WK 5- Gastrointestinal Emergencies Flashcards Preview

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Flashcards in WK 5- Gastrointestinal Emergencies Deck (45):
1

What does the GIT consist of

oropharynx, oesophagus, stomach, duodenum, SI, appendix, LI, liver, pancreas, rectum, anus

2

What is somatic/parietal pain

Caused by inflammation, trauma or bleeding of the parietal peritoneum-> is well localised to the site of trauma

3

If the pain is exacerbated by moving/coughing/breathing, what kind of pain is it

Somatic/parietal pain

4

What is visceral pain

-may be induced by tension or stretching of hollow viscera or of the capsule of parenchymal viscera and by peritoneal traction or stretching→
True visceral pain - not referred - is manifested in the abdominal midline, without precise location in the epigastrium, periumbilical region or mesograstrium, in general described as colic and associated to nausea, vomiting, sweating or paleness

5

What organs are retroperitoneal

remainder of the duodenum, the cecum and ascending colon, the descending colon, the pancreas, and the kidneys.

6

What condition typically produces referred pain to the right iliac fossa
-testicular torsion
-MI
-appendicitis
-ruptured ovarian cyst

Torsion
-referred meaning the RIF is not the source of the pain

7

What non-abdominal condition causes RUQ pain
-fractured ribs
-RLL pneumonia
-fractured right scapular
-MI

RLL pneumonia

8

Which of the following causes parietal pain
-Colic
-Ruptured ectopic pregnancy
-Small bowel obstruction

Ruptured ectopic-> causes bleeding and pus-> causes refined pain

9

In acute liver failure, which blood test measures synthetic function
-ALT, AST
-Urea and creatinine
-INR and Albumin

INR and albumin
-liver synthesises clotting functions and albumin
-but AST and ALT will be raised in liver failure as these indicate cell death and inflammation

10

Elevation of which liver enzymes suggest liver inflammation
-AST
-Gamma GT
-Insulin

-AST and ALT

11

Which blood test is raised in pancreatitis
-INR
-Glucose
-Lipase

Lipase

12

What is the action of metoclopromide
-5HT antag
-Chemoreceptor zone
-D2 agonist

Chemoreceptor trigger zone

13

A five year old child presents with vomiting and diarrhoea. They are restless and have sunken eyes, tachycardia and decreased skin turgor. What is their level of dehydration
-some dehydration
-severe dehydration
-critical dehydration

Severe dehydration

14

What treatment would a severely dehydrated child need
-oral fluids
-IV fluids
-normal diet

IV fluids for rapid rehydration

15

20 y old male patient with RIF pain, what feature suggests appendicitis
-moving around a lot
-unable to get comfortable
-lying still with no movement
-high fever

Lying still with no movement--> parietal pain
-moving around/unable to get comfortable is indicative of visceral pain (plus they both say the same thing)
-high fever only indicates infection

16

What micronutrient supplement has been shown to improve outcome in children with diarrhoea?

Zinc

17

What organs are found in the right hypochondriac region

Ascending colon, gall bladder, liver, right kidney, small intestine, transverse colon

18

What organs are found in the epigastric region

Esophagus, liver, pancreas, right and left adrenal glands, right and left kidneys, small intestine, spleen, stomach, transverse colon

19

What organs are found in the left hypochondrium

Descending colon, left kidney, liver, pancreas, small intestine, pancreas, stomach, transverse

20

What organs are found in the lumbar region

Ascending colon, gall bladder, liver, right kidney, small intestine

21

What organs are in the umbilical region

Cisterna chyli, pancreas, kidneys, ureter, small intestine, stomach, transverse colon

22

What organs are found in the left lumbar region

Descending colon, left kidney, small intestine

23

What organs are found in the right iliac region

Appendix, ovary, small intestine, fallopian tube, cecum and ascending colon

24

What organs are found in the hypogastric region

Prostate, rectum, both fallopian tubes, both ureters, seminal vesicles, sigmoid colon, SI, bladder, uterus, vas deferens

25

What organs are found in the left iliac region

fallopian tubes, ovary, SI, descending colon, sigmoid colon

26

If the GI pain is described as 'waxing and waning' and the pt is unable to get comfortable, what type of pain is it most likely to be

colic - due to peristaltic contractions of organs

27

If there is pain in the right lower quadrant, what could this indicate

appendicitis, psoas abscess, renal/ureteric stone, ruptured ectopic pregnancy, mesenteric adenitis (inflammation of the mesenteric lymph nodes), testicular torsion, ovarian cyst, chrons disease, diverticulitis

28

If there is pain in the upper right quadrant, what could it indicate

Acute cholecystitis, duodenal ulcer, hepatitis, appendicitis, right lung pneumonia, pyelonephritis, hepatomegaly

29

If there is pain in the upper left quadrant, what could it indicate

Ruptured spleen, gastric ulcer, aortic aneurysm, perforated colon, pyelonephritis, left lung pneumonia, perforated colon

30

If there is pain in the lower left quadrant, what could it indicate

appendicitis, psoas abscess, renal/ureteric stone, ruptured ectopic pregnancy, mesenteric adenitis (inflammation of the mesenteric lymph nodes), testicular torsion, ovarian cyst, chrons disease, diverticulitis

31

If there is pain in the epigastrium, what could it indicate

MI, peptic ulcer, acute cholecystitis, perforated oesophagus

32

If there is pain in the upper lower left quadrant, what could it indicate

Intestinal obstruction, acute pancreatitis, aortic aneurysm, diverticulitis, early appendicitis, mesenteric thrombosis

33

What is haematemesis

-always stomach or duodenum
vomiting blood – may be fresh or denatured (dark)

34

What is haematochezia

-lower GI bleeding most often
The passage of bloody stools

35

What is melaena

foul smelling- need to do DRE to examine →black tar-like stool (usually from upper GI bleeding)

36

What are some causes of GIT bleeding

bleeding can be due to inflammation, ulceration, infection, neoplasia or trauma
-can also be concealed and should be considered for hypovolemic/shock patients who do not have any other signs→ perform a DRE to assess for blood

37

What is the MOA of metoclopramide

-antiemetic
-Metoclopramide inhibits gastric smooth muscle relaxation produced by dopamine, therefore increasing cholinergic response of the gastrointestinal smooth muscle.
→Reduce nausea & vomiting through antagonism of D2 Rs in CTZ- decrease GIT motility

38

What is the MOA of ondansteron

-5-HT3 antagonists
-antiemetic activity of the drug is brought about through the inhibition of 5-HT3 receptors present both centrally (medullary chemoreceptor zone) and peripherally (GI tract)→ inhibits the visceral afferent stimulation of the vomiting center as well as through direct inhibition of serotonin activity within the area postrema and the chemoreceptor trigger zone.
-used for post-operative nausea

39

What are some functions of the liver

Bile production and excretion
-Excretion of bilirubin, cholesterol, hormones, and drugs
-Metabolism of fats, proteins, and carbohydrates
-Enzyme activation
-Storage of glycogen, vitamins, and minerals
-Synthesis of plasma proteins, such as albumin, and clotting factors
-Blood detoxification and purification
-Stores iron

40

What is the consequence of liver failure/dysfunction

-inability to excrete or produce bile→ inability to digest fats
-inability to synthesis proteins
-build up of metabolites and toxic wastes in the blood
-low clotting factors
-low colloidal pressure → oedema, ascites
-decrease in iron stores

41

What are the function of the pancreas

-Endocrine= glucagon and insulin, somatostatin→ regulate glucose levels in the body
-Exocrine= pancreatic lipase (fats), tripsin (proteins), amylase (carbs)→ breakdown fats, proteins and carbs

42

What haematological and biochemical markers can be measured in the laboratory to evaluate liver pathology/dysfunction?

albumin, aspartate amino transferase, alanine amino transferase, bilirubin, prothrombin, protein C, antithrombin and fibrinogen

43

What is the consequence of pancreatic dysfunction

inability to regulate glucose levels within the body → diabetes
-inability to break down fats, proteins and carbohydrates→ unable to absorb nutrients= malabsorption and malnutrition= weight loss, anorexia
-frequent diarrhoea/steatorrhea→ unable to digest food

44

What is the presentation of gastroenteritis

-mild fever and vomiting followed by 1-4 days of non-bloody diarrhoea
-abdominal cramps

45

Why is it important to test for GIT bleeding in shock

-Bleeding in the GIT can go unnoticed and therefore lead to hypovolemia and extreme blood loss