ABDOMEN + ELECTROLYTES & pH W5 Flashcards
(144 cards)
1
Q
Name the 6 general functions of the GI-Tract
A
- Ingestion
- Mechanical digestion
- Chemical digestion
- Secretion
- Absorption
- Defecation
2
Q
Functions of the oral cavity
A
- Crushes/sheares food = mechanical digestion
- Lubricates food
- Begins chemical digestion
- Senses and analyses food
3
Q
Functions of the tongue
A
- Prepares food for swallowing
- Produces lingual lipase
- Rich in sensory cells (sweet, sour, salty, bitter, savoury)
- Important for speech
4
Q
Pathophysiology in the oral cavity in relation to bacteria
A
- Bacteria colonises oral cavity
- Bacteria breaks down sugar and releases acid and builds up plague damaging the emal
5
Q
Salivary glands produces
A
Saliva
6
Q
What is the functions of saliva
A
- Moists the food
- Contains enzyme
- Provides antibodies (IgA) and lysosome for protection of the mouth
7
Q
What are the 3 regions of the throat?
A
- Nasopharynx
- Oropharynx
- Laryngopharynx
8
Q
What leads the food “bolus” from the pharynx to the stomach?
A
Oesophagus
9
Q
The 3 phases of swallowing?
A
- Buccal phase
- Pharyngeal phase
- Oesophageal phase
10
Q
What are the functions of the stomach
A
- Storage of ingested food
- Mechanical and chemical digestion
- Production of acid/enzymes
- Production of intrinsic factor (for B12 absorption)
11
Q
What is the function of the lower Oesophageal Sphincter?
A
Contracts to keep the ingested food in the Fundus of the stomach
12
Q
Name the 3 cells of the stomach and their function
A
- Parietal cells (produces hydrochloric acid)
- Chief cells (produces pepsinogen)
- Mucous cells (protects mucosa)
13
Q
What is GERD?
A
Incompetence of LES
Causing acid to harm the oesophagus resulting in inflammation and burning chest pain.
14
Q
What is the treatment of GERD?
A
PPI (proton-pump-inhibitors) that affects the parietal cells causing less production of acid.
15
Q
Name a common PPI drug
A
Pantropazole
16
Q
What is gastritis?
A
Inflammation of the stomach due to imbalance of acids and protective components
17
Q
Name the 3 structures of the small intestines
A
- Duodenum
- Jejunum
- Ileum
18
Q
What is the function of the small intestines?
A
90% of chemical digestion and nutrient absorption happens here
19
Q
What is the function and characteristics of duodenum?
A
- C-Shaped first segment approx. 25cm long
- “Mixing bowl” of chyme, bile and pancreatic juice
- Has few folds and small vilii
- Absorbs the majority of iron in chyme
20
Q
What is the function and characteristics of jejunum?
A
- 2m long
- Many folds and vili (increasing surface)
- Responsible for the bulk of chemical digestion and nutrient absorption
21
Q
What is the functions and characteristics of Ileum?
A
- 3m long
- Quite similar to Jejunum (but har smaller vili)
- Has lymphatic nodes at the terminal end that protects the small intestine from bacteria from the colon.
- Absorbs Vitamin B12
22
Q
Name the 3 segments of the large intestine
A
- Cecum
- Colon
- Rectum
23
Q
Name the 3 segments of the colon
A
- Ascending
- Transverse
- Descending
24
Q
What is the function of the large intestine?
A
- Compacting intestinal content into faces
- Absorbing bile-salts and vitamines
- Storage of feces
25
Where is the appendix attached?
To the Cecum
26
What is the function of cecum?
1. Receives intestinal juice from ilocecal valve
2. Reabsorbes water and sodium
3.Origin of the appendix
27
Symptoms of appendicitis
1. Pain migrating from the umbilicus to the RLQ above the appendix
2. Nausea/vomiting
3. Diarrea
4. Elevated WBC levels
5. Fever
28
How long does it normally take from infection of the appendix before it ruptures?
48-72 hours
29
What is the function of the colon?
Compacts faces and reabsorbs water and sodium
30
What is the function and characteristics of the rectum?
1. 15cm long
2. Stores feces
3. Rectal distention causes urge to defecate
4. Some of the veins drains directly into the vena cava and some into hepatic portal
31
Food requirements
25kcal/kg per day
50-55% carbohydrates
25-30% lipids
15-20% proteins
32
Water requirements
30ml/kg per day
33
What is the difference in energy deprived from lipids vs proteins and carbohydrates?
1g lipid=9kcal
1g carb or protein=4kcal
34
What is the contents of stool?
1. Water (75%)
2. Indigestible materials (20%)
3. Bacteria (5%)
35
What is the average normal defecation frequency?
Anything between once every 3 days up to 3 times a day
36
Causes of constipation?
1. Age/gender
2. Immobile lifestyle
3. Low fibre diet
4. Low liquid intake
5. Hypothyrodism (slow metabolism)
6. Opiod intake
7. Fear of bathrooms
37
Treatment of constipation
1. Address underlying disease
2. Increase fibre and liquid intake
3. Increase physical activity
4. Use laxatives (movicol, dulcolax)
38
Causes of diarrea
Infections (viral/bacterial/paracites)
39
RED flag symptoms of dysentery (infection of intestines)
1. Crampy abdominal pain
2. Bloody diarrea
3. Fever >38,5
40
Treatment of diarrea
1. Rehydrate (oral or IV)
2. Isolate patient
3. Medicine (loperamid)
4. Abx if indicated
41
3 most important functions of the lever
1. Metabolic regulation
2. Hematologic regulation
3. Bile production
42
General functions and characteristics of the liver
1. Largest visceral organ (1,5kg)
2. Center of metabolism
3. Capability to regenerate
4. Absorbed nutrients and drugs enter the lever via the hepatic portal system
43
What is the function of metabolic regulation in the liver?
1. Venous blood from the portal veins drains into the liver
3. Mobilizes reserves and synthesizes nutrients
4. Removes or decomposes metabolic waste
44
What happens in the liver during events of low BS (blood sugar)?
Glycogen gets transformed into glucose that is released into the blood to raise BS-level
45
What happens in the liver during events of high BS (blood sugar)?
Glucose in the blood gets transformed into glycogen or fat and is stored.
46
What is the function of hematologic regulation?
1. Production of plasma proteins
2. Macrophages in the liver removes aged/damaged blood cells.
3. Macrophages removes pathogens and act as antigen-presenting cells to activate the immune system
47
What is bile?
An alcaline liquid consisting of water and bile-salts produced by the liver
48
What gives bile its colour?
Hemoglobine of the old/damaged RBC's decomposes to bilirubin in the liver. Bilirubin ads a yellowish/green colour to the bile
49
What is the function of bile?
1. Counterweights the hydrochloric acid of the stomach
2. Emulsifies lipids so that enzymes in the GI-tract can digest them
50
What is the function of the gallbladder?
1. Stores bile between meals
2. Concentrates bile
51
What can cause jaundice?
1. Increased production of bilirubin (e.g. in malaria)
2. Lever dysfunction (infection, toxins, cirrhosis)
52
What are the causes and symptoms of Hepatitis
Causes: Inflammaition of the liver due to alcohol, medications or infection.
Symptoms: Fatigue, fever, nausea, jaundice, pain.
53
What is the characteristics of Hepatitis A?
1. Tramsmission via fecal/oral route
2. Causing acute hepatitis
3. Prevention with vaccine.
4. Symptomatic treatment
54
What are the characteristics of Hepatitis B?
1. Transmission via sex, blood products or mother to newborn
2. Causing acute hepatitis
3. Prevention with vaccine.
4. Treatment is difficult
55
What are the characteristics of Hepatitis C?
1. Transmission via blood products or surgical equipment
2. Causing mainly chronification
3. Not preventable with vaccine
4. Treatable
56
What is cirrhosis?
1. End stage liver disease
2. Transformation of liver tissue into fibrous tissue
57
What is gallstone disease caused by?
Imbalance of substances in bile causing "crystals" to build.
Typically caused by high cholesterol levels in blood
58
Symptoms of gallstone disease?
1. Mid epigastric pain.
2. Bloated
3. Pain after meals
4. Reflux
5. In case of gall bladder infection migration of pain to the lateral side + fever
59
What does the pancreas do?
1. Produce insulin
2. Produce glucagon
3. Produce pancreatic juice
60
What is the endocrine function of the pancreas?
Secreting hormones into the blood (insulin, glucagon)
61
What is the exocrine function of the pancreas?
Secreting enzymes that digest carbs, lipids and protein into the duodenum
62
Name the most common hormone production cells of the pancreas
1. Alpha cells (glucagon)
2. Beta cells (insulin)
63
What is the pancreas secreting to "neutralise" acid from the stomach?
Bicarbonate (secreted with the pancreatic juice)
64
What are the most common causes of pancreatitis?
1. Large alcohol consumption over a long time
2. Gallstone-disease
65
Symptoms of pancreatitis
1. Severe abdominal pain
2. Radiation to the back
3. Typical non palpable pain
4. Nausea/vomiting
66
Treatment of pancreatitis?
1. Aggressive hydration (3-6L of fluids/day IV)
2. PPI or light diet
3. ERCP or removal of gallbladder or stones in bile duct that causes pancreatitis
67
What are the characteristics of the spleen?
1. Largest individual lymphatic organ
2. Located I LUQ below 9.th and 11.th rib
3. Blood supplied by splenic artery
68
What are the structures and functions of the spleen?
Red pulp
1. Rich in RBC
2. Stores 1/3 of platelets
White pulp
1. Rich in lymphatic tissue
2. Initiates immune response to pathogens in the blood
69
What is NCTH
Non Compressible Torso Haemorrhage
70
Name some organs that can cause NCTH due to traumatic injury?
1. Liver
2. Spleen
3. Kidney
71
What are the symptoms of mononucleosis
Flu-like with
1. Fatigue
2. Fever
3. Sore throat
4. Rash
5. Head and body aches
6. Swollen lymph nodes
7. Swelling of liver and spleen (50%)
72
What is the primary purpose of vomiting?
To avoid digestion of ingested toxins
73
Name the triggers of nausea and vomiting
1. Intraperitoneal (infections of GI-tract)
2. Metabolic-toxic (e.g. opioids)
3. CNS-disorders (increased ICP)
4. Pregnancy
5. Myocardial infarction
74
Drugs for treating nausea/vomiting (nice to know)
1. Serotonin receptor antagonists (odansetrone)
2. Dopamin receptor antagonists (primperan)
3. 1st gen histamine receptor antagonists (Benadryl)
4. Acetylcholine receptor antagonists (scopolamine)
5. Corticosteroids (Dexamthasone)
75
Components of the dorsal vagal complex
1. Area postrema (chemoreceptor triggerzone)
2. Nucleus of the solitary tract (sensory inputs)
3. Dorsal motor nucleus of the vagus (elicits vomiting as response)
76
Were are the kidneys located?
In the retroperitoneum below the 11th / 12th ribs
77
What are the functions of the kidneys
1. Maintain homeostasis
2. Regulate blood volume and pressure
3. Regulate blood concentration of electrolytes/salts
4. Regulates blood pH
5. Assisting the liver in detoxifying poisons
78
What are the steps in urine excretion?
1. Filtration (plasma is pushed out of the vessels)
2. Reabsorbtion (large amount of plasma is reabsorbed
3. Secretion (active)
79
What is a nefron?
Structure in the kidney that extracts the urine from the blood
80
Characteristics of urine
1. pH 4,5-8 (normally 6)
2. Water content 93-97%
3. 700-2000ml/day
4. Protein in urine suggests kidney disease
5. Glucose in urine suggests diabetes
81
What is the ureter?
25cm long tube that transports urine from the kidneys to the bladder via peristaltic movements
82
What are the characteristics of the urinary bladder?
1. Can hold 500-1000ml urine
2. You feel the urge to pee at 300ml
3. Controlled by sphincter and detrusor muscles
83
What is the urethra?
18-20cm (male), 3-5cm (female) tube from the bladder through the genitals that lets urine out
84
What does hypothermia cause regarding diuresis?
1. Causes "cold diuresis"
2. Core perfusion increases due to peripheral vasoconstriction. This leads to increased glomerular filtration (in the nefron).
3. Can cause "Cold dehydration"
85
What happens if blood sugar remains too high (above 10mmol/l)
Glucose will be secreted in the kidneys and due to its osmotic activity it draws water with it causing larger amounts of urine
86
What can cause kidney failure?
1. Hypovolemia
2. Medication or rhabdomyolysis
87
What are the signs & symptoms of kidney stones?
1. Colicky pain (on/off)
2. Blood in urine
3. Possible fever (infection)
88
What can "costo vertebral angle tenderness" be a sign of?
1. Kidney stones
2. Infection of the kidney
89
What are the two types of catheterisation?
1. Transurethral (through the genitalia)
2. Suprapupic (through the abdomen into the bladder)
90
What is an easy field diagnostic tool regarding urine?
Dipstick analysis
91
Name the components of the male body (solid, water)
40% solid components
60% water
92
What are the disposition of water in the male body?
60% ICF (Intracellular fluid)
40% ECF (extracellular fluid)
93
Name different types of ECF (extracellular fluid)
1. CSF (cerebrospinal fluid)
2. Pleura fluid
3. Blood plasma
4. Interstitial fluid
94
What are the characteristics of interstitial fluid?
1. Free floating fluid in the tissue (not inside cells)
2. Contains high levels of sodium and potassium ions
95
Name the 3 sources of fluid intake
1. Eating (40%)
2. Drinking (48%)
3. Metabolism (12%)
96
Name the 4 sources of fluid loss
1. Urination
2. Feces
3. Perspiration
4. Sweating
97
How does the body regulate in case of dehydration?
Releases ADH and activates RAAS causing thirst and water/sodium conservation in kidneys
98
How does the body regulate in case of "hypervolmme/overload"
Releases ANP causing reduced thirst and block ADH and RAAS resulting in increased diuresis
99
What is fluid shift?
Movement between ICF and ECF.
Water moves in response to osmotic concentration to reestablish homeostasis
100
What happens in capilary beds with water?
1. Hydrostatic pressure forces water out of the arteries
2. Coloidosmotic pressure reabsorbed water due to protein in the vessels
3. Excess fluid in the surrounding tissue is drained via lymphatic vessels
101
Name the 3 most important electrolytes
1. Sodium
2. Potassium
3. Calcium
102
Were is most of the calcium of the body found?
99% is found in the bones
103
Were is the concentration of potassium highest?
In ICF (intracellular fluid)
104
Were is the concentration of sodium highest?
In ECF (extracellular fluid)
105
Why do we administer calcium in addition to blood infusion?
Blood products contains citrate (anti clotting) which absorbs the calcium in the body when administered. To replace this we administer 1g of calcium pr unit of blood
106
What is true for coagulopathy and calcium?
Hypocalcemia will increase coagulopathy. Causing the worsening of the blood clotting factors.
107
What crystalloid comes closest to the bloods natural electrolyte components?
Ringers acetate or lactate
108
What condition contraindicates use of ringers lactate?
Crush syndrome
109
What causes respiratory acidosis?
1. Hypoventilation
2. Sedation/medications
110
What causes metabolic acidosis?
1. Diabetes
2. Kidney failure
3. Diarrea (loss of sodium-bicarbonate)
111
What causes metabolic alkalosis?
1. Dehydration
2. Vomiting
3. Intake of steroids
112
What causes respiratory alkalosis?
1. Hyperventilation
2. Anxiety
113
Normal pH is...
7,35-7,45
114
Acidosis is when...
Blood pH <7,35
115
Alkalosis is when...
Blood pH >7,45
116
Name the most important buffer-system regarding electrolyte/pH
Bicarbonate-buffer
117
Explain how the bicarbonate-buffer works
Hydrogen ions released by metabolic acids combine with bicarbonate producing water and CO2 (which is then ventilated in the lungs)
118
Explain what happens with CO2 in the body
1. In tissue CO2 converts into carbonic acid
2. Carbonic acid separates into H+ and bicarbonate
3. Bicarbonate can combine with H+ and form CO2+water
4. CO2 can be exhaled by the lungs
119
If the bicarbonate buffer is not sufficient to remove excess acid, what compensative mechanisms steps in?
1. Immediate response = Respiratory compensation
2. Long term = renal compensation
120
What happens in the respiratory compensation to low blood pH?
1. Increased respiratory rate
2. Increased depth
121
What happened in the renal compensation to low blood pH?
1. Kidneys secrete excessive H+
2. Kidneys reabsorb more bicarbonate in the nephrons
122
What happens in a crush injury?
1. Direct compression damage to the muscle causing decomposition
2. Hypoxia in distal tissue due to compression of vessels at the injury site
123
What is rhabdomypolysis?
Muscle cells damage causing the release of myoglobin, potassium and metabolic acids typically caused by crush injuries or compartment syndrome
124
What is crush syndrome?
The systemic effect after decompressing a part of the body that was crushed or compressed for a longer period
125
Converting a tourniquet after 2 hours can cause what?
Same symptoms as crush syndrome - rhabdomyolysis
126
What is the treatment for crush syndrome?
1. Agressive fluid resuscitation (2000ml bolus) + 1000ml/hr normal saline
2. Treat hyperkalemia
127
What are the signs of hyperkalemia?
1. Bradycardia or arrhythmia
2. Peaked T-waves on ECG
3. Cardiac arrest...
128
What are the treatments for hyperkalemia?
1. Inhalation of beta-agonist
2. Glucose 50% + insulin 10 IU
3. Calcium glutinate 10ml 10%
129
Name the 2 phases of abdominal trauma were the source of bleeding is impossible to locate with precision
1. Early phase (NCTH) Bleeding
2. Late phase (infection or other complications of the GI-tract)
130
Name the 3 commonly affected organs in blunt abdominal truma
1. Spleen
2. Liver
3. Small intestine
131
Name the 4 commonly affected organs or structures in penetrating abdominal trauma
1. Small intestine
2. Colon
3. Liver
4. Abdominal vessels
132
Name the physical findings you might encounter in abdominal trauma during inspection
1. Distention
2. Contusion
3. Laceration
4. Eviceration (organs like intestines falling out of the skin)
133
Name the physical findings you might encounter in abdominal trauma during palpation
1. Tenderness
2. Abdominal muscle guarding
3. Rebound tenderness
4. Signs of pelvic instability
134
What is the purpose of FAST?
To examine for free fluids in spaces that there should not be any fluid (in cavities or around organs)
135
Which types of injuries should be immediately evacuated?
1. All pelvic-abdominal penetrating injuries
2. Blunt trauma with suspected internal bleeding
136
What are the most commonly injured organs in abdominal trauma?
1. Spleen (Kehr's sign)
2. Liver (Morrison's pouch)
3. Kidney
4. Pancreas
5. Small intestine
6. Large intestine
137
How do you treat evisceration of a bowel?
1. Stop massive haemorrhage if possible
2. Rinse with water or saline
3. Cover with plastic
4. Wrap in bandage
5. Give ABx
138
What transducer is most commonly used?
Phased array
139
What structures appear white, grey and dark on ultrasound?
White: Bone, diaphragm, air
Grey: Muscle, liver, kidney
Dark: Fluid, blood, urine
140
The hepatorenal recess is found?
In RUQ (right upper quadrant)
141
The splenorenal Recess is found?
In LUQ (Left upper quadrant)
142
What space are you looking at when assessing the male pelvis with ultrasound?
The vesicorectal space
143
What space are you looking at when assessing the female pelvis with ultrasound?
The rectouterine space
144
