Chapter 3 GI System Flashcards
Why are VPCs common in GDVs?
VPCs and V-tach are common in GDV secondary to reperfusion injury, ischemia, and cardiac depressant released.
GDV
Malposition of the stomach when it rapidly fills with air and rotates. Vena cava gets compressed, leading to a decrease in venous return to the heart through the vena cava.
A partial or complete blockage of the portal vein which can cause the liver or pancreas to become ischemic.
The spleen which is attached to the stomach on the upper left region of the abdomen can also be twisted and become ischemic.
What are the signs of GDV?
Non-productive retching Abdominal distention Pain Anorexia Restlessness Shock
What is the treatment of GDV?
Treat shock with IV fluid therapy
Severe abdominal pain with pain medication
Oxygen for respiratory distress due to enlarged stomach pressing on diaphragm
What does lactate response tell us about the GDV patient?
A decrease in 50% or greater from the starting lactate within 12 hours of presentation is a good indicator for survival.
What is the diagnosis for GDV?
Pre fluid bloods
Right lateral radiograph
Chest radiograph to rule out aspiration pneumonia and metastasis
What is the treatment for GDV?
Gastric decompression - orogastric tube measured from nose to the last rib
Gastrocentesis (trocharization)but since prone to DIC - check coagulation factors first - 14-18 gauge needle, patient in left lateral recumbency
Surgery - always recommended as can’t confirm an atomic
Treat ventricular arrhythmia
What are the complications of GDV post surgery?
Sepsis
DIC
Gastritis
Cardiac arrhythmias
Ischemia - reperfusion (I/R) injury
VPCs and ventricular tachycardia
- acid base and electrolyte abnormalities, myocardial depressant
factors and myocardial ischemia
- only treat if more than 160bpm or patient is clinical
-weak pulses, shock, perfusion decreased
- lidocaine or procainamide
I/R injury complications include
Systemic inflammatory response syndrome (SIRS)
Multiple organ failure (MODS)
Rhabdomyolysis (Damaged skeletal muscle breakdown)
What is hemorrhagic gastroenteritis (HGE)?
An intestinal disease characterized by:
-acute loss of blood, fluids and electrolytes from the GI tract
Symptoms:
- acute vomiting (possible hematemesis - vomiting of coffee ground blood)
- anorexia
- hematochezia (fresh blood per anus)
- rapid decline
- moderate (7%) to severe (10-12%) dehydration
- hypovolemic shock
Cause unknown
What is melena?
Passage of black tarry stools
What is gastric or intestinal obstruction?
Inability of food to pass through part of the GIT
Symptoms: Abdominal pain Vomiting Anorexia Straining to defecate Diarrhoea *Biggest concern = perforation= Septic peritonitis
What is septic peritonitis?
Inflammation of the pertoineum (membrane that lines the abdominal cavity) due to bacteria in the abdominal cavity from perforation or rupture of a hollow viscus (tumour).
What happens systemically in septic peritonitis?
1) Bacteria in abdomen causes inflammatory cascade to become activated.
2) Neutrophils & macrophages attack affected tissues.
3) Inflammatory cytokines are released from activated neutrophils.
4) Cytokines signal to T-cells and macrophages to travel to injury site.
5) Bacteria can cause DIC, SIRS, hypertension & shock.
6) Cardiac functions are frequently compromised due to electrolytes and acid-base disturbances.
What are the signs and symptoms of a patient in septic peritonitis?
Shock Injected MM Dull mentation Fever Weak peripheral pulses Tachycardia Very painful abdomen in advanced stages
How do you diagnose septic peritonitis?
Increased white blood cell count. Anemia Thrombocytopenia Electrolyte imbalances Increased kidney or liver enzymes Coagulation factors to be monitored Abdominal radiographs - loss of detail or free glass in abdominal cavity Ultrasound to find underlying cause Abdocentesis to obtain fluid sample for analysis, culture and susceptibility and view in house microscopically - presence of neutrophils & bacteria indicates septic peritonitis
How do you treat septic peritonitis?
IV fluids
Antibiotics
Analgesics to start immediately
If DIC - heparin & plasma to begin
Surgery once stable to eliminate contamination source - open or closed abdomen
Overall survival rate is 25% - guarded prognosis
What is protein losing enteropathy (PLE) and what are the causes?
Where protein leak into the gut lumen. Loss of albumin and globulin resulting in a decrease in intravascular oncotic pressure, development of abdominal and pleural effusion & peripheral edema.
Thromboembolisms may occur due to decrease in antithrombin.
Causes: Lymphangiectasis Parvovirus Intussuception Lymphosarcoma Lymphatic-plasmacytic enteritis Inflammatory bowel disease HGE
How do you diagnose PLE?
Intestinal biopsy
What is acute abdomen/ abdominal pain?
When a patient presents with a sudden onset of severe abdominal discomfort or pain. Pain is due to the stretching and inflammation of nerve fibres located within the organs and GIT.
What is hypovolemic shock?
It is characterised by a significant decrease in intravascular volume resulting in a decrease in stroke volume and cardiac output.
*Stroke volume = vol. of blood pumped from the left ventricle per beat.
What kind of medication should be avoided when a patient is suffering from acute abdomen?
Non-steroidal anti-inflammatories (NSAIDS) until GI ulceration can be ruled out and hypoperfusion is no longer a concern.
What is DPL?
It stands for diagnostic peritoneal lavage used to rule out various diseases that causes acute abdomen.
How much fluid must be present in the abdominal cavity to be able to perform a successful abdocentesis?
More than 6ml/kg.
Ultrasound guided abdocentesis will yield better results.
Using the 4 quadrant tap technique.
