Abdominal presentation Flashcards
Discuss the anatomy and physiology of the abdominal organs and GI tract
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Clinical manifestations, diagnostics, management, nursing considerations of GIT bleed
Upper GI bleed (above the duodeno-jejunal junction)
Clinical manifestations
- Heamatemesis
- (bright - recent bleed, coffee-ground - old blood accumulated in the stomach long enough to become hematin)*
- Malena
Lower GI bleed
Clinical manifestations
- Passing of bright red blood from the rectum
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Investigations
- FBE, APTT, INR, LFT, UEC, glucose, Hb with repeat, G&H, VBG, lactate
- Imaging, can include CXR
- Endoscope, colonoscope, barium enema, sigmoidoscopy
- ECG
Management
A/B: consider oesophageal varacies/ visualisation if intubating
C: Crystalloids then PRBC, NBM. Reverse coagulopathies
D: ?NGT
Clinical manifestations, diagnostics, management, nursing considerations of Bowel Obstruction
Mechanical/functional obstruction of the intestines.
Occurs at any level distal to the duodenum of the small intestine.
Fluid/gas build up proximal to obstruction → distension reduces absorption → increased pressure causes increased cap permeability → leak of fluids into peritoneal cavity → hypotension/hypovolaemic shock.
Clinical manifestations
Cramps
Vomiting (rare in lower)
Distention
Altered bowel sounds
Diagnostics
- Physical ax, hx of bowel habits, AXR, barium enema, colonoscopy
Management
NBM
NGT
?surgery, colonoscopy/ileostomy
Clinical manifestations, diagnostics, management, nursing considerations of Cholecystitis
Inflammation of the gallbladder due to obstruction of the common bile duct (carried bile from liver to gallbladder) by gallstones.
Distention of the gallbladder → pressure decreases blood flow → bacterial invasion.
Clinical manifestations
- Pain, epigastric to RUQ, can radiate to R scapula
- Abdo rebound tenderness, guarding
- Nausea/vomiting
- Fever
- Jaundice if CBD obstructed
- Fever
Diagnostics
- Abdo U/S
- FBE, UEC, Cr, glucose, LFT, biliruben, amylase, lipase
- Blood cultures if febrile
Management
- NBM
- ABx
- Analgesia
- ?ERCP - removes stones
Clinical manifestations, diagnostics, management, nursing considerations of Pancreatitis
Inflammation causes third spacing of fluid ++ into the peritoneum.
Causative factors: Mechanical block of pancreatic duct, gallstones, tumor, inflammation, trauma, surgery, alcohol, ABx, chemo
Clinical manifestations
- Sudden onset mild/severe stabbing pain
- Pain aggravated by alcohol, fatty foods, laying supine
- NVD, melena, heamatemesis
- mild/mod ascites
- diminished breath sounds/crackles to bases
- Cullens sign (periumbilical bruising and oedema)
- Grey Turners sign (flank bruising)
Diagnostics
- ECG
- Raised amylase/lipase/CRP
- AXR, CXR
- CT with contrast (ID’s fluid collection and pancreatic size/inflammation)
- *Need 2 of 3 criteria:**
- acute upper abdo pain
- lipase/amylaze 3 x usual
- MRI/CT/US
Management
A/B: Consider possibility of pleural effusions, ARDS, assess for resp distress/MV need.
C: Early agressive fluid resus to prevent the development of necrosis. NBM. Antiemetics - control loss. Monitor/correct ABx. IDC. ?inotropes if not responding to fluid resus
D: Analgesia, BGL +/- insulin. ?cholecystectomy if gallstone related
Clinical manifestations, diagnostics, management, nursing considerations of Liver cirrhosis
Damage to the liver parenchyma so severe that normal metabolic functions are no longer possible.
Cirrhosis = fibrosis nodules replace normal hepatic tissue. Decreased hepatic venous blood flow, increased portal vein pressure (HTN), causing 3rd spacing into the peritoneal cavity. Portosystemic shunt diverts blood around the liver causing renal vasoconstriction and decreased filtration.
Clinical manifestations
- Ascites
- Splenomegaly (fluid backed up into spleen)
- Kidney failure (hepatorenal syndrome)
- Hepatic encephalopathy, tremor (decreased detoxification of ammonia)
- Jaundice
- Pruritis
- Decreased albumin in blood (liver creates)
- Decreased clotting factors (liver creates)
Diagnostics
- Liver biopsy
p Elevates serum biliruben, LFT, ALP, GGT
- thrombocytopenia
Managemaen
- Scarring generally irreversable
- prevent continued liver damage
- stopping alcohol consumption and antivirals
- liver transplant
Clinical manifestations, diagnostics, management, nursing considerations of Liver failure
What liver failure causes
- Cirrhosis
- Portal HTN
- Oesophageal varicies
- Hepatic encephalopathy
- Hepatorenal syndrome
- Fluid shifts
Clinical manifestations
- Ascites
- Retention of salt and water
Diagnostics
- Serology (hep a b c, CMV)
- Clotting (INR)
- LFT’s
- Billiruben >300
- ALT, AST, GGT, ALP, Albumin
- U&E, glucose, ABG, FBE, Cultures
- CXR, ECG, CT
