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EM > WK 5- Gastrointestinal Emergencies > Flashcards

WK 5- Gastrointestinal Emergencies Flashcards

1
Q

What does the GIT consist of

A

oropharynx, oesophagus, stomach, duodenum, SI, appendix, LI, liver, pancreas, rectum, anus

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2
Q

What is somatic/parietal pain

A

Caused by inflammation, trauma or bleeding of the parietal peritoneum-> is well localised to the site of trauma

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3
Q

If the pain is exacerbated by moving/coughing/breathing, what kind of pain is it

A

Somatic/parietal pain

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4
Q

What is visceral pain

A

-may be induced by tension or stretching of hollow viscera or of the capsule of parenchymal viscera and by peritoneal traction or stretching→
True visceral pain - not referred - is manifested in the abdominal midline, without precise location in the epigastrium, periumbilical region or mesograstrium, in general described as colic and associated to nausea, vomiting, sweating or paleness

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5
Q

What organs are retroperitoneal

A

remainder of the duodenum, the cecum and ascending colon, the descending colon, the pancreas, and the kidneys.

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6
Q

What condition typically produces referred pain to the right iliac fossa

  • testicular torsion
  • MI
  • appendicitis
  • ruptured ovarian cyst
A

Torsion

-referred meaning the RIF is not the source of the pain

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7
Q

What non-abdominal condition causes RUQ pain

  • fractured ribs
  • RLL pneumonia
  • fractured right scapular
  • MI
A

RLL pneumonia

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8
Q

Which of the following causes parietal pain

  • Colic
  • Ruptured ectopic pregnancy
  • Small bowel obstruction
A

Ruptured ectopic-> causes bleeding and pus-> causes refined pain

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9
Q

In acute liver failure, which blood test measures synthetic function

  • ALT, AST
  • Urea and creatinine
  • INR and Albumin
A

INR and albumin

  • liver synthesises clotting functions and albumin
  • but AST and ALT will be raised in liver failure as these indicate cell death and inflammation
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10
Q

Elevation of which liver enzymes suggest liver inflammation

  • AST
  • Gamma GT
  • Insulin
A

-AST and ALT

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11
Q

Which blood test is raised in pancreatitis

  • INR
  • Glucose
  • Lipase
A

Lipase

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12
Q

What is the action of metoclopromide

  • 5HT antag
  • Chemoreceptor zone
  • D2 agonist
A

Chemoreceptor trigger zone

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13
Q

A five year old child presents with vomiting and diarrhoea. They are restless and have sunken eyes, tachycardia and decreased skin turgor. What is their level of dehydration

  • some dehydration
  • severe dehydration
  • critical dehydration
A

Severe dehydration

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14
Q

What treatment would a severely dehydrated child need

  • oral fluids
  • IV fluids
  • normal diet
A

IV fluids for rapid rehydration

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15
Q

20 y old male patient with RIF pain, what feature suggests appendicitis

  • moving around a lot
  • unable to get comfortable
  • lying still with no movement
  • high fever
A

Lying still with no movement–> parietal pain

  • moving around/unable to get comfortable is indicative of visceral pain (plus they both say the same thing)
  • high fever only indicates infection
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16
Q

What micronutrient supplement has been shown to improve outcome in children with diarrhoea?

A

Zinc

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17
Q

What organs are found in the right hypochondriac region

A

Ascending colon, gall bladder, liver, right kidney, small intestine, transverse colon

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18
Q

What organs are found in the epigastric region

A

Esophagus, liver, pancreas, right and left adrenal glands, right and left kidneys, small intestine, spleen, stomach, transverse colon

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19
Q

What organs are found in the left hypochondrium

A

Descending colon, left kidney, liver, pancreas, small intestine, pancreas, stomach, transverse

20
Q

What organs are found in the lumbar region

A

Ascending colon, gall bladder, liver, right kidney, small intestine

21
Q

What organs are in the umbilical region

A

Cisterna chyli, pancreas, kidneys, ureter, small intestine, stomach, transverse colon

22
Q

What organs are found in the left lumbar region

A

Descending colon, left kidney, small intestine

23
Q

What organs are found in the right iliac region

A

Appendix, ovary, small intestine, fallopian tube, cecum and ascending colon

24
Q

What organs are found in the hypogastric region

A

Prostate, rectum, both fallopian tubes, both ureters, seminal vesicles, sigmoid colon, SI, bladder, uterus, vas deferens

25
Q

What organs are found in the left iliac region

A

fallopian tubes, ovary, SI, descending colon, sigmoid colon

26
Q

If the GI pain is described as ‘waxing and waning’ and the pt is unable to get comfortable, what type of pain is it most likely to be

A

colic - due to peristaltic contractions of organs

27
Q

If there is pain in the right lower quadrant, what could this indicate

A

appendicitis, psoas abscess, renal/ureteric stone, ruptured ectopic pregnancy, mesenteric adenitis (inflammation of the mesenteric lymph nodes), testicular torsion, ovarian cyst, chrons disease, diverticulitis

28
Q

If there is pain in the upper right quadrant, what could it indicate

A

Acute cholecystitis, duodenal ulcer, hepatitis, appendicitis, right lung pneumonia, pyelonephritis, hepatomegaly

29
Q

If there is pain in the upper left quadrant, what could it indicate

A

Ruptured spleen, gastric ulcer, aortic aneurysm, perforated colon, pyelonephritis, left lung pneumonia, perforated colon

30
Q

If there is pain in the lower left quadrant, what could it indicate

A

appendicitis, psoas abscess, renal/ureteric stone, ruptured ectopic pregnancy, mesenteric adenitis (inflammation of the mesenteric lymph nodes), testicular torsion, ovarian cyst, chrons disease, diverticulitis

31
Q

If there is pain in the epigastrium, what could it indicate

A

MI, peptic ulcer, acute cholecystitis, perforated oesophagus

32
Q

If there is pain in the upper lower left quadrant, what could it indicate

A

Intestinal obstruction, acute pancreatitis, aortic aneurysm, diverticulitis, early appendicitis, mesenteric thrombosis

33
Q

What is haematemesis

A

-always stomach or duodenum

vomiting blood – may be fresh or denatured (dark)

34
Q

What is haematochezia

A

-lower GI bleeding most often

The passage of bloody stools

35
Q

What is melaena

A

foul smelling- need to do DRE to examine →black tar-like stool (usually from upper GI bleeding)

36
Q

What are some causes of GIT bleeding

A

bleeding can be due to inflammation, ulceration, infection, neoplasia or trauma
-can also be concealed and should be considered for hypovolemic/shock patients who do not have any other signs→ perform a DRE to assess for blood

37
Q

What is the MOA of metoclopramide

A

-antiemetic
-Metoclopramide inhibits gastric smooth muscle relaxation produced by dopamine, therefore increasing cholinergic response of the gastrointestinal smooth muscle.
→Reduce nausea & vomiting through antagonism of D2 Rs in CTZ- decrease GIT motility

38
Q

What is the MOA of ondansteron

A
  • 5-HT3 antagonists
  • antiemetic activity of the drug is brought about through the inhibition of 5-HT3 receptors present both centrally (medullary chemoreceptor zone) and peripherally (GI tract)→ inhibits the visceral afferent stimulation of the vomiting center as well as through direct inhibition of serotonin activity within the area postrema and the chemoreceptor trigger zone.
  • used for post-operative nausea
39
Q

What are some functions of the liver

A

Bile production and excretion

  • Excretion of bilirubin, cholesterol, hormones, and drugs
  • Metabolism of fats, proteins, and carbohydrates
  • Enzyme activation
  • Storage of glycogen, vitamins, and minerals
  • Synthesis of plasma proteins, such as albumin, and clotting factors
  • Blood detoxification and purification
  • Stores iron
40
Q

What is the consequence of liver failure/dysfunction

A
  • inability to excrete or produce bile→ inability to digest fats
  • inability to synthesis proteins
  • build up of metabolites and toxic wastes in the blood
  • low clotting factors
  • low colloidal pressure → oedema, ascites
  • decrease in iron stores
41
Q

What are the function of the pancreas

A
  • Endocrine= glucagon and insulin, somatostatin→ regulate glucose levels in the body
  • Exocrine= pancreatic lipase (fats), tripsin (proteins), amylase (carbs)→ breakdown fats, proteins and carbs
42
Q

What haematological and biochemical markers can be measured in the laboratory to evaluate liver pathology/dysfunction?

A

albumin, aspartate amino transferase, alanine amino transferase, bilirubin, prothrombin, protein C, antithrombin and fibrinogen

43
Q

What is the consequence of pancreatic dysfunction

A

inability to regulate glucose levels within the body → diabetes

  • inability to break down fats, proteins and carbohydrates→ unable to absorb nutrients= malabsorption and malnutrition= weight loss, anorexia
  • frequent diarrhoea/steatorrhea→ unable to digest food
44
Q

What is the presentation of gastroenteritis

A
  • mild fever and vomiting followed by 1-4 days of non-bloody diarrhoea
  • abdominal cramps
45
Q

Why is it important to test for GIT bleeding in shock

A

-Bleeding in the GIT can go unnoticed and therefore lead to hypovolemia and extreme blood loss

EM (11 decks)

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