Abdominal and diabetic emergencies and management

Question 1

Acute gallstones?

Answer 1

Formed when chemicals harden into a mass.
Cholelithiasis - gallstones in gallblader.
Cholecystitis - inflammation of the gallbladder.

Question 2

Acute gall stones?

Answer 2

RUQ pain radiating to shoulder, nausea, fever, positive murphys sign.
Red flags: persistant RUQ pain fever with jaundice, hypotension or confusion.
Management - pain relief e.g. IV Paracetamol or morphine.
Anti emetics

Question 3

Pancreatitis?

Answer 3

Inflammation of the pancreas caused by gallstones alcohol or other triggers.
Can lead to peritonitis.

Question 4

Presentation of pancreatitis?

Answer 4

Cullens sign (periumbilical bruising) or grey turners sign (flank bruising). Persistant vomiting leading to dehydration
Evidence of systematic inflammatory response.

Question 5

Red flag symptoms of pancreatitis

Answer 5

Rebound tenderness and guarding
Sudden cessation of pain follwed by severe worsening
Fever and tachycardia.

Management:
Pain relief morphine
Fluid resuscitation
Monitor vitals for shock

Question 6

Appendicitis?

Answer 6

Inflammation of the appendix caused by a blockage.
Initial inflammation producing umbilical pain, as the appendix becomes more inflammed, it produces localised pain - RIF.

Question 7

Presentation of Appendicitis?

Answer 7

Severe epigastric pain radiating to back nausea vomiting hypotension. Classically, appendicitis causes migratory pain starting in the umbilical region before RIF.

Question 8

Red flags of appendicitis?

Answer 8

Rebound tenderness and guarding
Sudden cessation of pain followed by severe worsening
Fever and tachycardia.

Question 9

Gastrointestinal Bleeds

Answer 9

Cause of upper GI bleeds
Peptic ulcers
Gastritis
Oesophageal varices
Neoplasms
Inflammation of the GI lining from ingested materials.
Causes of lower GI bleeds
Diverticular disease
Neoplasms
Inflammatory bowel disease
Infectious diarrhoea
Polyps
Haemorrhoids
Anal fissures

Question 10

Gastrointestinal Bleeds

Answer 10

Presentation - haematemesis, melena, hypotension, pallor, tachycardia.

Red flags - haematemesis (vomiting blood) melena (black stools) hypotension with tachycardia
Persistant bright red rectal bleeding

Management: IV access for fluids
High flow oxygen
Monitor for signs of shock

Question 11

Abdominal aortic aneurysm

Answer 11

Presentation - localised weakness of aortic wall with dialation. Severe abdominal or back pain hypotension, pulsating mass

Red flags - sudden severe abdominal or back pain
Pulsatile abdominal mass on palpation
Hypotension with signs of shock

Management: Do not palpate pulsatile mass
Iv fluid bolus 250ml incrememnts for hypotension.

Question 12

Ectopic pregnancy

Answer 12

A fertilised egg implants outside the uterus, often in the fallopian tube
Red flags:
Severe lower abdominal pain especially one sided.
Vaginal bleeding with hypotension or dizziness
Shoulder tip pain

Question 13

What is a UTI?

Answer 13

Caused by infection usually caused by bacteria.

Question 14

Urinary retention

Answer 14

Inability to pass urine, leading to bladder distention.
Red flags: severe lower abdominal pain and palpable bladder.
Signs of kidney dysfunction
Recurrent episodes or underlying infection.

Question 15

Testicular torsion

Answer 15

Sudden severe testicular pain, swelling, nausea
Acute scrotal pain should be treated as testicular torsion until proven otherwsie.
Red flags: sudden onset of severe testicular pain
Testicular swelling, redness or abnormal position
Nausea and abdominal pain
If testicular torsion is not identified ad treated urgently complications can include atrophy or necrosis.

Question 16

Renal Colic

Answer 16

A combination of both patient and environmental risk factors can predispose to renal calculi formation.
Red flags:
Severe intermittent flank pain radiating to the groin
Fever and chills
Persistant vomiting with dehydration

Question 17

GI Assessment

Answer 17

Look at abdo
Maintain patient modesty at all times ensure warm bright area, expose full abdomen
Look for masses, swelling, discoluration, distention, hernieas

Feel (palpate) patient should be supine.
Painful areas should be palpated last with caution
Palpate the supraclavicular fossa on each side

Lightly palpate each region, note tenderness,

Question 18

Type1 diabetes?

Answer 18

Insulin dependant more prone to hypoglycaemia, DKA
Type 2 diabetes - often non insulin may experience hypoglycaemia, HHS

Question 19

Hypoglycaemia?

Answer 19

Defintion: blood glucose levels below 4mmol/L.
Signs and symptoms: sweating, pallor, confusion, agitation.
Causes: insulin overdose, missed meals, excessive alcohol.

Question 20

Management of hypoglycemia

Answer 20

Oral carbohydrates 15g - 20g
Oral glucose gel 10-20g
Recheck after 15 minutes
Severe hypoglycaemia
Intramuscular Glucagon 1mg
IV Glucose 10% solution administer in increments until blood glucose stabilizes above 44mmol/L

Question 21

Hyperglycaemia

Answer 21

Definition: BG levels above 11mmol/L.
Signs and symptoms: polyuria, polydipsia, fatigue. Tachycardia, hypotension, dehydration, kussmaul breathing.

Question 22

Hyperglycemia management

Answer 22

Supportive care and transport to hospital if ketones and symptoms indicate
DKA and HHS management
Fluids initiate IV access and administer fluids as per local protocols
Reassess vitals: monitor BP HR, RR and mental status.

Question 23

DKA?

Answer 23

Capillary blood glucose above 11mmol/L where a ketone level of 3.0mmol/L or more are considered to be at high risk of DKA.

If clinically shocked, 500ml NaCI over 15 minutes. Repeat once over 15 minutes if patient remains hypotensive.