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National Diploma > Abdominal > Flashcards

Abdominal Flashcards

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1
Q

What is the pre-hospital management for acute appendicitis?

A

IV fluid and pain relief

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2
Q

What are the symptoms of an acute appendicitis?

A

Guarding and percussion tenderness in lower right quadrant.
Initially there is pain in the umbilicus area as the visceral pain receptors are stimulated. As the inflammed appendix begin to irritate the omentum, parietal pain receptors are stimulated leading to localisation in the right iliac fossa.
Patients with appendicitis tend to lie very still as pain is aggrevated with movement.

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3
Q

What is colic?

A

Colic refers to intermittent pain. Tends to occur when there is an obstruction in the lumen of a hollow organ.

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4
Q

What is biliary colic?

A

Arises from a blockage of the neck of the gallbladder. Is not true colic as the pain is not intermittent. It comes, is constant for a period of minutes and goes away again.

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5
Q

What are gallstones?

A

These are very common and can often cause biliary colic. Most are made of cholesterol, either by itself or mixed with bilirubin.

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6
Q

What can provoke biliary colic?

A

After a fatty meal, the gallbladder contracts which can cause one of the stones to get stuck in the neck of the gall bladder. This will cause pain until the gallbladder relaxes.

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7
Q

What is acute cholecystitis?

A

Where a gall stone get stuck in the neck of the gall bladder for some time. Pain is similar to biliary colic but it will be more severe and present for longer. There is often also nausea, vomiting and fever.

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8
Q

What are the symptoms of acute cholecystitis?

A

Pain similar to biliary colic but more severe and present for longer. Often will be nausea, vomiting and fever. O/E there will usually be right upper quadrant tenderness and there may be guarding.
There may be right shoulder tip pain.

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9
Q

What is obstructive jaundice?

A

Where a gall stone has gotten stuck in the bile duct.

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10
Q

What are the symptoms of obstructive jaundice?

A

Pain similar to that of acute cholecystitis.
Jaundice
Severe itching

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11
Q

Why does gall bladder time sometimes lead to right shoulder tip pain?

A

The nerve that supplies the gall bladder is very close to the diaphragm and may irritate it. The diaphragm is supplied by the same nerve (C4) as the shoulder tip so the pain may be referred.

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12
Q

How do we manage biliary colic/acute cholecystitis?

A

Appropriate positioning
Pain relief
IV fluid if dehydrated.

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13
Q

What commonly causes acute pancreatitis?

A

Alcohol binging and gallstones

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14
Q

What is the pathophysiology of acute pancreatitis?

A

Exocrine cells die releasing digestive enzymes into the space surrounding the pancreas. This results in an oedema in the retroperitineal space, resulting in hypovolemic shock.

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15
Q

What are the symptoms of acute pancreatitis?

A 
Epigastric pain which radiates to the back with guarding
Severe/constant pain
Nausea/vomiting
Pale/sweaty
Tachycardic
Hypotensive
Grey Turners sign (flank bruising)
Cullens sign (umbilical bruising)
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16
Q

What is the treatment for acute pancreatitis?

A

Positioning
Pain relief
Antiemetics
Aggressive fluid resuscitation

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17
Q

What does GI bleeding refer to?

A

Haematemesis and Melena

not PR bleeding

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18
Q

What are peptic ulcers?

A

Ulcers of the stomach/duodenum
Often caused by helicobacter pylori eroding the mucosal membrane
Often relieved by losec, can bleed

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19
Q

Oesophageal varices?

A

Dilated veins at the base of the oesphagus
Can bleed heavily
Common in those with chronic liver disease
Always suspect them in alcoholics with GI bleeding

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20
Q

What is a Mallory Weiss tear?

A

A tear in the muscosal membrane of the oesphagus
Common after prolonged vomiting
Benign

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21
Q

What are the layers of an artery?

A

Intima
Media
Adventia
Structural and elastic properties come from the media

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22
Q

What is the pathophysiology of an AAA?

A

The degeneration of the aortic media due to atherosclerotic changes. This results in a loss of structural integrity.

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23
Q

What is the mortality of an AAA?

A

Usually asymptomatic until they expand/rupture. More than half who rupture will die before reaching hospital.

24
Q

What are the symptoms of an expanding AAA?

A

Sudden, severe, constant lower back/flank/abdo pain

Pulsating sensation

25
Q

What are the symptoms of a ruptured AAA?

A 
As for an expanding AAA
Profound hypovolemic shock
Tachycardia
Hypotension
Decreased LOC
Cyanosis
Mottled skin
Pulsatile abdominal mass
26
Q

What is the prehospital management for AAA?

A 
Airway
High flow oxygen
Positioning
Back up
Constant monitoring
Early R40
Large bore IV fluids if severely shocked
27
Q

What is ileus?

A

Decreased ability of the bowel to perform peristalsis.

28
Q

What are the most common causes of small bowel obstructions?

A

Adhesions following surgery

29
Q

What are the most common cause of large bowel obstructions?

A

Neoplasms

30
Q

What are some cuases of bowel obstruction in the duodenum?

A

Stenosis
Foreign Body
Stricture
SMA syndrome

31
Q

What are some common causes of small bowel obstruction?

A 
Adhesions
Hernia
Intussception
Lymphoma
Stricture
32
Q

What are some common causes of large bowel obstruction?

A 
Carcinoma
Faecal impaction
Ulcerative Colitis
Volvulus
Diverticultis
Intussception
Pseudo-obstruction
33
Q

What is the usual history of someone with a bowel obstruction?

A

As obstruction develops the bowel becomes congested and intestinal contents cannot be absorbed. This is then followed by vomiting and decreased oral intake. The combination of decreased intestinal absorption, vomiting and decreased oral intake can lead to dehydration and electrolyte imbalance. This can ultimately lead to renal failure and shock.

34
Q

How does a bowel obstruction lead to bowel necrosis?

A

When pressure in the lumen exceeds the capillary and venous pressure of the bowel wall, bowel absorption and drainage decrease. At this point bacteria may enter the bloodstream, the bowel may become ischaemic and septicaemia and bowel necrosis can occur. Shock can follow.

35
Q

Describe the pain associated with a bowel obstruction?

A

Mostly cramping and intermittent pain
Small bowel instructions are often associated with pain lasting only minutes and being centred near the umbilicus.
Pain associated with large bowel obstruction tends to be lower in the abdomen and constant.

36
Q

What bowel sounds are associated with a bowel obstruction?

A

Bowel sounds may be increased early in an obstruction but may become diminished or absent as the obstruction continues

37
Q

How do we manage a patient with bowel obstruction?

A

Administered oral pain relief.
Entonox is contraindicated.
IV fluid may be given if shock or dehydration is present.

38
Q

What is nausea?

A

First phase of vomiting.
Subjective feeling of wanting to vomit (sign not a symptom)
Often associated with pallor, sweating and salivation

39
Q

What is retching?

A

Follows nausea.
Expulsion of the gastric contents doesn’t occur in this phase by retching generates the pressure that leads to vomiting.
This pressure is generated by a combination of the abdominal muscles, chest wall and the diaphragm.

40
Q

What is vomiting?

A

Involuntary, coordinated, forceful expulsion of the contents of the stomach and duodenum through the mouth.

Vomiting involves coordination of the muscles in the throat, chest, abdomen and the diaphragm as well as the smooth muscle in the duodenum, stomach and oesophagus.

41
Q

Where is the vomiting reflex initiated from?

A

The vomiting centre (VC) located in the medulla. It is a junction where many nerve pathways converge.

42
Q

Where does the vomiting centre receive input from?

A

Higher cortical centres such as those that deal with pain, smell, sight, fear. memory and anticipation.
Stomach and small intestine chemical and stretch receptors.
Labyrinths (vestibular system) in the ear such as the cochlea.
Chemoreceptor trigger zone (CTZ) which is outside the blood brain barrier and is sensitive to stimuli such as drugs and toxins in the blood and cerebrospinal fluid.

43
Q

How is vomiting different from regurgitation or reflux?

A

Vomiting is the active expulsion of stomach contents. Reflux/regurgitation is the passive flow of stomach contents into the oesophagus.

44
Q

What is an antiemetic?

A

A drug that treats nausea and vomiting.

45
Q

What is ondansetron?

A

A selective %-HT3 (serotonin) receptor antagonist.

46
Q

Why does ondansetron work as an antiemetic?

A

Approximately 80-90% of the bodys serotonin is found in the GI tract, in the endocrine cells that line the mucousa.

47
Q

How does ondansetron work?

A

It blocks serotonin receptors centrally and peripherally. 5-HT is the abbreviation for serotonin (5-hydroxytryptamine). The small 3 indicates the receptor type. It is a special ion channel that 5-HT opens to allow ions such as sodium to cross the membrane.

48
Q

What does serotonin do?

A

in the CNS serotonin is a neurotransmitter that is important i nthe modulation of anger, body temp, mood, sleep, sexuality, appetite, metabolism and vomiting.

49
Q

When is ondansetron indicated?

A

For severe nausea/vomiting
Provided the patient is over 1 year of age.
Not used prophylactically to prevent nausea with opiate use but is used if nausea occurs as a result of opiate treatment.

50
Q

Do we prefer oral dose or IV dose for ondansetron?

A

Oral

51
Q

When is IV ondansetron indicated?

A

if vomiting is continuous or if severe nausea and or vomiting persists 10 or more minutes after oral administration.

52
Q

When is IM ondansetron given?

A

When IV access cannot be gained. IV/IM ondansetron may be repeated once after 10 minutes to a max dose of 16mg by all routes for adults.

53
Q

What are common side effects of ondansetron?

A

Headaches
Flushing
Metallic taste

54
Q

What are some uncommon side effects of ondansetron?

A 
Constipation
Chest Pain
Hypotension
Dysrhythmias
Bradycardia
Hiccups
55
Q

What are the contraindications of ondansetron?

A

less than one year of age.
Universals
It is light sensitive so needs to be protected from the light

56
Q

What is gastroenteritis?

A

Children with viral gastroenteritis usually do not need intravenous fluid resuscitation and are generally managed with oral fluids.

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