Gastro Flashcards
what are the indications of an NG tube?
Diagnostic and Therapeutic indications:
Diagnostic:
- Evaluation of upper GI bleeding
- Aspiration of gastric fluid content
- Identification of the esophagus and stomach on a chest radiograph
- Giving radiographic contrast to the GI tract
Therapeutic:
- Gastric decompression
- Feeding
- Bowel irrigation
- Medication administration
If a patient with acute abdomen needs surgical input after your assessment, what are some mx things you need to include after those in A-E?
- intravenous access, nil-by-mouth (NBM) status set,
- analgesia +/- antiemetics,
- initial imaging (as discussed above),
- VTE prophylaxis,
- urine dip, bloods (including amylase).
- If the patient is unwell, consider a urinary catheter and/or nasogastric tube if necessary, monitor fluid balance.
what is peritonism? how does it present?
Peritonism (not peritonitis) refers to the localised inflammation of the peritoneum, usually due to inflammation of a viscus that then irritates the visceral (and subsequently, parietal) peritoneum.
This leads to patients stating that their abdominal pain starts in one place (irritation of the visceral peritoneum) before localising to another area* (irritation of the parietal peritoneum) or becoming generalised.
The classic example of this is acute appendicitis, with the pain migrating from the umbilical region to the right iliac fossa
describe colicky pain and give examples
Colic is an abdominal pain that crescendos to become very severe and then goes away completely. The most common types of colic are seen in biliary colic, ureteric colic, and bowel obstruction.
how does an ischaemic bowel disease present?
3 types: acute mesenteric ischaemia, chronic mesenteric ischaemia, and colonic ischaemia.
Any patient who has severe pain out of proportion to the clinical signs has ischaemic bowel until proven otherwise.
Patients will often complain of a diffuse and constant pain, however the examination can often otherwise be unremarkable.
The clinical course may range from transient and reversible to fulminant.
Can present post MI or similar event
what are ivx findings of ischaemic bowel?
FINISH
They are often acidaemic with a raised lactate and physiologically compromised.
what is the aetiology of ischaemic bowel disease?
Arterial:
emboli, thrombosis, vasculitis
Venous:
Thrombosis
Hypoperfusion:
shock (heart failure, dialysis), infection, trauma, drugs
Complications of iscahemic bowel?
- Fear of food, Short bowel syndrome, Stricture
- Perforation, infarction, peritonitis
Mx of ischaemic bowel?
Imaging:
Definitive diagnosis is via a CT scan with IV contrast.
Rx:
Refer to surgical team
- If evidence of complications; perforation, infarction, peritonitis
A. Resuscitation + supportive
B. Empirical abx
C. Correct cause / surgery- embolectomy / bowel resection
D. Post op Anticoagulation - heparin - No evidence of complications
A. Resuscitation + supportive
C. Correct cause / surgery- embolectomy / bowel resection
D. Post op Anticoagulation - heparin
how does peritonitis present?
Patients with a generalised peritonitis present will often lay completely still (not to move their abdomen) and look unwell; this is especially important when compared to a renal colic, whereby patients are constantly moving and cannot get comfortable.
On examination, they will show signs of:
Tachycardia and potential hypotension
A completely rigid abdomen with percussion tenderness
Involuntary guarding – the patient involuntarily tenses their abdominal muscles when you palpate the abdomen
Reduced or absent bowel sounds, suggesting the presence of a paralytic ileus
what is a paralytic Ileus?
Paralytic ileus is the condition where the motor activity of the bowel is impaired. Neuromuscular failure involving the myenteric (Auerbach’s) and submucous (Meissner’s) plexus.
The intestine fails to transmit peristaltic waves, resulting in a functional obstruction, allowing fluid and gas to collect in the intestine.
It is the small intestine that is predominantly affected, but the colon and stomach could also be involved.
Although the condition may be self‐limiting, it is serious and if prolonged and untreated will result in death
how does ileus presnt?
The resultant stasis leads to accumulation of fluid and gas within the bowel with associated distension, vomiting, decrease of bowel sounds, and absolute constipation.
peritonitis can cause Ileus
ivx findings in ileus?
AXR:
- Generalised distension of small and large bowel
- Air fluid levels in bowel
causes of peritonitis?
perforation of an abdominal viscus.
The causes of perforation are broad but include peptic ulceration, small or large bowel obstruction, diverticular disease, and inflammatory bowel disease.
Which acute abdomen causes require most urgent intervention?
Bleeding: Ruptured AAA Ectopic pregnancy Trauma Gastric ulcer
