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YEAR 3 GP - RT > Tutorial 1 - Acute emergencies and pre hospital care > Flashcards

Tutorial 1 - Acute emergencies and pre hospital care Flashcards

1
Q

What are the possible cause for an acute abdomen?

A
  • Think about systems:
    GI system:
  • Acute cholecystitis.
  • Acute appendicitis.
  • Meckel’s diverticulitis.
  • Acute pancreatitis
  • Diverticulitis
  • Gastroenteritis
  • Peptic ulcer disease
  • Pelvic inflammatory disease
  • Intestinal obstruction
  • Acute intestinal ischemia

Urinary system:
- Urinary tract stones
- Acute urinary retention

Cardiovascular system:
- Abdominal aortic aneurysm

Reproductive system:
- Testicular torsion

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2
Q
  1. What is acute cholecystitis?
  2. How does it present
  3. What are its risk factors?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Acute cholecystitis is when a gallstone occludes the cystic duct (duct going from gallbladder to CBD) , this cause inflammation of the gallbladder.
  2. Persistent RUQ pain, fever, nausea/vomiting, loss of appetite, positive murphy sign. Abdominal guarding. Rebound tenderness.
  3. Risk factors often follow the 3 Fs: Forty(older people), female, fat(overweight people).
  4. Ultrasound scan, blood tests for inflammation, potentially other scans i.e., CT scan.
  5. If AC suspected - you will be admitted to secondary care. For the first week you will be put on a regime - nil by mouth, IV fluids and analgesia to help with the pain. After a week or so the gallstone should fall back through into the gallbladder. In order to prevent repeated bouts of AC, the doctors may recommend a cholecystectomy.
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3
Q
  1. What is acute appendicitis?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. The appendix is a small pouch attached to the large intestine. If it becomes blocked with faecal matter, it can lead to ischemia of the tissue, which make infection more likely - which then causes inflammation.
  2. Right iliac fossa pain. Nausea/vomiting. Loss of appetite. Constipation/diarrhoea. Tenderness of McBurney’s point. Abdominal guarding. Abdominal tenderness. Rovsings sign (palpate contralateral iliac fossa - pain elicited in other iliac fossa)
  3. Faecal matter, lymphoid hyperplasia.
  4. Imaging i.e., CT, x-ray, ultrasound, FBC, CRP. Can do a urine dipstick to rule out a UTI.
  5. Negative imaging findings - continue with IV fluids and antibiotic therapy. Positive imaging result - appendectomy.
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4
Q
  1. What is Meckel’s diverticulitis?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
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5
Q
  1. What is acute pancreatitis?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Acute pancreatitis is inflammation of the pancreas.
  2. Upper abdominal pain/tenderness, nausea/vomiting, pain radiates to the back. Abdominal guarding/rebound tenderness.
  3. Often due to gallstones. Can also be due to excessive alcohol consumption.
  4. Blood tests - checking for amylase/lipase. Imaging including CT, x-ray and ultrasound.
  5. IV fluids, antibiotics. Surgical intervention depends on cause. If gallstones causing it, may remove gallstones, may remove gall bladder.
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6
Q
  1. What is a diverticulosis, diverticular disease and diverticulitis?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Diverticulosis is where you have outpouchings of the mucosa(herniate through even the muscular folds) - thought to be related to increased intra-luminal pressure from constipation/low fibre diet. Diverticulosis is the presence of symptomatic diverticula - you will have lower abdominal pain. Diverticulitis is an emergency - it is when there is inflammation i.e., due to infection.
  2. Depending on severity, lower abdominal pain, rectal bleeding, fever, abdominal guarding
  3. Age, low fibre diet, smoking, obesity.
  4. Blood tests. Imaging (colonoscopy/CT scan/).
  5. Supportive - high fibre diet, analgesia, antibiotics. In cases of complications, colectomy may be needed.
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7
Q
  1. What is gastroenteritis?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Gastroenteritis is infection of the GI system. It can be caused by various micro-organisms - campylobacter, E-coli, salmonella, shigella.
  2. It presents with SUDDEN watery diarrhoea, nausea/vomiting, fever, stomach cramps.
  3. Various different bacteria, viruses and fungi. Can be infected due to various reasons i.e., consuming undercooked meat, contact with infected animals etc.
  4. Stool culture.
  5. Supportive measures (rest, fluids, analgesia). Anti - emetics. Following stool culture results - antibiotics/antifungals/antivirals. However some of the infections can be self limiting and not need any medication. If showing signs of severe dehydration admit to hospital for IV fluids.
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8
Q
  1. What is peptic ulcer disease?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Peptic ulcer disease are ulcerations deep to muscularis mucosae. They are an umbrella term for both gastric and duodenal ulcers.
  2. Burning stomach pain(epigastrium), heartburn, nausea, pain exacerbated by meals (gastric), pain relieved by meals (duodenal).
  3. H-pylori infection, smoking/alcohol, NSAIDS use.
  4. Urea breath test(H-pylori). Upper endoscopy.
  5. Antibiotics, PPI, H2 blockers, antacids, offer lifestyle advice regarding stress, alcohol, smoking.
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9
Q
  1. What is pelvic inflammatory disease(PID)?
  2. How does it present?
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
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10
Q
  1. What is intestinal obstruction?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Intestinal obstruction is a blockage of the GI tract which stops food/liquid from passing.
  2. Abdominal pain(intermittent), constipation/vomiting, loss of appetite, inability to have a bowel movement/pass gas, palpable abdominal swelling.
  3. Intestinal adhesions(inevitable after surgery), hernias, colon cancer, intussusception (of small bowel), IBD, diverticulitis, volvulus.
  4. Physical examination, x-ray, CT, ultrasound, air/barium enema.
  5. Nasogastric tube(help remove food), IV fluids. Air enema for intussusception. Surgical removal of blocked substances.
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11
Q
  1. What is intestinal ischemia appendicitis?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. The bowel is supplied by the SMA and IMA. The SMA forms the ileocolic, right colic and middle colic branches. The IMA forms the left colic and sigmoidal. Blocked blood vessels, drop in blood pressure.
  2. SEVERE abdominal pain, vomiting, diarrhoea.
  3. Emboli in
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12
Q
  1. What is mesenteric ischemia ?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. The bowel is supplied by the SMA and IMA. The SMA forms the ileocolic, right colic and middle colic branches. The IMA forms the left colic and sigmoidal. Blocked blood vessels, drop in blood pressure.
  2. SEVERE abdominal pain, vomiting, diarrhoea.
  3. Emboli in branch of SMA/IMA.
  4. Angiography - thin tube inserted through groin - helps image mesenteric vessels.
  5. Angioplasty (balloon inflates blood vessel, doctor may also insert stent). Bypass surgery. Antiplatelets/anticoagulants. These are just possible treatments.
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13
Q
  1. What are urinary stones(bladder, kidney)?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Urinary stones, often made of calcium oxalate become lodged in the urinary system i.e., in ureter. These the block flow of urine.
  2. Pain (depending on the site of pain - back pain just below the ribcage, lower abdominal pain). Blood in urine. Cloudy urine. Nocturia/polyuria. Dysuria.
  3. Dehydration, family history, diet (high in protein, sugar,salt).
  4. Urine dispstick (checking for nitrates, leucocyte and blood). CT/ultrasound.
  5. Watchful waiting, alpha blocker, shockwave lithotripsy (fragment stone).
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14
Q
  1. What is acute urinary retention?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. Acute urinary retention is a sudden inability to pass urine.
  2. Painful, tender, distended abdomen.
  3. In men often caused due to BPH, phimosis, paraphimosis. In women due to prolapse, pelvic mass i.e., fibroids. Can also be due to bladder stones, bladder cancer, prostate cancer and neurological conditions such as MS.
  4. Urine dipstick (check for infection), abdominal and pelvic ultrasound and CT, spine MRI to check for disc prolapse.
  5. Cather drainage, TWOC + alpha blockers (relax muscles of bladder and prostate).
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15
Q
  1. What is an abdominal aortic aneurysm?
  2. How does it present?
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. AAA - permanent, irreversible dilation of artery.
  2. Pulsatile sensation in stomach, abdominal pain, lower back pain. If burst - SOB, severe pain, tachcardyia, tachopynea, dizziness/faint.
  3. Hypertension, hyperilipidemia, family history, smoker.
  4. Ultrasound, CT.
  5. Watchful waiting + screening, attention to risk factors I.e., hypertension, hyperlipidemia, smoking.
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16
Q
  1. What is testicular torsion?
  2. How does it present?
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
17
Q

What are the possible causes for chest pain?

A
  • Think about systems.
    Cardiovascular system:
  • MI (STEMI/NSETMI).
  • Hypertrophic cardiomyopathy.
  • Abdominal aortic dissection.
  • Pericarditis.
  • Stable and unstable angina.
  • Coronary dissection.

Respiratory system:
- Infection (pneumonia, TB)
- Pleuritis
- Hemothorax
- Pleural effusion
- Pulomonary embolism (PE)
- Asthma / COPD

Gastro-intestinal system:
- GORD (hiatal hernia)
- PUD
- Pancreatitis
- Esophageal spasm

Muscloskeltal:
- Costochondritis

Other:
- Depression
- Anxiety

18
Q
  1. What are acute coronary syndromes (ACS)?
  2. How does it present?
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A
  1. ACS is an umbrella term for 3 serious heart conditions . STEMI, NSTEMI and unstable angina. They all lie on a spectrum of progressive occlusion of the coronary arteries. They are differentiated by if they have elevated ST segments and if they present with elevated troponins. STEMI and NSTEMI present with elevated ST and troponins (STEMI - affects trans - mural and NSTEMI only effects the endocardium).
  2. Chest pain (feels like elephant sitting on chest), can spread to shoulder, arm, abdomen,back,jaw. Nausea/vomiting. Dyspnoea. Sudden sweating.
  3. Plaque +/- rupture causes occlusion of coronary vessels and lack of blood supply to heart muscle. Risk factors include age, high blood pressure, high cholesterol, smoking, poor diet, obesity.
  4. ECG (ST elevation), bloods (troponins).
  5. Thrombolytics, antiplatlets, nitroglycerin, beta blockers, ACEI, ARB’s, statins, angioplasty, bypass surgery.
19
Q
  1. What is pericarditis?
  2. How does it present
  3. What causes it?
  4. What investigations are requested?
  5. What is the management plan of the condition?
A

YEAR 3 GP - RT (24 decks)

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