HNN227: Musculoskeletal + GIT Flashcards
Appendicitis Pathophysiology
Inflammation of the appendix; worm-like structure attached to the Seacom of the large intestine, unknown function.
Intestinal lumen continues to secrete mucus, the blockage causes a build up, increasing the pressure in the appendix.
a. Increased pressure of the surrounding visceral nerve fibres.
b. Gut flora is trapped and multiplies > immune response > pus build up.
c. Ischemia in the appendix due to capillary compression.
d. Rupture > bacteria escapes into the peritoneum.
Apendicitis SS
Symptoms
* Right lower quadrant abdominal pain
* Abdominal guarding
* Fever
* N+V
Hernia Pathophysiology
Loop of intestine pushes through a weakness in the muscular wall of the abdominopelvic cavity.
Non-reducible = intestines become trapped in the abdominal wall and cannot be pushed back.
Strangulated = intestines become trapped in the abdominal wall and compromise vascular supply to the trapped tissue.
Adhesion Pathophysiology
Scar tissue that forms following after abdominal surgery, peritonitis, or due to Crohn’s disease.
May cause obstruction by trapping loops of the intestine or by kinking the intestine.
Intussusception Pathophysiology
Rare disorder where the intestine folds in on itself. Lumen is narrowed and blood vessels are squeezed.
Hernia SS
Symptoms
* Pain
* Local deformity
* N+V
* Sepsis
Interssusception SS
Symptoms
* Abdominal pain
* Paroxysms 15 minutes apart
* N+V
* Anorexia
* Blood in stool
Diverticular Disease Pathophysiology
Projections of the large intestinal wall and lumen.
Occur when small hard faeces form requiring high pressure in the intestine to push them along. This induces a structural change in the colon wall causing ballooning out of the mucosa/submucosa through the muscle wall.
Diverticular Disease SS
Symptoms
* Left lower quadrant pain
* N+V
* Altered bowel habits
* Bloating
Ileus Pathophysiology
Functional obstruction resulting from an inability of the intestine (bowel) to contract normally and move waste out of the body.
Fluid and gas accumulate.
Ileus SS and Management
Symptoms
* Abdominal pain
* N+V
* Anorexia
* Abdominal distension
Management
* Nil by mouth until resolved
* Symptom relief: NSAIDS, NG tube
Clinical Presentations of Soft Tissue Injuries
- Pain
- Decreased ROM
- Localised oedema
- Localised haematoma
- Deformity
- Loss of function
- Reduced peripheral perfusion (hard to fine pulses, delayed capillary refill)
Management of Soft Tissue Injuries
- RICER: rest, ice, compression, elevation, referral
- Regular neurovascular obs
- If neurovascular compromise is detected, limb should not be elevated above the heart
- NO HARM: no heat, alcohol, running, massage
Sprain
Injury to a ligament (connects bone to bone/cartilage). Can occur as a result of twisting or stretching beyond the ROM of a joint.
Strain
Stretching or tearing injury to a muscle or a tendon (connects muscle to bone). Can occur as a result of twisting or stretching beyond the ROM of a joint.
Dislocation
Displacement of one or more ends of articulating bones. Occur when extreme forces damage a ligament and permit the two bones to seperate. Can result in nerve or blood vessel damage.
Subluxation
The partial dislocation of one or more ends of articulating bones. The ligaments anchoring the two bones experience less damage than a dislocation.
Avulsion
Forcible detachment of a tendon, ligament, muscle, or bone from its point of attachment.
Bursitis
Condition that results in inflammation and accumulation of fluid in the subcutaneous bursae (sac-like structures filled with fluid to reduce friction between two surfaces).
In inflammation cause the bursae to become painful and lose their friction reducing properties. Usually cause repetitive use of joints.
Tendinitis
Inflammation of a tendon resulting from chronic overuse.
Fractures: Complications affecting the bone
Delayed union: prolonged period of time before bone healing succeeds due to compromised circulation, infection, immobilisation.
Non-union: unsuccessful unification of the bone ends due to tissue loss, compromised circulation, infection, improper splinting, pathological fractures.
Malunion: misalignment of bone ends due to improper splinting.
Avascular necrosis: tissue death due to loss of blood supply.
Osteomyelitis: infection of bone.
Fractures: Complications affecting the limb
Compartment syndrome: High pressure build up in a group of muscles due to inflammation or bleeding into the muscle compartment. Due to the fascia, pressure is directed inwards compressing capillaries, nerves, and myocytes. Can decrease blood flow, preventing nourishment and oxygen from reaching nerve and muscle cells. (5 P’s)
Blood vessel damage: Can result in ischemia or anoxia leading to necrosis.
Peripheral nerve damage: Altered function or sensation.
Fat embolus syndrome: Pelvis or long bone fractures. Fat globules from the bone marrow may enter circulation.
1) Mechanical factors: vessel obstruction
2) Chemical factors: damaged cells produce of toxic metabolites
Deep Vein Thrombosis: blood clot in the lining of a large vein compromising blood flow or causing embolus.
Stages of Bone Healing
HAEMATOMA FORMATION
5 days
* Blood collects and clots
* Local osteocytes die
* Osteoblasts and osteoclasts proliferate
FIBROCARTILAGINOUS CALLUS FORMATION
1 week
* Fibroblasts and osteoblasts lay collagen fibres
* Chondroblasts fabricate cartilage
* Osteoblasts lay bone matrix
OSSIFICATION
3 months
* Soft callus is mineralised
* Hard callus forms
REMODELLING
* Osteoblasts strengthen bone
* Osteoclasts remove excess bone
