peristalsis and paralytic ileus. |
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What is the presontation of pancreatitis with severe epigastic abdominal pain? (abrupt onset (may raiate to back)) |
- nausea and vomiting - weakness - tachycardia - +/- fever - +/- hypotension or shock. - Grey turner sign - flank discolouration due to retroperitoneal bleed in pt. with pancreatic nevrosis (rare) - Cullens sign - periumbilical discoloration (rare) |
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What are further presontations seen in pts with pancreatitis? |
Upper abdo pain rapidly increasing in severity, often within 60mins. Epigastric pain Right-sided pain Diffuse abdomal pain with radiation to back pain rarely only in left upper quadrant Restless Prefer to sit and lean Nausea and vomiting Fever Tachycardia Bowel sounds - genrally absent. |
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Upon abdominal examination of a pt with pancreatitis, what are some things you should expect to find? |
Decreased or absent bowel sounds. Abdominal tenderness Guarding Palpable mass in epigastric area Biliary colic Haundice if theres obstruction of the bile duct Cullens sign and Grey turners sign (Dyscoloration) |
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In regards to fluid resuscitation, what should you do for a patient with pancreatitis? |
- pts with acute pancreatitis may have a fluid shift of 4-12L into retroperitoneal space and peritoneal cavity due to inglammatin. - In severe acute pancreastits, blood vessels in and around the ancreas may also become disrupted, resulting in haemorrhage. - Replace fluids (you want a radial pulse) - Monotor for signs and symtoms of haemorrhage. |
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What is chronic pancreatitis? |
Patho: irreversible parenchymal destruction leading to pancreatic dysfuction. - persistent, recurrent episodes of severe pain - anorexia, nausia - constipation and flatulence. - steatorrhoea - diabetes - aetiology - chronic alchole abuse (90%), gallstones. Hyperparathyroidism, congenital malformation and idiopathic. |
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What is acute appendicitis? |
Commonest cause of acute abdominal pain requiring surgical intervention. - history (common) - periumbilical pain, after 12-24 hours pregresses to right lower quadrent amdominal pain, persistant - aggravated by movement an dinspiration. Presontation - nausea, anorexia, vomiting and low grade fever - 37.7C - 38.0C |
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What are some differential diagnosis for acute appendicitis? |
Non-specific abdo pain, pelvic inflamatory disease, ovarian cyst, ovarian follicle rupture, ectopic pregnancy, diverticulitis, chrones disease, colitis, cancer, referred testicular pain, acute pyelone ohritis, ureteric colic, renal calculi, cystolithiasis, cholecythtis, discending AAA, hernia (strangulated or otherwise), cystits and pancreatits. |
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What are the two types of inflamatory bowel disease? |
Crohn's disease and ulcerative - bleeding a more frequent presentation. |
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Tell me about crohns disease? |
- affects the ileum and/or the colon - <30 yrs - autoimune in origen - herediatry - intestinal wall thickening swelling and development of scar tissue - causes ulcers - symptoms similar to those of IBS and uncerative colitis. - pain often relentless - frequent loose bowel motions that can sometimes be bloody. eww |
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Please tell be about ulcerative colitis? |
- ulceration of the mucosa of the rectum and lower part of the colon. - rectal bleeding and production of pus. - presontation - fatigue, weight loss, anorexia, rectal bleeding, loss of bodily fluids, bloody diarrhoes and ando cramping. - removal of the diseased colon may be indicated in the most severe of cases. |
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What are some causes of acute liver failure? |
Drug-induced liver injury (hepatotoxicity) - paracetamol overdose that is left untreated until hepatic tissue necrosis. - Viral hepaptitis A, B and C. - Autoimmune liver disease. - shock (BP <80 = liver is not perfused. - hypoperfustion - idiopatic |
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What is diverticulosis? |
A sac or pouch that is common in advancing age nd associated with diets low in fibre. the outpouches are known as diverticulosis. These can be obstructed with faecal matter and sometimes perforation of the bowel. Common cause of recatl bleeding in older adults. Can lead to peritonitis if bacteria escapes into the abdomen. |
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What are some common causes of rectal bleeding/haematochezia? |
Common presontation in those >50 yrs. Causes; - Haemorrhoids - eczema and dermatitis around the anus - cancer - polyps - ulcerations - infections - inflammatory bowel disease - colitis - proctitis - antithrombotic therapy - antiplatelet therapy - NSAIDs - alchole dependence and abuse. - Trauma caused by sexual practices. |
