Abdominal assessment, differentiation and management Flashcards
What is a bowel obstruction?
a blockage of the lumen in the small or large intestine that prevents food, liquid, and gas from moving through normally
What are some common causes for bowel obstructions?
Adhesions from past surgery, bowel cancer, herniation and inflammatory bowel diseases like crohns disease.
What does a complete obstruction prevent?
Prevents onward passage
Describe colicky pain:
painful cramps in your abdomen due to a blockage in your large intestine or small intestine. A sharp wave like pain.
What can be the presentation of a pt with a bowel obstruction?
In a high obstruction there tends to be early vomiting, colicky (wave like) pain and distension.
In a low obstruction there is constipation and an inability to pass flatus resulting in distension.
What are some differential diagnosis for bowel obstruction?
Renal colic (blockage) - pain that occurs when a stone blocks your urinary tract - Kidney stones
Billary Colic (blockage) - sudden, severe, and often cramping pain in the upper right abdomen, which may radiate to the back or right shoulder - common symptom of gallstones
Appendicitis
Gastroenteritis
What are some specific signs and symptoms associated with a bowel obstruction?
Always consider hernia entrapment especially in the inguinal regions or beneat scars from previous surgeries.
Always ask about stools looking for abnormal habits and bleeding.
What is the management for a bowel obstruction?
Symptom management - Analgesia, fluids if indicated and anti-emetic
May need urine catheter and NG tube
Referral for considerations of medical management or surgical intervention
What is a anti-emetic
a medication that prevents or relieves nausea and vomiting
Give an example of an anti-emetic
ondansetron
Define what diverticulitis is:
inflammation or infection of small pouches (diverticula) that can form in the wall of the large intestine (colon)
What is the cause of diverticulitis?
Diverticula are dead-end pouches most commonly within the descending colon wall. Inflammation or infection of these pouches causes diverticulitis.
What is the presentation of diverticulitis?
Lower abdominal pain radiating to the left iliac fossa often with guarding on palpation.
What are some associated symptoms of diverticulitis?
Unilateral left iliac fossa or left flank pain, anorexia, nausea/ vomiting and bowel changes including rectal bleeding.
What some differentials of diverticulitis?
Haemorrhoids - lumps inside and around your anus that can cause symptoms like bleeding, itching, and discomfort.
Anal fissure - tear or open sore (ulcer) that develops in the lining of the large intestine, near the anus, causing pain and sometimes bleeding during bowel movement.
Inflammatory bowel disease - cause severe abdominal pain and diarrhoea
What are some specific signs for diverticulitis?
Sometimes people present with profuse frank rectal blood loss.
What is the management for diverticulitis?
Symptom management such as analgesia
Transport
What is the cause of biliary colic?
Interruption of normal bile flow by stones or sludge causing the muscular distended gallbladder to repeatedly try to squeeze the bile past the blockage.
What is the presentation of billary colic?
episodic right upper quadrant colicky pain
What are some associated symptoms with billary colic?
- Jaundice if there is a blockage of the common bile duct
- Dark urine
- Nausea and vomiting
Define pelvic inflammatory disease:
Umberella term for many different conditions in the upper genital tract
What is the management of pelvic inflammatory diseases?
Pain relief, SDEC?, alternative pathway for specifc antbiotics. May not be able to exclude other conditions
What is acute cholecystitis?
inflammation of the gallbladder, usually caused by gallstones blocking the cystic duct.
What causes acute cholecystitis?
Ongoing prevention of bile outflow, leading to distension, irritation, inflammation, infection and potentially perforation of the gallbladder
