WK 5- Gastrointestinal Emergencies Flashcards
What does the GIT consist of
oropharynx, oesophagus, stomach, duodenum, SI, appendix, LI, liver, pancreas, rectum, anus
What is somatic/parietal pain
Caused by inflammation, trauma or bleeding of the parietal peritoneum-> is well localised to the site of trauma
If the pain is exacerbated by moving/coughing/breathing, what kind of pain is it
Somatic/parietal pain
What is visceral pain
-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
What organs are retroperitoneal
remainder of the duodenum, the cecum and ascending colon, the descending colon, the pancreas, and the kidneys.
What condition typically produces referred pain to the right iliac fossa
- testicular torsion
- MI
- appendicitis
- ruptured ovarian cyst
Torsion
-referred meaning the RIF is not the source of the pain
What non-abdominal condition causes RUQ pain
- fractured ribs
- RLL pneumonia
- fractured right scapular
- MI
RLL pneumonia
Which of the following causes parietal pain
- Colic
- Ruptured ectopic pregnancy
- Small bowel obstruction
Ruptured ectopic-> causes bleeding and pus-> causes refined pain
In acute liver failure, which blood test measures synthetic function
- ALT, AST
- Urea and creatinine
- INR and Albumin
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
Elevation of which liver enzymes suggest liver inflammation
- AST
- Gamma GT
- Insulin
-AST and ALT
Which blood test is raised in pancreatitis
- INR
- Glucose
- Lipase
Lipase
What is the action of metoclopromide
- 5HT antag
- Chemoreceptor zone
- D2 agonist
Chemoreceptor trigger zone
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
Severe dehydration
What treatment would a severely dehydrated child need
- oral fluids
- IV fluids
- normal diet
IV fluids for rapid rehydration
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
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
What micronutrient supplement has been shown to improve outcome in children with diarrhoea?
Zinc
What organs are found in the right hypochondriac region
Ascending colon, gall bladder, liver, right kidney, small intestine, transverse colon
What organs are found in the epigastric region
Esophagus, liver, pancreas, right and left adrenal glands, right and left kidneys, small intestine, spleen, stomach, transverse colon
What organs are found in the left hypochondrium
Descending colon, left kidney, liver, pancreas, small intestine, pancreas, stomach, transverse
What organs are found in the lumbar region
Ascending colon, gall bladder, liver, right kidney, small intestine
What organs are in the umbilical region
Cisterna chyli, pancreas, kidneys, ureter, small intestine, stomach, transverse colon
What organs are found in the left lumbar region
Descending colon, left kidney, small intestine
What organs are found in the right iliac region
Appendix, ovary, small intestine, fallopian tube, cecum and ascending colon
What organs are found in the hypogastric region
Prostate, rectum, both fallopian tubes, both ureters, seminal vesicles, sigmoid colon, SI, bladder, uterus, vas deferens
What organs are found in the left iliac region
fallopian tubes, ovary, SI, descending colon, sigmoid colon
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
colic - due to peristaltic contractions of organs
If there is pain in the right lower quadrant, what could this indicate
appendicitis, psoas abscess, renal/ureteric stone, ruptured ectopic pregnancy, mesenteric adenitis (inflammation of the mesenteric lymph nodes), testicular torsion, ovarian cyst, chrons disease, diverticulitis
If there is pain in the upper right quadrant, what could it indicate
Acute cholecystitis, duodenal ulcer, hepatitis, appendicitis, right lung pneumonia, pyelonephritis, hepatomegaly
If there is pain in the upper left quadrant, what could it indicate
Ruptured spleen, gastric ulcer, aortic aneurysm, perforated colon, pyelonephritis, left lung pneumonia, perforated colon
If there is pain in the lower left quadrant, what could it indicate
appendicitis, psoas abscess, renal/ureteric stone, ruptured ectopic pregnancy, mesenteric adenitis (inflammation of the mesenteric lymph nodes), testicular torsion, ovarian cyst, chrons disease, diverticulitis
If there is pain in the epigastrium, what could it indicate
MI, peptic ulcer, acute cholecystitis, perforated oesophagus
If there is pain in the upper lower left quadrant, what could it indicate
Intestinal obstruction, acute pancreatitis, aortic aneurysm, diverticulitis, early appendicitis, mesenteric thrombosis
What is haematemesis
-always stomach or duodenum
vomiting blood – may be fresh or denatured (dark)
What is haematochezia
-lower GI bleeding most often
The passage of bloody stools
What is melaena
foul smelling- need to do DRE to examine →black tar-like stool (usually from upper GI bleeding)
What are some causes of GIT bleeding
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
What is the MOA of metoclopramide
-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
What is the MOA of ondansteron
- 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
What are some functions of the liver
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
What is the consequence of liver failure/dysfunction
- 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
What are the function of the pancreas
- Endocrine= glucagon and insulin, somatostatin→ regulate glucose levels in the body
- Exocrine= pancreatic lipase (fats), tripsin (proteins), amylase (carbs)→ breakdown fats, proteins and carbs
What haematological and biochemical markers can be measured in the laboratory to evaluate liver pathology/dysfunction?
albumin, aspartate amino transferase, alanine amino transferase, bilirubin, prothrombin, protein C, antithrombin and fibrinogen
What is the consequence of pancreatic dysfunction
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
What is the presentation of gastroenteritis
- mild fever and vomiting followed by 1-4 days of non-bloody diarrhoea
- abdominal cramps
Why is it important to test for GIT bleeding in shock
-Bleeding in the GIT can go unnoticed and therefore lead to hypovolemia and extreme blood loss
