Abdominal Emergencies Flashcards
Esophagus
Posterior portion of pharynx
Like a deflated tube, allowing air to pass into trachea easily
Unable to dissolve food but helps transport
Gastric Distention
Occurs when too much positive pressure ventilation occurs and causes the esophagus to dialate and let air in impeding lung expansion
Peristalsis
Transports food from mouth to stomach using rhythmic contractions
Esophageal Veins
Veins intertwined around esophagus
Portal Vein
Conversion of esophageal veins.
Transports venous blood from GI Tract directly to the liver for nutrients that have been absorbed.
No valves exist.
Cardiac Sphincter
Doorway connecting esophagus and the stomach.
Called so because people that have regurgitation of acid from the stomach to the esophagus often feel as if they are having a heart attack
Stomach
Secretes HCl acid to break down food.
Contracts and mixes it’s food until smooth consistency achieved.
Water and fat soluble substances dissolved
Pyloric Sphincter
Doorway between the inferior portion of stomach to the entry of the small intestine
Chyme
Material that exits the pyloric sphincter
Duodenum
First part of small intestine.
Connects gallbladder, liver and pancreas to the digestive system.
Liver
Produces bile and stored in gall bladder.
Also can promote carbohydrate conversion.
Liver can convert glycogen into glucose.
Fat and protein metabolism occurs when blood flows through the liver.
Detoxifies drugs, break downs red and white blood cells, stores vitamins and minerals.
Bile
Enzyme that helps break down fats
Small Intestine
Where 90% of all absorption occurs.
20’ long.
Water soluble and fat-soluble vitamins absorbed by diffusion into blood stream.
Three sections of Small Intestine
Duodenum ( last part of upper GI )
Jejunum ( first part of lower GI )
Ilieum
Large Intestine
Or colon.
5’ long.
All nutrients have already been dissolved by small intestine and waste is now called feces.
Cecum, Ascending Colon, Transverse Colon, Descending Colon, Sigmoidal Colon, Rectum
MAIN role of Large Intestine is to complete the resorption of water to solidify stool. If hindered, this process causes diarrhea.
Time of Digestion
From mouth to anus takes 8 to 72 hours.
Ascites
Fluid buildup in the abdomen
Striae
Stretch marks
Protuberant
Protruding abdomen
Scaphoid
Concave abdomen
Normal bowel sounds
Occur 5-30 times a minute
Borborygmi
Prolonged stomach growling indicating strong contractions of the intestines
Visceral Pain
Difficult to localize.
Describe as burning, cramping, or aching. Felt superficially.
Organ contracts too forcefully or is distended
Parietal Pain
Steady, achy pain. Easier to localize.
Pain increases with movement.
Caused by inflammation (bleeding or infection)
Somatic Pain
Localized pain, felt deeply.
Injury to tissue
Referred Pain
Pain originating one place and occurring elsewhere.
Occurs after somatic, visceral and parietal pain.
Orthostatic Vital
Vitals standing and sitting to gauge hypovolemia
Pain management for abdominal Pain
Morphine 5-10mg Toradol 15-60mg Fentanyl 50-100mcg Demerol 50-150mg Nubian 10mg
Medications for nausea
Zofran 4mg
Benadryl 10-50mg
Visatril 25-100mg IM
Phenegran 12.5-25mg
Hyponatremia
Low sodium
Swelling of cells
Symptoms- weakness, cramps, convulsions
Hypernatremia
High sodium
Shrinking of cells
Main cause oh hypovolemia
Vomiting and diarrhea
Second cause- hemmorage
Hyperkalemia
High potassium
Shortened QT interval and tented t waves
Symptoms- bradycardia, cramps, weakness
Hypokalemia
Low patassium
Prolonged QT interval and flattened QT intervals
Symptoms- weakness, paralysis, heart failure
Upper GI bleeding by Cause
Esophagus- Varices, Cancer, Tear, Dilated Veins, Cirrhosis, GERD
Stomach- Ulcers, Cancer, Gastritis
Small intestine (duodenum)- ulcer
Lower GI bleeding by Cause
Small Intestine- irritable bowel disease, cancer
Large Intestine- infections, ulcerative colitis, colorectal polyps, diverticula disease
Rectum- hemorrhoids
Esophagogastric Varices
Caused by pressure increases in the blood vessels that surround esophagus and stomach. These vessels drain into portal system. If liver is damaged blood cannot effectively flow through it easily, causing blood to back up and create pressure.
Esophageal Varices Assessment
Initially signs of Liver Disease- fatigue, weight loss, jaundice
Rupture of Varices is sudden- pain in threat, dysphasia, vomiting of bright red blood
Esophageal Varices Management
Fluid resuscitation
In hospital, cauterize effected area
Mallory-Weiss Syndrome
Junction between esophagus and stomach tears, causing severe bleeding. Reason for tearing is during an act of vomiting, pressure in the stomach can increase so greatly that causes a failure of structure
Mallory-Weiss Syndrome Assessment
Linked to vomiting.
Woman, can be related to hyperemsis graviadarum.
Mallory-Weiss Syndrome Management
Fluid resuscitation
Peptic Ulcer Disease
Protective layers of stomach and duodenum have been eroded, allowing acid to eat into the lining.
Can be caused by chronic use of NSAIDS, SMOKING and ALCOHOL
PUD Assesment
Pain in the stomach that subsides after eating and then reemerges after 2 or 3 hours.
Pain described as burning and gnawing.
Nausea, vomiting, heartburn and severe then bleeding can occur.
PUD Management
Assess degree of blood loss.
Orthostatic signs are critical in determining fluid needs.
In hospital- acid neutralization and antibiotics
Gastroesophageal Reflux Disease (GERD)
The Sphincter between the esophagus and the stomach opens, allowing stomach to move superiorly.
“Acid reflux disease”.
Smoking, obesity, and pregnancy increase chances of GERD
GERD Assesment
Heartburn most common and may increase with position, Like lying flat.
GERD Management
Pain may be confused with an infacrtion
Ask how many antacids patient has taken
Hemorrhoids
Swelling and inflammation of the vessels around the rectum. Caused by straining, irritation or pressure of the rectum.
Hemorrhoids Assesment
Bright red blood during defecation.
Mass on rectum formed by clotting of broken vessels
Anal Fissure
Linear tears to the mucosal lining in and near the anus.
Passage of large hard stools or physical activities.
Anal Fissure Assesment
Pain and bright red blood with defecation
Anal Fissure Management
Facilitate Pt comfort with a 5x9 over affected area
Hepatitis
Inflammation of the live, pain in upper right quadrant
Peritonitis
Inflammation of abdomen that is generalized pain and experiences rebound tenderness
Biliary Tract Disorders
Involve inflammation of gallbladder
- choleangitis
- cholelithiasis
- cholecystitis
- acalculus cholecystitis
Choleangitis
Inflammation of bile duct
Cholelithiasis
Presence of stones in gallbladder
Cholecysitis
Inflammation of gallbladder
Gall stones
Increased production of bile
Decrease emptying of bile
Gallbladder inflammation
Arise from decreased flow of biliary materials
-trauma, sespsis, sickle cell Disease, fasting
Women get cholecystitis two to three times more than men
Cholecystitis Assesment
No pain until fatty meal is present (gall bladder releases bile to break down foods)
Then severe RUQ pain
Cholecystitis Management
Pain control- morphine and meperidine
Nausea controlled
Fluid replenishment
Appendicitis
Inflammation of appendix occurs when fecal matter accumulates in the appendix causing pressure to build and eventually will rupture. Decrease blood flow with pressure and decrease lymph fluid causing decreases in body’s ability to fight infection.
Appendicitis Assesment
Early- periumbilical pain, nausea, vomiting, low grade fever
Ripe- pain in LRQ (McBurney’s point)
Rupture- decrease in pain and tenderness, rebound tenderness, generalized pain
Dumphy Sign
RLQ pain with coughing indicative for peritonitis
Appendicitis Management
Pain control
Fluid replenishment
Diverticulum
A weak area in the colon that begins to have small outcropping that turn into pouches. Condition called diverticulosis.
Adhesions can develop narrowing of colon resulting in constipation.
Diverticulitis Assesment
Abdominal Pain localized to the LLQ.
Symptoms- fever, malaise, body ache, nausea, chills
Pain can occur anywhere in colon, thus, resulting in pain presenting as another condition
Fitsulas can occur with colon and bladder
Diverticulitis Management
Fluid resuscitation and possible vasopressors
Pancreatitis
Caused from “auto digestion of pancreas”.
Occurs when tube in pancreas carrying enzymes that break down substances becomes block and starts to break down substances of pancreas leading to inflammation
Main causes are alcohol consumption and gallstones
Pancreatitis Assesment
Pain localized to RUQ or epigastric area.
Can be sharp and quite severe.
Radiation of the back is common.
-Nausea, fever, malaise, tachycardia, muscle cramps, hypotension
Tends to cause hypocalcemia which leads to muscle spasms
Hemorrhage can occur if autodigestion is advanced
Cullen Sign
Grey Turner Sign
Bruising around umbilicus
Bruising in flanks
-indicative of severe hemorrhage
Peritonitis Management
Assess for severe hemorrhage
Fluids resuscitation
Pain control- meperidine
Ulcerative Colitis
Caused by inflammation of the colon
Which causes weak spots of the colon forming ulcers
Ulcerative Colitis Assesment
Gradual onset of bloody diarrhea, hematochezia (bloody poop), and abdominal Pain, fever, malaise
UC Management
Assess degree of hemodynamic stability
Irritable Bowel Syndrome
Pain and changes in bowel habits
-hypersensitivity of pain
-hyperresponsiveness of smooth muscles causing diarrhea and cramps (constipation)
-psychiatric causes or IBS causes psychiatric
Can be triggered by stress, large meals, wheat, rye, chocolate and soda
IBS Assesment
Pain relieved by bowel movements
-diarrhea, steatorrhea (oily fatty stools that float) or constipation or bloated
IBS Management
Supportive
Psychiatric condition may be coexistant
Pain control
Crohn Disease
Similar to Ulcerative Colitis, however, the entire GI tract can become involved.
Usually ileum tends to be involved more.
(Last portion of small intestine before joining large intestine)
Unknown cause
Immune system attacks GI tract
Crohn’s Assesment
Chronic complaint of abdominal pain
Often in RLQ
-rectal bleeding, weight loss, diarrhea, skin problems, and fever
Crohn’s Management
Volume control
Pain control
Nausea
Acute Gastroenteritis
Family of conditions revolving around a central theme of infection with fever, abdominal pain, malaise, nausea and vomiting.
Viruses enter through fecal-oral route and seen when swimming or drinking contaminated water
Acute Gastroenteritis Assesment
-GI upset and diarrhea in hours or days of contamination and can last days to weeks or until death
Dehydration and hyponeutremia occurs resulting in death
Acute Gastroenteritis Mangement
Analyze degree of fluid deficient
Orthostatic vitals!
Analgesic and Anti-emetics
-control fluids, diarrhea and nausea/vomiting
Rectal Abscess
Rectum creates mucus to lubricate feces during defecation.
If ducts become blocked an Abscess can occur.
Blockage allows bacteria to grow and spread around anus
Abscess Assesment
Rectal pain that increases with defecation
Fever and rectal drainage
Abscess Management
Comfortability
Transport in POC
Liver Disease: Cirrhosis
Defined as “liver failure” can be from multiple causes such as drinking, hepatitis, trauma, autoimmune disorder
Cirrhosis Assesment
First Phase: joint aches, weakness, fatigue, nausea, vomiting, urticaria and itching
Second Phase: severe damage characterized by alcoholic stools, darkening of urine, jaundice, icteric conjuctiva and ascites.
Cirrhosis Management
Drugs given will remain in body much longer due to liver comprimisation
Use lower ends of dose range for liver failure patients
Give medications at longer intervals
Liver Disease: Hepatic Encephalopathy
When brain function begins to decline from liver failure.
Ammonia levels rise in body with lever failure, and effect neurons.
Small-Bowel Obstruction
Postoperative adhesions most common cause in small intestine
SBO Assesment
Abdominal pain with cramping
Increase in pressure from buildup causing increased in peristalsis causing severe cramping
Large Bowel Obstruction
Caused by mechanical obstruction or dialate on causing decreased internal diameter
LBO Assesment
Abdominal Pain with nausea and vomiting
Record recent Bowel habits
Hernia
Protrusion of organ or structure into an adjacent cavity.
Can be felt during a cough by increase abdominal pressure.
COPD related due to constant coughing
Hernia Assesment
Reducible: returns to normal place with manipulation
Incarcerated: trapped in new location
Strangulated: Intestine trapped and squeezed until blood supply is diminished
Incisional: from prior surgeries, herniation occurs
Hernia Management
Pain control
Mesenteric Ischemia
Mesentery artery occluded
Gastroschisis
Baby born with bowel outside of the body due to malformation
Pyloric Stenosis
Hypertrophy of pyloric Sphincter of stomach
