Gastroenterology: Notes Flashcards
Where does visceral pain originate
Walls of hallow organs like gallbladder, appendix, or in the capsules of solid organs. Described as vague or cramp like pain.
What mechanisms can cause visceral pain?
Inflammation, distension, ischemia.
What causes somatic pain?
Bacterial and chemical irritations.
Usually chemicals come from perforated ulcer, or inflamed pancreas. Resultant peritonitis can lead to sepsis and even death.
What kind of pain does appendicitis present with?
Periumbilical pain
What often causes upper gastrointestinal bleeding?
Often caused by ulcerated lesions
What are the six major identifiable causes of upper GI hemorrhage?
Peptic ulcer disease Gastritis Variceal Rupture Mallord-Weiss Tear Esophagitis Duodenitis
What are primary treatments for upper GI bleeding?
Oxygen
2 large bore IV’s (one for blood, one for fluid replacement)
IV fluids at 20cc/kg
Esophageal Varix
Swollen vein of the esophagus. Often these rupture and hemorrhage.
What causes Esophageal Varix?
Increase in portal pressure, which is usually a result of damage to the liver. This blood backs up into the left gastric veins causing bulges (varices). Two thirds of these cases are a result of Alcoholic liver cirrhosis.
What are signs and symptoms of esophageal varix?
Painless bleeding Hematemesis with bright red blood Dysphagia (difficulty swallowing) Burning or tearing sensation Increased pulse Increased respirations Signs of Shock
Acute Gastroenteritis
Caused by damaged vili in the intestine (which absorb water). Damage done by chemical agents or commonly, aspirin. Alcohol and tobacco users at higher risk. Signs and symptoms: Diarrhea Hypovolemia secondary to dehydration Tachycardia Melena Hematochezia Fever N/V Malaise Widespread pain, not focused on one region Treatment: O2 if needed Oral rehydration IV fluid Antiemetic- phenergan (promethazine)
Peptic Ulcers
Commonly caused by NSAIDS, acid-stimulating products like alcohol and nicotine, or Helicobacter Pylori (found in 80% of gastric and duodenal ulcers) Signs and Symptoms if Hemorrhaging: Acute, sever pain Ecchymosis and distension Hematemesis Melena-colored stool Signs of Shock Treatment: Oxygen IV fluid resuscitation
Lower GI Bleed
Common Causes: Aging Colon Lesions Rectal Lesions Ulcerative colitis Crohn's Disease Signs and Symptoms: Cramping nausea/vomiting Melena (if slow bleeding) Treatment: O2 if needed CPAP if needed Fluid resuscitation if needed
Ulcerative Colitis
Inflammatory bowel disorder: 2 types Type One: Pancolitis- spans entire colon Type Two: Proctitis- Limited to rectum Signs and symptoms: Bloody Diarrhea or stool with mucus Nausea/Vomiting Fever Weight Loss Signs of Shock Treatment: Oxygen IV access and fluid replacement Antiemetics
Crohn’s Disease
Can occur anywhere from mouth to rectum. Significant GI bleed in this disease is rare. Can cause fistulas between intestinal linings. Signs and symptoms: GI bleeding Weight Loss Abdominal Cramping/pain Nausea Vomiting Diarrhea Fever Pain can't be localized Tenderness Treatment: Managed airway Antiemetics
Diverticulitis
Small outpouchings of mucosal and submucosal tissue that push through the outermost layer of the intestine.- Balloons out of the intestines Signs and Symptoms: Lower left sided pain Signs of hemorrhage if present Fever N/V Bright red and blood feces Treatment: Supportive/ Treat for hemorrhage if signs of shock present
Hemorrhoids
Small masses of swollen veins that occur in the anus or rectum.
Signs and Symptoms:
Bright red bleeding and pain on deviations
Treatment:
Usually emotional reassurance
Bowel Obstructions
Blockages- usually in small intestines Signs and Symptoms: Decreased appetite Fever Malaise N/V- vomit looks and smells like feces Weight Loss Visceral pain Ecchymosis if significant hemorrhage occurs Treatment: Supportive unless shock present, then treat shock
Appendicitis
Inflammation of vermiform appendix at the junction of the large and small intestines.
Signs and Symptoms:
Diffuse colicky pain
N/V
Fever
Loss of appetite
Pain in umbilical region or at McBurney’s Point which in 1-2 inches above the anterior iliac crest in direct line from iliac crest to umbilicus.
Cholecystitis
Inflammation of the gallbladder
Caused when bile is supersaturated with calculi (stones) that lodge in common filed duct, obstructing the flow of bile causing gallbladder inflammation.
Signs and Symptoms:
Acute attack of upper right quadrant abdominal pain- with referred pain to right shoulder- often after eating fatty meal.
Signs and Symptoms:
Right upper quadrant pain referred to right shoulder
Paled cool clammy skin with sympathetic stimulation, or warm skin if inflamed peritoneum.
N/V
Treatment:
ABCs
oxygen
Managed Pain
Pancreatitis
Inflammation of the pancreas. 80% due to alcohol intake.
Signs and Symptoms:
Intense abdominal pain- upper left quadrant radiating to epigastric region.
N/B
Ecchymosis and swelling of the left upper quadrant with diaphoresis, tachycardia, and hypotension if hemorrhaging.
Treatment:
ABC’s
Oxygen
IV fluid resuscitation
Hepatitis
Transmitted oral-fecal route- damaged liver cells.
Signs and Symptoms:
Upper right quadrant abdominal tenderness
Anorexia, Losing weight, Clay colored stools, Jaundice, nausea and vomiting, malaise, photophobia, Pharyngitis, cough.
Treatment:
ABC’s
IV line
Antiemetic
