MISC Gastro Flashcards
Abdominal Compartment Syndrome
Normal 5-7 mmHg
20mmHg (10 for kids) = IACS
Measured via bladder pressure
MANAGEMENT
Optimise abdo compliance:
- Semi-upright
- Paralyse PRN
- Low vent
- Treat hyperinflation
Reduce contents:
- Minimise or stop feeds
- NGT
- Drain bladder
- Remove ascites, collections
- Prokinetics/ laxatives to empty
Optimise perfusion:
- IA perfusion presssure >60mmHg
- O2, pH etc.
Laparotomy
NGT insertion:
Select product:
- Fine bore single lumen (feeding)
- Salem Sump (dual lumen with air intake for free-flowing high vol drainage/lavage. Usually surgical conditions)
Select size
- Options: 6-24F
- Paeds: ETTx2
- Most adults 14ish
Check no:
- BOS #
- Bleeding/ anatomical
Insert
PPE
Sit up
Place Bluey and emesis bag
Check nostrils
Measure Nare to tragus to xiphi
—> Mark with tape (or note cm)
Flush with water
Lubricate
Along floor of nose
Swallow whilst advancing
Asp and check (pH should be <5.5)
Attach to bag/ spigot
CXR
—> if in place, remove guidewire (fine bore)
Management of feeding tubes:
NGT, NJT, PEG, jejunostomy
____________________
BLOCKED PEG
- Milk it
- Feed guidewire/ stylet (external portion ONLY)
- Infuse warm water. Wait 20mins.
–> Also carbonated drink, pancreatic enzyme
- Flush (can push/suck back and forth)
DISLODGED PEG
- ? more than 3 weeks old? Okay to touch in ED.
- ? dislodged for >4 hours? May need to dilate/ use smaller French.
- Lignocaine jelly
- Deflate, remove. (balloon type only. NOT internal bumper)
- Replace Foley or new tube
–> Direct
–> Over bougie
Age-specific causes of abdo pain:
NEONATE/ INFANT
- NEC
- Volvulus (midgut)
- Hirschsprung
- Strangulated hernia
CHILD
- Mesenteric adenitis
- Intussusception
- Meckel’s (usually painless)
- DKA
- Foreign body
- Testicular torsion
ADOLESCENT
- Mittelschmertz
- PID
- Ectopic pregnancy
- Ovarian torsion
- Appendicitis
ADULT
- Biliary
- Pancreatitis
- PUD
- Appendicitis
- Ectopic pregnancy
- Pre-eclampsia/ HELLP
- Cholestasis of pregnancy
- Endometriosis
- Peritonitis
- Haemoperitoneum
- IBD
- Portal vein thrombosis
ELDERLY
- Volulus (sigmoid)
- Mesenteric ischaemia
- Neoplasm
- Aorta
- Diverticulitis
Medical causes of abdo pain:
EBV
Sickle cell
Envenomation
–> Funnel web, black widow
–> Snake
Toxicology
–> Iron + other heavy metals
–> Methanol
DKA
Hypercalcaemia
Addison’s (Adrenal insufficiency)
Thyroid storm
Anaphylaxis/ angioedema
Porphyria
