Abdominal Emergencies ESA Flashcards
What does rigidity in the abdomen suggest?
Peritonitis
Rigidity in the absence of guarding is a medical emergency.
What are the mechanical causes of abdominal pain?
Distension, pulling, tearing
These can lead to discomfort and require assessment.
How is visceral pain characterized?
Dull, diffuse, cramping, poorly localized
It is often caused by the distension of an organ.
What type of pain is caused by inflammation of the peritoneum?
Parietal pain
This type of pain is intense and localized.
What is referred pain?
Visceral pain felt in other parts of the body
This occurs due to intersecting nerve pathways.
What are signs of upper GI bleeds?
Coffee ground emesis, bright red emesis
These symptoms indicate bleeding above the stomach.
What are signs of lower GI bleeds?
Bright red blood in stool, possible melena
These indicate bleeding from the colon.
What is peptic ulcer disease?
Ulcers that occur in the lower esophagus stomach or duodenum
It can be caused by Helicobacter pylori infection, increased gastric secretions, or decreased mucosal barrier.
What can cause esophageal varices?
Liver cirrhosis leading to portal hypertension
This condition increases pressure around the esophagus, risking rupture.
What are common causes of gastritis?
- ETOH
- Foods
- Bulimia/anorexia
- Drugs
- Infections
Inflammation of the stomach lining can arise from various factors.
What are the signs and symptoms of diverticulitis?
ABD pain, fever, N/V, chills, cramping, constipation
Symptoms severity depends on infection extent.
What is the definition of gastroenteritis?
Inflammation of the mucosal lining of the GI tract
It shares causes similar to gastritis.
What are the main causes of inflammatory bowel disease (IBD)?
Genetic and environmental factors
IBD includes conditions like ulcerative colitis and Crohn’s disease.
What is Ulcerative Colitis?
Inflammation limited to the inner lining of the colon
Characterized by periods of remittance and exacerbation, often with diarrhea and hematochezia.
What are the causes of symptoms in Ulcerative Colitis?
- Inflammation (may suffer systemically due to autoimmune quality)
- Malnutrition (anemia, electrolyte imbalances)
- Frequent infections
- Hemorrhage
What is Crohn’s Disease?
Inflammation usually extends from the inner lining through the entire thickness of the bowel wall
Creates ‘skipped lesions’ and has periods of remittance and exacerbation.
What are the causes of symptoms in Crohn’s Disease?
- Inflammation (may suffer systemically due to autoimmune quality)
- Malnutrition (anemia, electrolyte imbalances)
- Frequent infections
- Complications (fistulas/obstructions)
What are the key differences between Crohn’s Disease and Ulcerative Colitis?
- Crohn’s: Full thickness inflammation with skipped lesions
- Ulcerative Colitis: Contiguous inflammation limited to the inner lining
What is peritonitis?
Inflammation of the peritoneum causing swelling due to fluid movement into the peritoneum
Can lead to profound hypovolemia and obstruction of abdominal organs.
What are the signs and symptoms (S/S) of peritonitis?
- True abdominal rigidity
- True inability to lay flat
- Intense pain
What are the common causes of bowel obstruction?
- Adhesions
- Hernia (small bowel)
- Tumors
- Impaction (large bowel)
What are the common signs and symptoms of bowel obstruction?
- N/V
- ABD pain in waves
- Constipation
- Distention
- Decreased bowel sounds past obstruction
- Palpable hard mass
- SOB
What is appendicitis?
Obstruction caused by fecal matter, tumors, or foreign objects leading to inflammation and swelling of the appendix
Rupture increases mortality rate.
What are the signs and symptoms of appendicitis?
- Pain initially diffuse around the umbilicus and localizes to McBurney’s point
- N/V
- Fever
- Rupture leads to diffuse pain and peritoneal infection.
What is cholecystitis?
Inflammation of the gallbladder caused by obstruction by a gallstone, usually at the cystic duct.
What are the signs and symptoms of cholecystitis?
- RUQ Pain
- Referred pain to right shoulder
- Recent ingestion of fatty foods
- N/V
What are the two major types of gallstones?
- Cholesterol gallstones (80% of stones)
- Pigment gallstones
What are the causes of cholesterol gallstones?
- Liver secretes too much cholesterol
- Liver does not produce enough bile to dissolve cholesterol
What is pancreatitis?
Inflammation of the pancreas commonly caused by an obstruction or alcohol consumption.
What are the signs and symptoms of pancreatitis?
- Severe upper abdominal pain radiating to back
- Worse with eating
- N/V
- Fever
What are the major functions of the liver?
- Maintenance of blood glucose level
- Lipid metabolism
- Protein metabolism (Ammonia & Clotting Factors)
- Detoxification of drugs and hormones
- Excretion of bilirubin
- Bile production
- Phagocytosis
What is Hepatitis A and how is it transmitted?
Spread through fecal-oral mode of transmission
incubation 2-6 weeks
Common in refugee camps and overcrowded populations with poor sanitary conditions.
What are the characteristics of Hepatitis B?
- Spread by close contact, especially sexual contact
- Chronic and carrier states
- Persistent flu-like symptoms
*1-6 month incubation
What is unique about Hepatitis C transmission?
-Believed to be spread by blood transfusion and STD/STI
-50% of individuals becoming chronically infected.
-Incubation 2week to 6 month
What is Hepatitis D?
Requires the presence of Hepatitis B and can become ‘super’ hepatitis.
incubation 2 week to 10 weeks
What is Hepatitis E and where is it most common?
-Fecal-oral transmission
-can cause epidemics
-most common in Asia and Africa.
What is hepatic cirrhosis?
Inflammation due to damage or disease causing impaired fatty acid metabolism and scar tissue formation.
What are the complications of hepatic cirrhosis?
- Kidney failure
- Confusion leading to coma
- Ascites/Esophageal varices
- Hypoglycemia
- Reduced clotting
- Jaundice
What are the major functions of the kidney?
- Regulation of blood volume and composition
- Regulation of blood pH
- Regulation of BP
- Regulation of Hematocrit
What are the stages of renal failure?
- Early stage (60% function of normal)
- Renal insufficiency (25% of normal)
- End stage (less than 10% of normal)
*Renal failure
What is chronic renal failure?
Damage to nephron impairs kidney’s ability to perform normal functions.
What is the significance of Glomerular Filtration Rate (GFR) in chronic renal failure?
Classified by GFR, indicating the level of kidney function.
What are the most common causes of chronic renal failure?
HTN and DM
What are emergency complications of chronic renal failure?
- Pulmonary Edema
- Anemia
- Hyperkalemia
- Acidosis (May show Kussmaul respirations)
- Uremia and Coma
What are some other complications of chronic renal failure?
- HTN
- Osteoporosis
- Oliguria
- Polyuria
- Anuria
- Fluid retention
- Electrolyte imbalances
What is uremia?
The buildup of nitrogenous waste (urea) that is normally excreted by the kidneys
urea is damaging to all tissues in the body, and therefore will cause multisystem damage to…
confusion-> coma
pulomnary edema
Arrythmias and pericarditis
impaired clotting
What are the effects of urea on the body?
- Confusion
- Coma
- Pulmonary Edema
- Arrhythmias and Pericarditis
- Impaired clotting
In renal patients, what does an abnormal ECG indicate?
Hyperkalemia until proven otherwise
What characterizes acute renal failure?
A sudden and marked decrease in filtration through the glomeruli, onset within hours
What are the classifications of causes for acute renal failure?
- Prerenal: Inadequate perfusion to kidneys
- Renal: Glomerular diseases, drugs, hypertension inside kidneys
- Postrenal: Obstructions after kidneys
What are the two types of dialysis used to manage renal failure?
- Hemodialysis
- Peritoneal Dialysis
What is a urinary tract infection (UTI)?
Introduction and colonization of bacteria inside the urethra
What are the risk factors for UTIs?
- Catheterization
- Female
- Elderly
What mnemonic would you use to assess an elderly patient with acute delirium for a potential UTI?
D Drugs (new meds, side effects, interactions)
E Electrolyte imbalances (e.g., dehydration, hyponatremia)
L Lack of fluids or food (dehydration, malnutrition)
I Infection – think UTI, pneumonia, sepsis
R Reduced sensory input (vision/hearing loss)
I Intracranial events (stroke, head injury)
U Urinary retention or UTI
M Metabolic issues (hypoglycemia, thyroid problems)
What is renal colic?
Otherwise known as kidney stones, a metabolic disorder characterized by the build-up of urea crystals in kidneys
What are the symptoms of renal colic?
- Extreme colicky pain
- Sharp, cramping pain in the back and side
- Dysuria
- Nausea and vomiting
What is lithotripsy?
A treatment that uses focused shock waves from outside the body on the kidney stone
What happens during renal obstruction?
Obstruction of the urinary tract leads to elevation of pressure in the nephron tubules
What are common causes of renal obstruction?
- Urethral and bladder outlet obstruction
- Ureteral obstruction
- Intrarenal obstruction
What are the signs and symptoms of genitourinary (GU) bleeds?
- Pain
- Shock
- Amount of bleeding (Serious vs. Non-serious)
What is testicular torsion?
Twisting of the spermatic cord around a testicle, cutting off blood supply
What are the symptoms of testicular torsion?
- Sudden and severe pain
- Enlargement of the affected testicle
- Tenderness
- Swelling
What is pelvic inflammatory disease (PID)?
Infection of a woman’s reproductive organs, spreading from the cervix to the uterus, fallopian tubes, and ovaries
What are common causes of abdominal aortic aneurysm?
- Arteriosclerosis
- Genetic factors
- Physical trauma
What are the signs and symptoms of abdominal aortic aneurysm?
- Unexplained hypotension
- Unexplained syncope
- Tearing or ripping pain in abdomen or back
- Pulsating mass usually located above umbilicus left of midline
What is an ostomy?
An opening through the skin of the abdomen into the intestine, where stool is formed
What are the two types of ostomies?
- Ileostomy
- Colostomy
How often should a patient with an ileostomy empty their pouch?
4 to 6 times a day
What are important aspects of stoma care?
- Look for reddening or swelling on the skin
- Ensure the stoma is pink or red and moist-looking
What is the primary assessment in abdominal emergency treatment?
- Full primary assessment
- Oxygen
- IV large bore
- ECG
What common labs are used for liver assessment?
- Alkaline phosphate (alk-phos/ALP)
- AST
What common labs are used for renal assessment?
Dipstick for blood/proteins
What common labs are used for pancreas assessment?
- Amylase
- Lipase
What should be reviewed in a patient’s history concerning medications?
Commonly prescribed medications
3 Main causes for Peptic ulcers?
- Helicobacter Pylori infection(70%)
- Increased gastric secretions
- Decreased mucosal secretions/barrier(NSAIDs causal)
S/S inflammatory Gastritis
- Epigastric pain
- Heartburn
- change of pain with eating(can be better or worst)
Diverticulum?
Outpouches through weak points of the intestinal tract.
Diverticulosis?
Outpouching without inflammation
Diverticulitis?
Outpouching with infection/inflammation
What is Hepatitis caused by?
Hepatotrophic virus
Rapid inflammation of the liver in Hepatitis B called?
Fulminant infection
