7) GI Flashcards
A&P) Retroperitoneal space organs:
= kidneys, proximal ureters, adrenals & most major ABDMN ves/
A&P) pelvic space organs:
= urinary bladder, distal ureters, proximal urethra, terminal sigmoid colon, rectum, & anal canal Females: uterus, Fallopian tubes, ovaries, and upper vagina. males: prostate
A&P) Peritoneal space organs:
= stomach, spleen, gall bladder, liver, pancreas, & intestines
ABDMN Cavity) 1 of largest cavities BUT:
most common reason for blunt abdominal and/or pelvic injuries
= Very little protection (takes Ls to change girth) (little protection)
= MVA
Abdominal Evisceration:
Treatment:
= (omphalocele } through umbilicus) Omentum 2 layers, S-intest, most likely organ to be exposed
= Remove/cut clothing away from wound area, Wet dressing then dry 4 sided occlusive on top(keep heat inside) could use burn/heat sheet Cover the area with a sterile dressing soaked with sterile normal saline
A&P) GI) Accessory GI organ:
= Liver, Gall blader, Pancreas (pancreotic juice creates buffer into deuodnium),
Liver) Fn:
Location w/ injury rate
= Detoxifies the blood, Produces bile for digestion, Manufactures clotting factors and is a major storage area for glycogen,
= Most common organ injured in the abdomen
Spleen) organ class
Location quadrant
= not an accessory GI organ, but part of immune system
= LUQ
A&P) RUQ contains:
=gallbladder, right kidney, most of the liver, some small bowel, a portion of the ascending & transverse colon, small portion of pancreas
A&P) LUQ contains:
LUQ = stomach, spleen, left kidney, most of pancreas, portions of the liver, small bowel, transverse & descending colon
A&P) RLQ contains:
RLQ =Appendix, Portions of urinary bladder, small bowel, ascending colon, rectum, (right ovary)
A&P) LLQ contains:
LLQ =sigmoid colon, portions of the urinary bladder, small bowel, descending colon, rectum, (left ovary)
A&P) Circ) ABDMN aorta & its major branches
gastric, superior and inferior mesenteric, splenic, hepatic, renal, gonadal, and iliac
Ascites:
Borborygmi:
Hyperperistalsis:
= bulges in flanks across abdomen indicating CHF
= loud prolonged “gurgling” (healthy GI) but can= hyperperistalsis
= more bowl sounds> + GI m-nt causing diarrhea/cramps
Normal bowel sounds consist:
More frequent sounds indicate:
Decreased or absent sounds suggest:
= Variety high-pitched gurgles & clicks occurring every 5-15 secs
= + GI m-nt possibly indicating diarrhea or early intestinal obstruction
= Paralytic ileus/peritonitis. Listen at least 2mins if abdomen is silent
Ascites:
Borborygmi:
Hyperperistalsis:
= bulges in flanks across abdomen indicating CHF
= loud prolonged “gurgling” (healthy GI) but can= hyperperistalsis
= more bowl sounds> + GI m-nt causing diarrhea/cramps
Blood:
Plasma:
Leukocytes:
Erythrocytes:
= Mixture of water, cells, proteins, & suspended elements.
= makes up 55% of the blood volume
= WBC & platelets make up the “Buffy Coat”
= RBC make up 45%
Blunt percussion:
technique:
Commonly used for:
= “Blunt weapon” best used for detecting pain/ inflammation.
= Simply strike PT’s skin w/ ulnar side of your fist w/ just enough force to elicit tenderness but not cause undue pain.
= in costovertebral angle when examining a PT for a kidney infection
Blunt Trauma) Deceleration & commonly w/:
Crushing & commonly w/:
Compression & commonly w/:
= Shear Injuries} AAA, ligament of teres (around liver shearing it)
= Solid organs} vascular & bleed a lott (Liver & Spleen most rich)
= Hollow organs
Dull percussion sound:
= “thud” , Medium intensity, medium pitched, medium duration, located in solid organs
Limited chest wall movement b/c pain maybe from:
The principles of managing the abdominal injury patient include:
= peritonitis or blood irritating the diaphragm
= treatment of hidden hemorrhagic shock from MOI
Ecchymosis around either L/R-ABDMN flank area is known as:
Grey Turner’s Sign
Enteric Nervous System
= “Gut-Brain” connection controlling digestion independently
Enzymes) Amylase:
Lipase:
= Breaks down carbohydrates (starches) into simpler sugars (e.g., maltose); found in saliva & pancreas.
= Hydrolyzes lipids into glycerol & fatty acids; secreted by the pancreas.
Evisceration, occurs most frequently through
the anterior abdominal wall and is usually associated with a large and deep laceration
A&P) GI) ABDMN cavity is bordered by:
Abdominal Cavity is divided into 3 spaces:
= Diaphragm, Spine & inferior ribs, Muscles of back, ABDMN muscles
= Peritoneal space, Retroperitoneal space, Pelvic space
A&P) GI) Peritoneal space:
Retroperitoneal space:
Pelvic space:
= Peritoneal space: ABDMN peritoneal
= Retroperitoneal space: Kidneys behind Peritoneum
= Holds 1.5Ls, True pelvis holds pelvic organs
A&P) GI) Starts & Ends@:
Parastalisis:
Digestion Tract:
= Mouth to anus
= GI moving stuff down
= 25ft-long hollow muscular tube for digestion & waste products
Mesenteric system
membrane vascular GI blood feeder
Melana:
= Pooping dark black stool (150mL of blood to make)
A&P) Hollow organs such as the:
Commonly injured by:
Hollow organ damage can cause:
= stomach, both bowels, rectum, urinary bladder, gallbladder & uterus
= rupturing from blunt trauma (also tear w/ penetration)
= hemorrhage/spillage into the peritoneal’s &pelvic spaces
How long should auscultation take per quadrant?
2 minutes
A&P) True Abdomen:
= Deoudum, S(illium longest & narrowest) &L interesting (illium longest & narrowest), deud/juj distal lower GI,
A&P) retroperitoneal :
Kidneys:
= Kidneys, Aorta
= RAAS system, secrete arythoportine hormone to tell bone to dev RBC, mineral reg,
A&P) Intrathoracic )Major vessels:
= Descending aorta & inferior organ shears are worst injuries
A&P) kidneys) located:
Blood:
Fn:
= the retroperitoneal portions of L&RUQ
= receive their blood supply from the abdominal aorta
= Reg pH, osmostasis, RAAS, reg Na
Lower Esophageal Sphincter (LES)
= Controls food entry into the stomach
A&P) GI) Lower GI System:
To overcome Lower esophageal & bottom pallor & bottom Sphincter
= duodenjejunal junction, to include the rest of the small intestine, large intestines, & rectum/anus.
= 20ml to overcome Lower esophageal Sphincter & bottom stomach pallor Sphincter
Mallory-Weiss Tears:
(common w/ bulimia), Lower sphincter & espohagus is erroded away from acid
Mesothelial Cells:
Pancreatic Acinar Cells:
= Line body cavities (pleura, peritoneum); secrete lubricating fluid.
= Secrete digestive enzymes (e.g., amylase, lipase) into the duodenum
Peritoneum:
parietal peritoneum:
visceral peritoneum:
= ABDMN membrane lining cavity & organs (resembles lung’s pleura & Fns similarly)
= The portion that lines the cavity
= the portion that covers ABDMN organs
Renal system) Podocytes:
Juxtaglomerular Cells:
Principal Cells:
= Form filtration slits to allow selective filtration of blood.
= Secrete renin to reg/ BP & Na balance.
= in collecting ducts; reg water & Na+ reabsorption via ADH & aldosterone.
Renal System) cells, Principal Cells,
= Podocytes, Juxtaglomerular Cells, Principal Cells
Risk Factors for GI Issues
= Alcohol, smoking, stress, caustic substances, poor bowel habits
Small Intestine
= Longest part of alimentary canal, absorbs 90% of nutrients
Spleen) is:
Injuries to the spleen common with:
Kehr’s Sign:
= Largest organ of LYMPH-system, Very vascular, removes abnormal RBC from the circulatory system. Stores iron
= common with blunt force trauma to the left flank region
= pain into the left shoulder classic of ruptured spleen
Terry’s nails:
Seen in:
= mostly whitish nail w/ band of reddish-brown at distal nail tip
= Aging, liver cirrhosis/failure, CHF, & diabetes
A&P) Circ) The abdominal aorta bifurcates at & into & eventually become what exiting where:
= upper sacral Lvl into large iliac arteries that eventually become the femoral arteries as they traverse and then exit the pelvis.
ABDMN cavity is bound superiorly by the:
When considering the pathophysiology of abdominal injury, remember:
= Diaphragm
= The abdomen is bound by muscles rather than skeletal structures
Peritoneum) def:
Inflammation to it:
= fine fibrous tissue surrounding interior of most of ABDMN cavity, most small bowel, & some ABDMN organs (Peritoneal space)
= Peritonitis
A&P) Circ) Inferior vena cava is located:
Fn:
= along R-side of the S/Cl
= drains venous blood from lower EXTRMS & ABDMN relatively parallel to the arterial system, returning it to the heart. T
The largest organ in the abdominal cavity is the:
Liver
The small bowel is composed of the:
Duodenum, jejunum, and ileum.
Tympany percussion sound:
= “drumlike” , loud intensity, High pitched, Medium duration, located in stomach
Crohn’s Disease complications
Obstruction, GI hemorrhage, weight loss, cramping
Esophageal Varices?
Swollen veins in esophagus, risk of rupture, 35% mortality rate
GI causes of chest pain?
GERD, gastric ulcers, duodenal ulcers, gallbladder disease
Hemorrhoids?
Swollen veins in rectum/anus
Hemorrhoids?
Swollen veins in rectum/anus, common in elderly, pregnancy
Peptic Ulcers?
Erosions from gastric acid, often caused by NSAIDs, alcohol, H. pylori
Gastroenteritis causes
Viral, bacterial, foodborne, medication-induced
Large Intestine fn
Reabsorbs water, absorbs vitamins, compacts feces
abdominal pain types
Visceral, Somatic, Referred
What can a Rectal Foreign Body cause?
Can cause rectal pain, infection, shock
Lower GI System structures
Jejunum, ileum, large intestine, rectum, anus
Upper GI System structures
Mouth, esophagus, stomach, duodenum
What does VALVUL/O- signify?
Tiny fold or small valve
valvul/itis tiny fold or small valve/inflamed
Hernia?
Abdominal sac protruding through muscle wall
Mallory-Weiss Tear?
Esophageal laceration from forceful vomiting
Mallory-Weiss Tear?
Esophageal laceration from forceful vomiting
AAA (Abdominal Aortic Aneurysm)
S/S:
= Dangerous dilation of aorta, risk of rupture
= Tearing back pain, pulsatile mass, hypotension
Aaron’s Sign?
Epigastric pain w/ palpation of McBurney’s Point
Acute Gastroenteritis?
Inflammation of stomach/intestines causing vomiting & diarrhea
Amylase?
Enzyme in saliva that breaks down carbs into simple sugars
Inguinal Hernia?
Most common hernia, occurs in groin
Appendicitis?
Inflammation of appendix, McBurney’s point pain, risk of rupture
Appendicitis?
Inflammation of appendix, RLQ pain, nausea, risk of rupture
Bowel Obstruction?
Blockage in intestines, causes: hernias, intussusception, volvulus, adhesions
Cholecystitis?
Inflammation of gallbladder, commonly caused by gallstones (cholelithiasis)
Cholecystitis?
Inflammation of gallbladder, usually from gallstones
Cholelithiasis?
Medical term for gallstones
Chyme?
Digested food mixed w/ stomach acid, passes through Pyloric Sphincter
Crohn’s Disease?
Idiopathic inflammatory disorder affecting any part of GI tract
Cullen’s Sign?
Bruising around umbilicus (sign of internal bleeding)
Cullen’s Sign?
Bruising around umbilicus (sign of internal bleeding)
Diverticulitis?
Infected/inflamed diverticula causing LLQ pain, fever, nausea
Diverticulosis?
Presence of small outpouchings in intestine
Grey Turner’s Sign?
Bruising on flanks (sign of retroperitoneal bleeding)
Hematemesis
Bloody vomit
Hematochezia?
Bright red blood in stool
Hemoptysis?
Coughing up blood from the respiratory tree “pty phlem”
Intussusception?
Telescoping of intestines, common in infants
Kehr’s Sign?
Left shoulder pain from ruptured spleen, right shoulder pain from cholecystitis
Mastication?
Chewing
McBurney’s Point?
RLQ location of appendicitis pain
Melena?
Very dark, sticky, foul-smelling stool indicating presence of partially digested blood
Mesenteric Ischemia?
Blocked blood supply to intestines, severe pain, risk of infarction
Murphy’s Sign?
RUQ pain w/ deep inspiration, indicates cholecystitis
Pancreatitis?
Inflammation of pancreas, often metabolic cause, severe upper abdominal pain
Pancreatitis
S/S:
Inflammation, often from alcohol, gallstones
= Severe epigastric pain, nausea, vomiting, fever
Peristalsis
Wave-like motion that propels food down the esophagus
Portal Hypertension?
Common cause of esophageal varices
Psoas Sign?
RLQ pain w/ hip extension, indicates appendicitis
Referred Pain?
Pain felt in a different location than the injury
Rovsing’s Sign?
RLQ pain when LLQ is palpated
Somatic Pain?
Sharp, localized pain from peritoneal irritation
blood vol/ for abdominal girth change?
4-6 liters
Bile fn
Helps digest fats
Pancreatic Juice fn
Helps digest carbs, fats, proteins
Duodenum fn
Initial site of chemical digestion w/ bile & pancreatic juice
Ileum fn
Longest section of small intestine, absorbs vitamin B12, bile salts
Jejunum fn
Middle section of small intestine, absorbs nutrients
Large Intestine?
Reabsorbs water, absorbs vitamins, compacts feces
Ligament of Treitz?
Marks delineation between Upper & Lower GI System
Normal appearance of stool?
Brown, well-formed
Abnormal: Pale, greasy, bloody
order of abdominal assessment?
Inspect → Auscultate → Palpate
palpation purpose
Define area of pain, identify affected organs
Small Intestine?
Longest part of alimentary canal, absorbs 90% of nutrients
Gastroenteritis rx
Fluids, antiemetics, electrolytes, antibiotics if bacterial
Pancreatitis rx
Fluids, pain management, monitoring for complications
Ulcerative Colitis?
Idiopathic inflammatory bowel disorder w/ bloody diarrhea, mucus
Upper GI Bleeding defined
Bleeding above Ligament of Treitz, 10% mortality rate
Upper GI Bleeding
common causes:
Bleeding above Ligament of Treitz,
= ulcers, gastritis, esophagitis
Visceral Pain?
Pain from hollow organs or organ capsules due to inflammation, distention, ischemia
Visceral Pain
Pain from hollow organs, organ capsules, peritoneum; caused by inflammation, distention, ischemia
Volvulus
Twisting of intestines, leads to ischemia
Most common ABDMN organ injured w/ stabbing to ABDMN region:
Liver
Structure separating the upper & lower GI system?
Ligament of Treitz
Risk Factors (intrinsic & extrinsic)
#1 (E) Excessive alcohol consumption
Gastrin released(when drinking) then tells proton pumps to release more acid & can eventually eat away at walls or come back up thus causing GERD
Backs up hepatic portal system (Liver 1st pass) making LP system to HP system making more back pressure & “Hemorrhoids of the liver”
Excessive smoking
Mess up pecide
Esophageal sphincter relaxes from heat
Increased stress
Ingestion of caustic substances
Poor bowel habits (people don’t poop)
GI mouth to Asshole
UP: Mouth, esophagus, stomach, duodenum (first part of small intestine).
Deuadnom separates Upper from Lower
Duodenum down makes lower
Lower GI System: Jejunum and ileum of the small intestine and entire large intestine, rectum, anus.
Ligament of Treitz Marks the delineation between the Upper and Lower GI System!
@ Dueudnum Jujuneum junction ligament suspends & connects to diaphragm
Autonomic NS : Enteric NS 2nd brain
Like chicken wire covers to innervate peristalsis
Small to large intestine
Innervation = peristalisis
Digestive Process
digestion start at mouth
Chewing is also known as what: Mastication
What is the important enzyme found in your saliva that starts breaking down carbs into simple sugars: Amylase
Breaks down carbohydrates
After your teeth do their job, your tongue pushes the clump of food to the back of the throat.
Gustation: taste “gust”
Your esophagus opens and the food travels downward.
As you swallow and food enters the esophagus, a wave like motion propels the food downward towards the stomach. “Peristalsis”
LES sphincter needs to open to allow food in but needs
Rugae increases surface area Ph 1
20-30cm of pressure to overcome shpincter
Food now enters your stomach through the LES
In the stomach the food is sloshed back and forth and mixed with powerful acids
Digested food from your stomach
now called “Chyme” passes into the small intestine through the Pyloric Sphincter
Very acid buffered by pancreas juice (assessory GI organ)
97% to make buffer base very alkalitic
90% of nutrient absorption occurs in the small intestine!
The small intestine is the longest part of the alimentary canal
Pylor stenosis lower stomach sphincter builds up making purge
Bile and Pancreatic Juice enter into the duodenum
What does Bile do? Buffer
What does Pancreatic Juice do? Buffers for passing PS
Large intestine (Ascend traverse descending sigmoid)
Cecum suspends appendix
Appendix stores good bacteria
Appendix gets clogged by undigested (Corn, seeds)
Hilum entry point of appendix
Clog & appendix rupture
Segmentation starts at ascending colon
Main job absorb water, seg,
Rectum poop garage
If body dont agree increase perstalisis PURGE PURGE
The small intestine is broken down into 3 sections
what are they? (Duodenum, Jejunum and the Ileum).
Of these three, which one is the longest? Ileum
Small intestine longest part of alimentary canal
Ilium Most common site for bowel obstruction!
Large Intestine: Main job is reabsorption of water
Absorbs vitamins
Compaction of indigestible contents into feces
Stores feces prior to defecation
Bile breaks down fat stored in gall bladder
Gallstone from overproduction & removal leads to not able to digest fat
Pancreatic juice is buffer juice
Small absorb large for
Bristol stool chart: 1 constipated, 4 normal, 7 liquid
BLEEDING & PAIN
Abdominal Assessment:
1st Visually inspect abdomen before palpating it,
auscultating it, or moving patient.
How much blood does it take in the ABDMN to cause a change in the PT’s girth? 4-6Ls
Cullens sign → 1st found w/ ectopic pregnancies ruptures
Grey turnings: Flank / Lateral
Auscultation minimum of each quadrant min 2mins
Percussion: Requires a quiet environment
Both of these provide little or no useful information – not routinely performed in the EMS setting.
Complete the physical examination: Palp pain last
Palpating abdomen can define the area of pain and identify the associated organ(s) – Auscultating abdomen provides little helpful information
Visceral Pain: Originates in walls of hollow organs (gallbladder or appendix), in capsules of solid organs (kidney or liver), or in visceral peritoneum.
Mechanisms that produce visceral pain: Inflammation, Distention & Ischemia.
Pain is the hallmark of an acute abdominal emergency
Three classifications of abdominal pain: Visceral(vague non-pinpont), Somatic parietal pain(Sharp pinpoint), Referred
Somatic (Starting to hit parietal )Sharp type of pain that travels along definite neural routes to the spinal column.
Pain localized to region or area.
Bacterial and chemical irritations of abdomen commonly cause somatic pain.
Degree of pain initially proportional to spread of irritant through abdominal cavity.
Something leaking & hitting parterneail
Referred Pain (phrenic nerve affect & efferent) attaches diaphragm pain up to shoulder
Originates in region other than where it is felt.
For example: dissecting abdominal aortic artery, produces referred pain felt between shoulder blades.
TAA & AAA
R shoulder pain indicates R sided ABDMN issue (Kehr’s sign)
Kehr’s Sign: Presence of shoulder tip pain associated with abdominal pain.
Left shoulder tip pain is often associated with a ruptured spleen
Right shoulder tip pain is often associated with cholecystitis (Liver or gallbladder)
Six major causes of upper GI hemorrhage:
Peptic ulcer disease (Most common reason)
Gastritis
Variceal rupture (esophageal varices High mortality from alcohol)
Mallory-Weiss tear (esophageal laceration) Bulimia self-purging)
Esophagitis
Duodenitis
Peptic Ulcers: Erosions caused by gastric acid #1 UGIB
Can occur anywhere in gastrointestinal tract
Important to get family history and estimate of patient’s last oral intake
Damaging lining of system
Spicy & Alcohol 2 biggest
Causes:
Nonsteroidal anti- inflammatory medications (aspirin, ibuprofen, naproxen)
Alcohol & nicotine
Helicobacter pylori bacteria
Zollinger-Ellison Syndrome
Prehospital Rx: Antacid treatment and support of any complications such as hemorrhage
Mallory Weiss tear,
LES proximal & distal to pylorus
Vomiting pulling down & acid breaking down lining
HX: of ED
Favor w/ 1-2 fingers
Russels sign: bruising across fingers knuckles from self-purging
Teeth eroded, coughing up blood,
Txa 1g over 10 min
Esophageal Varices: Heptic portal (!!!! airway Control)
Possible double tubing,
Swollen vein inside the esophagus that can rupture and hemorrhage
When they do, mortality rate over 35%!!!
Causes: Increase in portal pressure (portal hypertension), consumption of alcohol, ingestion of caustic substances
Tunica media cant hold pressure well
Stenosis of inside of vessels thus backing up
Darker red blood b/c venous
Rupture from inside to out
BAAM clogged esophoges (akers pt)
Suction max 15sec but most likely breakin rules
Acute Gastroenteritis
Inflammation of stomach and intestines associated with sudden onset of vomiting and/or diarrhea
Can lead to: Severe vomiting and diarrhea = dehydration
Electrolyte imbalances (hyponatremia)
Loss more water from diarrhea
Treatment: O2 as needed
IV fluids (lots of it)
Adequate volume replacement to minimize hypovolemia or hypovolemic shock
Antiemetics
Antibiotics (hospital)
Isotonic
Water compartments
Lower GI
Ulcerative Colitis: Classified as idiopathic inflammatory bowel disorder (IBD) LLQ Large instestine
Stress
75% of ulcerative colitis involves rectum or rectosigmoid portion of large intestine
~affecrs interior rectutum & descending colon
(colonoscopy) mucus & blood passed, Ulcers easily bleed
Recurrent disorder with bloody diarrhea or stool containing mucus
S/Sx : Abdominal pain (cramping), Rectal hemorrhage, N/V, Lowgrade Fever, Weight loss
Intermentiment cramping
Can progress to crohns diseases
After 40 loose 1% of kiney
Adhesions from surgery & only restart cycle
Crohn’s Disease
Autoimmune, can appear anywhere usually ascending & descending
Idiopathic inflammatory bowel disorder
Can occur anywhere from mouth to rectum
Complications: Complete intestinal obstruction, Lower GI hemorrhage
Signs and symptoms: GI hemorrhage, Recent weight loss, Intermittent ABDMN cramping/pain, N/V, Diarrhea & fever
Treatment? Morphine slows down peristalisis the most
Diverticulitis
Inflammation of diverticula secondary to infection *
Heriditary usually passed from mom
Most common LGI bleed
If pockets filled & bacterial stuck becomes infection
S/Sx:
Lower left-sided pain(descending colon), Fever, N/V; Tenderness on palpation, can have hematochezia
Treatment:
Males 3 testie w/ weigh lifting
SIR Hernia (strangulated, incarcerated, reducibible (best) )
Reducible
Strangeled by M
Incracereted trapped by M can become incarcerated
Hernias: come through
Hernia is a sac formed by the lining of the abdominal cavity (most common)
this sac comes through a weak area in the abdominal muscle wall
Severe Rx: Septic V/S & S/S
MAP at least 60
Mesenteric Ischemia : intertwines like chicken wire
When one of mesenteric arteries becomes narrowed or occluded.
Superior mesenteric artery (SMA)
Inferior mesenteric artery (IMA)
When blood flow through either of these vessels reduced or stopped, abdominal pain occurs. Nausea, vomiting, diarrhea common.
MODS: multi organ dysfunction “death” syndrome
Solid organs tend to fracture & bleed
Hallow ten to rupture & bleed
Appendicitis: Inflammation of vermiform appendix, located at Ileocecal junction
10 to 20% of population; young adults (usually 8- 25 y/o)
Acute appendicitis most common surgical emergency in field.
How does a ruptured appendicitis kill you? Massive infection!
Infection of peritoneum (peritonitis)
Most common obstruction that causes an appendicitis? Fecal material
Common site of pain:
McBurney’s point – 1 to 2 inches above anterior iliac crest along direct line from anterior crest to umbilicus
McBurney’s Sign: Pain on palpation to RLQ w/ rebound (McBurney’s Point)
Aaron’s Sign: Epigastric pain during palpation to McBurney’s Point) referred pain
Rovsing’s Sign: Pain in RLQ with palpation to LLQ refered
Psoas Sign(dont worry)
Once appendix ruptures, pain becomes diffuse due to development of peritonitis.
Do not repeatedly palpate for rebound tenderness; pressure that this exerts can cause inflamed appendix to rupture.
Prehospital Care:
Place patient in position of comfort, Give psychological support, Manage airway to prevent aspiration, Establish intravenous access, Pain medication?
Parietal process: prepping for hospital Naked for cath
TAA acute 10-10pain
Cholecystitis: Inflammation of gallbladde
Gallstones causes 90% of cholecystitis cases
Cholelithiasis (medical word for gallstones)
Ca, bulirubin, & majority hardened bile
Kehr’s Sign
Signs/Symptoms: Often pain occurs after meal high in fat content, N/V
Palpation may reveal diffuse right-sided tenderness or point tenderness under right costal margin
Positive Murphy’s sign: cup under rib & ask to inhale to P pressure & pain w/ pressure
Prehospital Treatment?
Metabolic alcoholism (mechanical stones) vascular decreased blood flow
Pancreatitis
What is Pancreatitis: Inflammation of pancreas
Four categories based on cause: Metabolic #1, Mechanical, Vascular, Infectious
Inky pigeon pook: Steatorrhera poop lipid lube
What is considered the most common reason for a patient to present with a lower GI hemorrhage?
Diverticulosis
Abdominal pain that is described as sharp in nature and the patient can usually pinpoint exactly where it is located at is known as:
Somatic pain
All of the following are considered solid abdominal organs except:
Gallbladder
Most organs of the abdomen are enclosed within the:
Peritoneum
The most common reason for a patient to develop Esophageal Varices is:
Alcoholism
Hematochezia is defined as:
Bright red blood in stool.
The main job of the large intestine is to:
Absorb water
Abdominal pain that is diffuse and hard to localize is termed:
Visceral pain
Irritation and inflammation of the peritoneum is called:
Peritonitis
Melena is defined as:
Dark, sticky, foul smelling stool.
Of the following, which one would probably result in a patient having a life-threatening hemorrhage?
Esophageal Varices
A common site of rebound tenderness associated with a patient experiencing an appendicitis is:
McBurning Point
You recognize any abdominal pain that persists longer than how many hours could be a true surgical emergency?
6
Hemoptysis is defined as:
Coughing up small blood clots.
Which of the following is not a hollow abdominal organ?
Kidney
Hematemesis is defined as:
Bloody vomit
A bowel obstruction that is caused when a portion of the small intestine twists around itself is:
Intestinal Volvulus
The ligament that is the dividing point between the upper and lower GI tract is the:
Ligament of Treitz
The presence of gallstones in a patient’s gallbladder is known as:
Cholelithiasis
A bowel obstruction that is caused by a portion of the small intestine folding over on itself is:
Intestinal Intussusception
An abdominal wall muscle contraction that the patient cannot control, resulting from inflammation of the peritoneum, is called:
Guarding
Pain that is felt in a body part removed from its point of origin is called:
Referred pain
Most of the nutrients from food are absorbed by the body in what part of the gastrointestinal system?
Small intestine
All of the following vital organs are located in the abdominal cavity except the:
Lungs
The appendix is located in the:
RLQ
Select all of the following abdominal organs that are considered solid:
Pancreas, Kidneys, Liver, Spleen
What is considered the most common reason for a patient to present with an upper GI hemorrhage?
Peptic Ulcers
A tear or lacerations in the distal part of the esophagus caused by excessive vomiting is known as:
Mallory-Weiss Tear
McBurney’s Sign is pain upon palpation to the:
RLQ
All of the following are found in the right upper abdominal quadrant except the:
Spleen
