- ABDOMINAL PRESENTATIONS - Flashcards
Outline the clinical manifestations of GIT bleeding
- Abdominal pain
- Nausea & vomiting
- Jaundice
- Ascites
- Explosive diarrhoea
- Haematemesis
- Malena
- Haematochezia
Outline the clinical manifestations of a bowel obstruction
- vary according to the location of the obstruction
- pain
- colicky cramps (more sever the higher the obstruction)
- vomiting (upper obsruction)
- distention (the lower the more distended)
- altered bowel sounds
- intitially high pitched, hyperactive then hypoactive and absent
Outline the clinical manifestations of Ulcerative colitis
- bloody diarrhoea (up tp 20 times a day)
- abdo pain (lower abdo cramping, generalised - perferetion)
- mucous in stool
- fever
- weight loss
- tachycardia
- dehydration
Outline the clinical manifestations of Chron’s disease
- abdo pain
- diarrhoea
- nausea and vomiting
- weightloss
Outline the clinical manifestations of cholecystitis
- Pain
- Epigastric to RUQ, severe and constant
- May radiate to (R) scapula area / back
- Abdo rebound tenderness and guarding
- Nausea/vomiting
- Fever
- Jaundice if CBD obstructed
- +Murphy’s sign
- Usually no peritoneal signs unless complications
Outline the clinical manifestations of pancreatitis
Range from mild to severe Airway/breathing: – tachypnoea – hypoxaemia – pleural effusion – atelectasis
Circulation: – hypotension – tachycardia – oliguria, renal failure – coagulation abnormalities
Disability: - Low grade fever - Hyperglycaemia - Nausea and vomiting - Hypoactive or absent bowel sounds - Jaundice - Raised WCC - Discoloration of abdominal wall (Cullen’s sign, Grey Turner sign)
- Abdominal pain / distention: – LUQ / epigastric – radiates to back – sudden onset – severe, deep, piercing, continuous – worse with eating – guarding
Outline the clinical manifestations of hepatitis
- jaundice
- fatigue
- abdo pain
- arthralgia
- anorexia
- nausea and vomiting
Outline the clinical manifestations of liver failure
- jaundice
- ascites
- coagulopathy
- hhepatic encephalopathy
- haemodynamic changes
- electrolyte disturbance
- renal failure (hepatorenal failure)
Outline the clinical manifestations of peritonitis
- decreased bowel sounds
- abdo pain
- anorexia
- N,V,D
- tachycardia
- hypotension
- fever
Outline the management of GIT bleeding
Airway/breathing:
– high flow oxygen
– pulse oximetry
– monitor work of breathing
Circulation:
– IV fluids
\+/- packed cells
– cardiac monitoring
– IDC
– nil by mouth
– ECG
Disability – GCS – BGL – temperature – focused abdominal assessment – PR exam / endoscopy
Interventions: • NGT • Medications – Octreotide – Antacids – Histamine-2 receptor antagonists • Cimetidine, Ranitidine, Famotodine etc. – Betablockers • Balloon tamponade ( see slides as for variceal bleeding) • Endoscopic control of bleeding – Adrenaline injection – cautery • Surgical interventions
Outline the management of a bowel obstruction
- history
- physical exam
- x-rays
- NGT
- ?enema if in large bowel and no suspected perferation
- colonoscopy
Outline the management of ulcerative colitis
- FBE, EUC, serum protein and electrolytes
- stool sample (examine for blood and pus then culture
- drug therapy
- scopes
Outline the management of chron’s disease
- in acute phase rest GI tract; fasting or fluids only
- path FBE,EUC,Electrolytes
- dietary management\
- specialist follow-up
- drug therapy
Outline the management of cholecystitis
- path (esp amylase, EUC, billiruben, urine)
- ECG (to exclude cardiac involvement)
- IV crystalioid
- antiemetics
- ?NGT for gastric decompression
- ?IVABS if infection is suspected
- narcotic analgesics
- intake/output
- vitals
- Sx laparotomy or laproscopic cholecystectomy
Outline the management of pancreatitis
• Airway / breathing – monitor respiratory rate – monitor oxygen saturation – treat hypoxaemia with oxygen – maximise lung expansion – chest x-ray
• Circulation: – haemodynamic monitoring – IV access – early aggressive intravenous hydration ( recommendation in ACG Guidelines, 2013) – ? Lactated ringers the preferred choice of crystalloid – manage losses – anti-emetics – correct electrolytes – +/- CVC, IDC – +/- inotropes
• Disability:
– analgesia – opiates, PCA, epidural anaesthesia
• Nutritional support
– in mild AP – oral feeding start immediately ( if no N & V )
– low fat solid diet
– in severe AP – enteral nutrition is recommended
– NG and NJ enteral feeding are both comparable in efficacy
and safety
- Monitor BGL
- Monitor for signs of infection
– antibiotics – no longer recommended as routine
– proton pump inhibitors
– Histamine H2-receptor antagonists
– insulin
Investigations: – pathology (lipase) – chest & abdominal x-ray – abdominal U/S – abdominal CT
Surgery:
– ERCP +/- cholecystectomy
– laparotomy
