WEEK 10 Flashcards
what are the boundaries of the abdomen
- Diaphragm - top
- Anterior abdominal wall - front
- Pelvic skeletal structures - bottom
- Vertebral column - back
WHat are the areas of the assessment of abdomen for paramedics?
Right upper quandrant - Left upper quandrant
Right lower quadrant - Left Lower quadrant
WHat are the areas of the assessment of abdomen rule of 9?
right hyperchondriac region - epigastric - L hyperchondriac
R Lumbar - umbillical - L lumbar
R illiac - Hypogastric - L illiac
What is the Mesentery
a new organ discovered…
connects all elements of the gastrointestinal tract
what are the abdominal and pelvic cavities?
retroperitoneal
peritoneal
pelvic
What are the solid organs of the GIT?
Liver
Spleen
Pancreas
What are the hollow organs of the GIT
Stomach Gallbladder Duodenum Small Intestines – Jejunum – Ileum Cecum Colon
what are the layers of the GIT Wall?
Serosa - connectiv tissue layer
Submucosa
Mucosa
Muscularis- circular muscular layer
what are the types of perforation and ulceration caused by ingesting foreign bodies?
- pressure necrosis (coins)
- perforation (pins/bones)
- chemical irritation (batteries/pills)
- obstruction (hair) -> repunzel syndrome
what are the s&s of GORD/Oesophagitis/Hiatus Hernia?
- Burning sensation in chest
- Sour taste
- Difficulty in swallowing
- Dry cough
- Sore throat
- Regurgitation of food/liquid
- “lump” in throat
what does GORD stand for?
gastro oesophageal reflux disease
what are the s&s of oesophageal spasm?
- Similar to cardiac chest pain
- Difficulty in swallowing
- Object “stuck in throat”
- Regurgitation
- Pain may subside after several minutes
- Normally have a Hx
What is a a Mallory-Weiss tear?
Oesophageal bleeding caused by excessive vomiting
What causes oesophageal varacis?
hypertension of the venous portal vein
What are the types of blood seen in Oesophageal bleeding?
– Frank – bright red blood
• Non‐digested blood
– Coffee grounds – brown/black with “lumps”
• Digested blood
–> Estimate amount
• Number of towels etc.
What are some key gastric/stomach conditions?
- Hiatus hernia
- Upper GI bleed
- Peptic ulcer disease
What is a hiatus hernia?
• Protrusion of part of the stomach through
diaphragmatic hiatus into thoracic cavity
What causes hiatus hernias?
Higher pressure in abdominal cavity compared to thoracic cavity; obesity, age, heredity
WHat is the presentation of a hiayus hernia?
• Very few patients experience significant symptoms – epigastric burning, – nausea, – regurgitation, – difficulty in swallowing Hiatus
What is Upper GIT Bleeding?
Bleeding originating proximal to ligament of Treitz
What are some causes of upper GIT bleeding?
- Peptic ulcer disease
- Erosive gastritis and oesophagitis
- Esophageal varices (chronic liver disease, portal hypertension)
- Mallory‐Weiss tear
- Tumors
What is peptic ulcer disease?
• Chronic illness manifested by recurrent
ulcerations in the stomach and proximal
duodenum
What causes peptic ulcer disease?
– Bacteria
– Excessive acid secretion
how does peptic ulcer disease usually present?
as GIT bleeding
what are some lower GIT conditions?
- Bowel obstruction
- Ischaemic bowel
- Diverticular disease
- Diarrhoea
What is a bowel obstruction?
• Inability of intestinal tract to allow for regular passage of food and bowel contents
(Mechanical or paralytic)
how does bowel obstruction present?
– Abdomen distention – “bloated” – Abdomen pain – Constipation – Diarrhoea – vomiting
What are some complications of Diverticular Disease?
– Older patients at higher risk of free
perforation of colon, which is often fatal.
– Diverticular bleeding usually painless and
results from erosion into the penetrating
artery of the diverticulum
what is diverticular disease?
break down of colon lining with age
what is diverticulitis?
• Acute inflammation of the wall of a
diverticulum and surrounding tissue
– Caused by micro or macro perforation
– Common disorder of industralised nations
– 1/3 population acquired by age 50
– 2/3 population acquired by age 85
– Occurs in 10‐25 % of patients with diverticulosis
What are some types of liver disease?
- Cirrhosis
- Viral hepatitis
- Hepatic failure
What are S&S of liver inflammation?
- Malaise, weakness, anorexia
- Intermittent nausea and vomiting
- Dull right upper quadrant pain
- Jaundice, dark urine within 1 week
- Yellow “white” of eyes
What is Liver Cirrhosis
– Scar tissue replaces healthy tissue causing
• decrease in liver function
• increased portal hypertension
What are the causes of pancreatitis?
– 80% of acute pancreatitis cases in US caused
by alcohol or cholelithiasis
– Primary inflammatory (alcohol)
– Secondary obstructive (usually biliary)
– Other: drugs, infection, inflammation, trauma,
metabolic disturbances
What are the S&S of pancreatitis?
– Mid‐epigastric/ LUQ pain – Pain and tenderness can include upper abdomen only or generalised (thought to be related to absence of capsule that might otherwise contain the inflammation) – N&V, abdominal bloating – Cullen's sign (peri‐ umbilical) – Turner’s sign (flank)
What would you see with haemorrhagic pancreatitis
Cullens sign
Turners sign
What is the most commonly diagnosed GIT disease in ED patients over 50?
Biliary tract disease (Gallstones)
What can be caused by Biliary calculi (Gall stones)?
– Cholecystitis,
– “biliary colic” – symptomatic cholelithiasis
– common duct obstruction
– Gallstone pancreatitis
What is Cholelithiasis
– Stone migration from gallbladder into biliary tract and eventual obstruction
– Pain, N&V
– If obstruction persists, acute cholecystitis
may develop
what is Cholecystitis
– Inflammation of gall bladder
– Mechanical, chemical, infectious factors
– Risk factors:
– Pregnancy, elderly, familial tendency, Asian descent, chronic liver disease
What is the presentation of cholecytisis
– RUQ or epigastric pain most common, with
• back/ shoulder radiation in 1/3
• N&V in ½ of patients;
• 10‐30% jaundiced
– Pain usually persistent, not colicky
• Intermittent and changing from visceral to parietal, with signs of systemic toxicity (tachycardia and fever) with progression
What is appendicitis?
Acute inflammation of the vermiform
appendix, located in right iliac region
• Inflammation occurs when obstruction (food matter, adhesions, lymphoid hyperplasia) occurs leading to infection • Arterial stasis, oedema leads to tissue infarction • Perforation and spillage of infected appendiceal contents into peritoneum
What are the S&S of appendicitis?
– Initial pain at umbilicus (visceral)
– Pain moves to Mc Burney’s point (somatic)
– Anorexia, N&V, ? constipation
– Fever is a relatively late physical finding
– Perforation → peritonitis
What are the relevant assessment techniques and referred pain locations of the key abdominal pain issues?
Kehrs sign - splenic rupture McBurneys point - appendicitis Murphys sign - Gallbladder/Liver Obturator sign - appendicitis Psoas sign - appendicitis
what is constipation?
- Most common digestive complaint in US
* The presence of hard stools that are difficult/unable to pass
What factors impact constipation?
Factors: dietary intake, fluid intake, exercise, medical conditions, and medications affect gut motility Constipation
what is gastroenteritis?
Syndrome consists of diarrhoea,
abdominal cramping or pain, N&V,
lethargy, malaise and fever
• May last for 1/7 – 3/52
• Infection of the GIT mostly transmitted through faecal‐oral route – Viruses – Bacteria – Protozoa
Define diarrhoea?
– Diarrhoea is the passage of 3 or more loose or liquid stools per day, or more
frequently than is normal for the individual.
– Diarrhoeal disease kills 1.5 million children every year.
– Globally, there are about two billion cases of diarrhoeal disease every year.
What are the 4 basic mechanisms of diarrhoea?
- Increased intestinal secretion
- Decreased intestinal absorption
- Increased osmotic load
- Abnormal intestinal motility
Define vomiting?
Forceful emptying of the stomach (and intestinal) contents through the mouth
– Differentiate from regurgitation
what are the 4 ways in which vomiting centre in medulla is excited?
- Vagal & sympathetic nerves from peritoneum, GI, biliary and genitourinary tracts; pelvic organs, heart, pharynx, head, vestibular apparatus
- Impulses converging at necleus tractus solitarius in medulla
- Chemoreceptor trigger zone – 4th ventricle
- Vestibular or vestibulocerebellar system
What is Crohn’s disease
– Chronic inflammatory disease
– Can involve any part of GI tract from mouth to anus
– Chronic abdominal pain, anorexia, weight loss, persistent diarrhoea/constipation, painful defecation, fever
What is ulcerative colitis?
Ulcerative Colitis
• Inflammatory bowel disease
• Ulcerated intestinal mucosa
• Often between 15‐30 y/o
What are the S&S of ulcerative colitis?
– Chronic abdominal pain, – anorexia, – weight loss, – persistent diarrhoea/constipation, – painful defecation, – fever, – rectal bleeding
What is Acute abdomen?
A syndrome characterised by pain,
shock and rigid abdomen, which
constitutes an acute surgical
emergency.
What are the vascular casues of acute abdomen?
Mesenteric ischaemia • Occlusive: • thrombotic (AF, hypercoagulable state) • Embolic • Nonocclusive ‐ low flow state (typically low flow state due to cardiac disease)
Ischaemic Colitis
• Predominantly older patients, presenting
with diffuse or lower abdo visceral pain,
diarrohea
What are some other causes of abdo pain?
• Acute coronary syndromes (and "angina equivalents") • Pneumonia (especially basilar) • Spontaneous pneumothorax • Pulmonary embolus (rare cause) • Pericarditis • Diabetic ketoacidosis (DKA) • Hyperlipidemia (often with pancreatitis) • Acute prophyrias • Sickle cell crisis (sequestration in spleen or liver, or vaso‐occlusive)
What is the difference between Visceral and Somatic pain?
– Visceral:
• Deep‐seated, dull pain from hollow viscera or capsule of solid organs
• Poorly localised, falls along midline
– Somatic (Parietal): • Pain becomes localised over time • Localises over organ involved • Pain sharper in intensity and constant • guarding, rigidity, legs raised, decreased movement
What is the difference between Local and Generalised peritonitis
– Local:
• Pain over affected organ with palpitation or stretching
– Generalised:
• Blood, gastric contents or pus in peritoneal cavity causes generalised pain with any movement or palpation
– Diaphragmatic irritation → ipsilateral supraclavicular/shoulder pain
– Biliary tract disease → right infrascapular pain
What is the pre-hospital test for peritoneal irritation?
– Ask patient to cough
• DO NOT USE REBOUND TENDERNESS
What are some mimics of acute abdomen?
– DKA – Food poisoning – Pneumonia – PID (pelvic inflammatory disease) – AAA
What are the 4 key steps to abdo assessment?
- Inspection
- Auscultation
- Percussion
- Palpation
