HNN227: Musculoskeletal + GIT

Question 1

Appendicitis Pathophysiology

Answer 1

Inflammation of the appendix; worm-like structure attached to the Seacom of the large intestine, unknown function.

Intestinal lumen continues to secrete mucus, the blockage causes a build up, increasing the pressure in the appendix.
a. Increased pressure of the surrounding visceral nerve fibres.
b. Gut flora is trapped and multiplies > immune response > pus build up.
c. Ischemia in the appendix due to capillary compression.
d. Rupture > bacteria escapes into the peritoneum.

Question 2

Apendicitis SS

Answer 2

Symptoms
* Right lower quadrant abdominal pain
* Abdominal guarding
* Fever
* N+V

Question 3

Hernia Pathophysiology

Answer 3

Loop of intestine pushes through a weakness in the muscular wall of the abdominopelvic cavity.

Non-reducible = intestines become trapped in the abdominal wall and cannot be pushed back.

Strangulated = intestines become trapped in the abdominal wall and compromise vascular supply to the trapped tissue.

Question 4

Adhesion Pathophysiology

Answer 4

Scar tissue that forms following after abdominal surgery, peritonitis, or due to Crohn’s disease.

May cause obstruction by trapping loops of the intestine or by kinking the intestine.

Question 5

Intussusception Pathophysiology

Answer 5

Rare disorder where the intestine folds in on itself. Lumen is narrowed and blood vessels are squeezed.

Question 6

Hernia SS

Answer 6

Symptoms
* Pain
* Local deformity
* N+V
* Sepsis

Question 7

Interssusception SS

Answer 7

Symptoms
* Abdominal pain
* Paroxysms 15 minutes apart
* N+V
* Anorexia
* Blood in stool

Question 8

Diverticular Disease Pathophysiology

Answer 8

Projections of the large intestinal wall and lumen.

Occur when small hard faeces form requiring high pressure in the intestine to push them along. This induces a structural change in the colon wall causing ballooning out of the mucosa/submucosa through the muscle wall.

Question 9

Diverticular Disease SS

Answer 9

Symptoms
* Left lower quadrant pain
* N+V
* Altered bowel habits
* Bloating

Question 10

Ileus Pathophysiology

Answer 10

Functional obstruction resulting from an inability of the intestine (bowel) to contract normally and move waste out of the body.

Fluid and gas accumulate.

Question 11

Ileus SS and Management

Answer 11

Symptoms
* Abdominal pain
* N+V
* Anorexia
* Abdominal distension

Management
* Nil by mouth until resolved
* Symptom relief: NSAIDS, NG tube

Question 12

Clinical Presentations of Soft Tissue Injuries

Answer 12

• Pain
  
  • Decreased ROM
  • Localised oedema
  • Localised haematoma
  • Deformity
  • Loss of function
  • Reduced peripheral perfusion (hard to fine pulses, delayed capillary refill)

Question 13

Management of Soft Tissue Injuries

Answer 13

• RICER: rest, ice, compression, elevation, referral
  
  • Regular neurovascular obs
  • If neurovascular compromise is detected, limb should not be elevated above the heart
  • NO HARM: no heat, alcohol, running, massage

Question 14

Sprain

Answer 14

Injury to a ligament (connects bone to bone/cartilage). Can occur as a result of twisting or stretching beyond the ROM of a joint.

Question 15

Strain

Answer 15

Stretching or tearing injury to a muscle or a tendon (connects muscle to bone). Can occur as a result of twisting or stretching beyond the ROM of a joint.

Question 16

Dislocation

Answer 16

Displacement of one or more ends of articulating bones. Occur when extreme forces damage a ligament and permit the two bones to seperate. Can result in nerve or blood vessel damage.

Question 17

Subluxation

Answer 17

The partial dislocation of one or more ends of articulating bones. The ligaments anchoring the two bones experience less damage than a dislocation.

Question 18

Avulsion

Answer 18

Forcible detachment of a tendon, ligament, muscle, or bone from its point of attachment.

Question 19

Bursitis

Answer 19

Condition that results in inflammation and accumulation of fluid in the subcutaneous bursae (sac-like structures filled with fluid to reduce friction between two surfaces).

In inflammation cause the bursae to become painful and lose their friction reducing properties. Usually cause repetitive use of joints.

Question 20

Tendinitis

Answer 20

Inflammation of a tendon resulting from chronic overuse.

Question 21

Fractures: Complications affecting the bone

Answer 21

Delayed union: prolonged period of time before bone healing succeeds due to compromised circulation, infection, immobilisation.

Non-union: unsuccessful unification of the bone ends due to tissue loss, compromised circulation, infection, improper splinting, pathological fractures.

Malunion: misalignment of bone ends due to improper splinting.

Avascular necrosis: tissue death due to loss of blood supply.

Osteomyelitis: infection of bone.

Question 22

Fractures: Complications affecting the limb

Answer 22

Compartment syndrome: High pressure build up in a group of muscles due to inflammation or bleeding into the muscle compartment. Due to the fascia, pressure is directed inwards compressing capillaries, nerves, and myocytes. Can decrease blood flow, preventing nourishment and oxygen from reaching nerve and muscle cells. (5 P’s)

Blood vessel damage: Can result in ischemia or anoxia leading to necrosis.

Peripheral nerve damage: Altered function or sensation.

Fat embolus syndrome: Pelvis or long bone fractures. Fat globules from the bone marrow may enter circulation.
1) Mechanical factors: vessel obstruction
2) Chemical factors: damaged cells produce of toxic metabolites

Deep Vein Thrombosis: blood clot in the lining of a large vein compromising blood flow or causing embolus.

Question 23

Stages of Bone Healing

Answer 23

HAEMATOMA FORMATION
5 days
* Blood collects and clots
* Local osteocytes die
* Osteoblasts and osteoclasts proliferate

FIBROCARTILAGINOUS CALLUS FORMATION
1 week
* Fibroblasts and osteoblasts lay collagen fibres
* Chondroblasts fabricate cartilage
* Osteoblasts lay bone matrix

OSSIFICATION
3 months
* Soft callus is mineralised
* Hard callus forms

REMODELLING
* Osteoblasts strengthen bone
* Osteoclasts remove excess bone