18 CEN: GI, GU, Gyn, and OB emergencies Flashcards
18 items on exam
what is a classic peritonitis sign?
Lying rigidly still
what S/S are suggestive of surgical conditions?
Fever and pain prior to vomiting, and/or syncope
How is GT length measured before insertion?
Measure from tip of nose to earlobe to xyphoid process
How is pt positioned for GT insertion?
Patient in high-fowler position if alert, flex head forward, sips of water; left side if altered mental status to decrease risk of aspiration
Examples of an acute abdomen?
Peritonitis, appendicitis
a condition that demands urgent attention and treatment. The acute abdomen may be caused by an infection, inflammation, vascular occlusion, or obstruction. The patient will usually present with sudden onset of abdominal pain with associated nausea or vomiting.
Causes of peritonitis? S/S?
Treatment?
→inflammation of the peritoneum from ruptured appendix, pancreatitis, penetrating trauma, or peritoneal dialysis; obstruction of the appendix leads to peritonitis
→diffuse pain, rebound tenderness, guarding, and fever.
→TX: with gastric tube, IVF’s, analgesics, antiemetics, and antibiotics.
Most common age of Appendicitis?
most common in males 10-30.
Extremes of age more likely to have atypical presentations.
S/S of Appendicitis?
S/S:
→Early: dull, steady periumbilical pain with anorexia and nausea;
→Later (12-48 hours): RLQ pain (McBurney’s point) with rebound tenderness (Roving’s sign), Markle sign (heel drop when up on toes), Obturator sign (pain on right hip flexion), Psoas sign (pain on extension of hip).
Dx and Tx of Appendicitis?
DX: CBC to detect leukocytosis (> 10,000 with > 10% bands); initial CT or ultrasound; frequent reassessment with ultrasound.
TX: IVF, analgesics, antiemetics, prepare for possible surgery (keep NPO).
Causes of Upper GI Bleed?
PUD, Mallory-Weiss syndrome, and frequent NSAID use
Mallory-Weiss syndrome from violent retching with alcohol or bulimia, aspirin use, or heavy lifting.
Esophageal varices - bleeding from dilated blood vessels secondary to liver disease from portal hypertension.
S/S of Upper GI Bleed?
S/S: Hematemesis (bloody vomit), signs of shock (dizziness, tachycardia).
DX: Serial H & H, coagulation panel, TXM, endoscopy (vasopressin may cause cardiac ischemia, consider nitroglycerin), high BUN (dry).
TX of Upper GI Bleed?
TX: Suction and secure airway if actively bleeding, IV access for fluid and blood replacement (hemoglobin < 7 g/dL),
questionable gastric tube (OK for PUD, not for bleeding varices), vasopressin, octreotide (Sandostatin).
What causes Esophageal varices?
- bleeding from dilated blood vessels secondary to liver disease from portal hypertension.
Causes of lower GI Bleed?
S/S, Dx, Tx?
- from inflammatory bowel disease.
S/S: Hematochezia (blood from anus), painless bleeding, signs of shock.
DX: Colonoscopy, serial H & H.
TX: IV access for fluid and blood
What is Cholecystitis? S/S?
Cholecystitis - inflammation of gallbladder.
S/S: severe crampy RUQ pain radiating to right shoulder aggravated by deep breathing; pain often after fatty foods or large meal; fever; jaundice (sclera) and dark urine; Murphy sign (point tenderness under right costal margin); flatulence.
Cholecystitis Dx and Tx?
DX: elevated WBC (leukocytosis), ALT, and bilirubin; abdominal ultrasound.
TX: IV access, antiemetics, analgesics, NPO/possible gastric tube, antibiotics, possible surgery.
If no surgery, D/C instructions focus on decreasing fat in diet.
What is Pancreatitis? S/S?
- inflammation and autodigestion of the pancreas
S/S: sudden onset of sharp epigastric pain radiating to the back, aggravated by eating, alcohol intake, or lying supine; pain relieved by leaning forward; fever; N/V/A; fever; signs of shock. Most common cause is alcohol abuse.
Pancreatitis Dx and Tx?
DX: elevated WBC, amylase (early), lipase (late, but more specific), glucose, and triglycerides; CT or ultrasound of abdomen, low calcium level.
TX: IV access for fluid resuscitation, antiemetics, analgesics (opioids), IV calcium gluconate, H2 blockers and glucagon to suppress pancreatic enzymes.
Complications of Pancreatitis?
Complications: hypocalcemia (see Chostek’s, Trousseau’s, and tetany), pleural effusions (may need thoracentesis), ARDS, hemorrhagic (Grey-Turner and Cullen sign), sepsis.
Hepatitis causes?
- “Vowels (A & E) from the Bowels” (Fecal-Oral), B-Body fluids (sex), C-Circulation (blood)
A - fecal-oral (vaccination available) - teach and return demonstration of handwashing.
B - body fluids - sexual, human bites (vaccination available).
C - circulation - blood exposure.
D - requires HBV for HDV, so protected by Hep B vaccine.
E - enteric (contaminated food or water).
Hepatitis S/S? Tx?
D/C instructions?
S/S: malaise N/V/A (early); jaundice, clay-colored stool, steatorrhea, dark-colored foamy urine (later).
TX: Fluid resuscitation for acute A & E. Interferon or Ribavirin for chronic hepatitis.
DC instructions: A & E - do not prepare food for others; B, C, D - do not donate blood, no sharing needles or razors, safe sex practices.
What abnormal labs are seen with Cirrhosis/Liver Failure?
↑ direct bilirubin (jaundice), ↑ LFTs, ↑ PT, ↑ PTT, and ↑ ammonia (hepatic encephalopathy);
↓ decreased urea, ↓ albumin, ↓ calcium.
Medication interventions for Cirrhosis/Liver Failure?
TX:
→Lactulose or PEG (MiraLAX) to remove ammonia,
→Neomycin to decrease production of ammonia,
→replacement of albumin, calcium, potassium, and vitamin K.
**Treat effective if ammonia decreases and LOC increases.
What is Diverticulitis? S/S?
- inflammation of (sigmoid-large) colon
S/S: abrupt onset of crampy pain, localizes to LLQ, anorexia, nausea, vomiting, alternating episodes of explosive diarrhea and severe constipation.
Tx for Diverticulitis?
D/C instructions?
TX: fluid resuscitation, bowel rest, antibiotic, antispasmodics, surgery if ruptured.
DC instructions: avoid straining, low-fat, low-fiber, low-residue diet during acute phase; then increase fiber in diet, take stool softeners, and increase water intake.
S/S of Esophageal Obstruction? Tx?
- difficulty swallowing and drooling from “something stuck” or “food bolus”
TX: keep patient upright and consider a carbonated beverage, glucagon IV or NTG SL; esophagoscopy for removal.
Bowels sounds with obstruction?
Early: high-pitched hyperactive bowel sounds early
Late: Absent
Small Bowel Obstruction S/S?
Small Bowel Obstruction - rapid onset, minimal distension, copious fecal vomiting, crampy pain
Large Bowel Obstruction s/s?
Large Bowel Obstruction - gradual onset, marked distension, rare vomiting, crampy pain.
S/S of Bowel (mesenteric) infarction?
- history of atrial fibrillation, severe abdominal pain with soft abdomen without guarding.
S/S of Bowel perforation?
- peritoneal signs (rigidity and guarding) after colonoscopy. Prepare for surgery.
PEDS: Tx for Gastroenteritis?
20 ml/kg of isotonic crystalloid solution boluses,
administer ondansetron (frequently 5 mL sips of pediatric rehydration solution.
PEDS: Tx for Cyclic vomiting?
Cyclic vomiting is recurrent disabling vomiting.
Treat with fluid boluses and antiemetics. Prevent wit antimigraine medications.
PEDS: What is Pyloric Stenosis? S/S? Tx?
narrowing of the pylorus preventing emptying of the stomach causing non-bilious projectile vomiting and continual hunger, poor weight gain, “olive-shaped mass”, and signs of dehydration;
TX: IVFs and prep for surgery to dilate pylorus.
PEDS: What is Intussusception? S/S?
Intussusception - telescoping of one segment of bowel into another; most often seen in infants;
episodic pain with currant jelly stools and bloody mucus, “sausage-shaped palpable mass in RUQ; diagnose and treat with air or barium enema; may require surgery.
PEDS: What is Volvulus (Malrotation)? S/S? Tx?
Volvulus (Malrotation) - bowel rotation resulting in strangulation; typically, in first month of life; bilious vomiting with abdominal distension, blood stools, and visible peristaltic waves;
prepare for surgery.
