Abdominal Emergencies Flashcards Preview

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Flashcards in Abdominal Emergencies Deck (103):
1

Esophagus

Posterior portion of pharynx
Like a deflated tube, allowing air to pass into trachea easily
Unable to dissolve food but helps transport

2

Gastric Distention

Occurs when too much positive pressure ventilation occurs and causes the esophagus to dialate and let air in impeding lung expansion

3

Peristalsis

Transports food from mouth to stomach using rhythmic contractions

4

Esophageal Veins

Veins intertwined around esophagus

5

Portal Vein

Conversion of esophageal veins.
Transports venous blood from GI Tract directly to the liver for nutrients that have been absorbed.
No valves exist.

6

Cardiac Sphincter

Doorway connecting esophagus and the stomach.
Called so because people that have regurgitation of acid from the stomach to the esophagus often feel as if they are having a heart attack

7

Stomach

Secretes HCl acid to break down food.
Contracts and mixes it's food until smooth consistency achieved.
Water and fat soluble substances dissolved

8

Pyloric Sphincter

Doorway between the inferior portion of stomach to the entry of the small intestine

9

Chyme

Material that exits the pyloric sphincter

10

Duodenum

First part of small intestine.
Connects gallbladder, liver and pancreas to the digestive system.

11

Liver

Produces bile and stored in gall bladder.
Also can promote carbohydrate conversion.
Liver can convert glycogen into glucose.
Fat and protein metabolism occurs when blood flows through the liver.
Detoxifies drugs, break downs red and white blood cells, stores vitamins and minerals.

12

Bile

Enzyme that helps break down fats

13

Small Intestine

Where 90% of all absorption occurs.
20' long.
Water soluble and fat-soluble vitamins absorbed by diffusion into blood stream.

14

Three sections of Small Intestine

Duodenum ( last part of upper GI )
Jejunum ( first part of lower GI )
Ilieum

15

Large Intestine

Or colon.
5' long.
All nutrients have already been dissolved by small intestine and waste is now called feces.
Cecum, Ascending Colon, Transverse Colon, Descending Colon, Sigmoidal Colon, Rectum
MAIN role of Large Intestine is to complete the resorption of water to solidify stool. If hindered, this process causes diarrhea.

16

Time of Digestion

From mouth to anus takes 8 to 72 hours.

17

Ascites

Fluid buildup in the abdomen

18

Striae

Stretch marks

19

Protuberant

Protruding abdomen

20

Scaphoid

Concave abdomen

21

Normal bowel sounds

Occur 5-30 times a minute

22

Borborygmi

Prolonged stomach growling indicating strong contractions of the intestines

23

Visceral Pain

Difficult to localize.
Describe as burning, cramping, or aching. Felt superficially.
Organ contracts too forcefully or is distended

24

Parietal Pain

Steady, achy pain. Easier to localize.
Pain increases with movement.
Caused by inflammation (bleeding or infection)

25

Somatic Pain

Localized pain, felt deeply.
Injury to tissue

26

Referred Pain

Pain originating one place and occurring elsewhere.
Occurs after somatic, visceral and parietal pain.

27

Orthostatic Vital

Vitals standing and sitting to gauge hypovolemia

28

Pain management for abdominal Pain

Morphine 5-10mg
Toradol 15-60mg
Fentanyl 50-100mcg
Demerol 50-150mg
Nubian 10mg

29

Medications for nausea

Zofran 4mg
Benadryl 10-50mg
Visatril 25-100mg IM
Phenegran 12.5-25mg

30

Hyponatremia

Low sodium
Swelling of cells
Symptoms- weakness, cramps, convulsions

31

Hypernatremia

High sodium
Shrinking of cells

32

Main cause oh hypovolemia

Vomiting and diarrhea
Second cause- hemmorage

33

Hyperkalemia

High potassium
Shortened QT interval and tented t waves
Symptoms- bradycardia, cramps, weakness

34

Hypokalemia

Low patassium
Prolonged QT interval and flattened QT intervals
Symptoms- weakness, paralysis, heart failure

35

Upper GI bleeding by Cause

Esophagus- Varices, Cancer, Tear, Dilated Veins, Cirrhosis, GERD
Stomach- Ulcers, Cancer, Gastritis
Small intestine (duodenum)- ulcer

36

Lower GI bleeding by Cause

Small Intestine- irritable bowel disease, cancer
Large Intestine- infections, ulcerative colitis, colorectal polyps, diverticula disease
Rectum- hemorrhoids

37

Esophagogastric Varices

Caused by pressure increases in the blood vessels that surround esophagus and stomach. These vessels drain into portal system. If liver is damaged blood cannot effectively flow through it easily, causing blood to back up and create pressure.

38

Esophageal Varices Assessment

Initially signs of Liver Disease- fatigue, weight loss, jaundice
Rupture of Varices is sudden- pain in threat, dysphasia, vomiting of bright red blood

39

Esophageal Varices Management

Fluid resuscitation
In hospital, cauterize effected area

40

Mallory-Weiss Syndrome

Junction between esophagus and stomach tears, causing severe bleeding. Reason for tearing is during an act of vomiting, pressure in the stomach can increase so greatly that causes a failure of structure

41

Mallory-Weiss Syndrome Assessment

Linked to vomiting.
Woman, can be related to hyperemsis graviadarum.

42

Mallory-Weiss Syndrome Management

Fluid resuscitation

43

Peptic Ulcer Disease

Protective layers of stomach and duodenum have been eroded, allowing acid to eat into the lining.
Can be caused by chronic use of NSAIDS, SMOKING and ALCOHOL

44

PUD Assesment

Pain in the stomach that subsides after eating and then reemerges after 2 or 3 hours.
Pain described as burning and gnawing.
Nausea, vomiting, heartburn and severe then bleeding can occur.

45

PUD Management

Assess degree of blood loss.
Orthostatic signs are critical in determining fluid needs.
In hospital- acid neutralization and antibiotics

46

Gastroesophageal Reflux Disease (GERD)

The Sphincter between the esophagus and the stomach opens, allowing stomach to move superiorly.
"Acid reflux disease".
Smoking, obesity, and pregnancy increase chances of GERD

47

GERD Assesment

Heartburn most common and may increase with position, Like lying flat.

48

GERD Management

Pain may be confused with an infacrtion
Ask how many antacids patient has taken

49

Hemorrhoids

Swelling and inflammation of the vessels around the rectum. Caused by straining, irritation or pressure of the rectum.

50

Hemorrhoids Assesment

Bright red blood during defecation.
Mass on rectum formed by clotting of broken vessels

51

Anal Fissure

Linear tears to the mucosal lining in and near the anus.
Passage of large hard stools or physical activities.

52

Anal Fissure Assesment

Pain and bright red blood with defecation

53

Anal Fissure Management

Facilitate Pt comfort with a 5x9 over affected area

54

Hepatitis

Inflammation of the live, pain in upper right quadrant

55

Peritonitis

Inflammation of abdomen that is generalized pain and experiences rebound tenderness

56

Biliary Tract Disorders

Involve inflammation of gallbladder
-choleangitis
-cholelithiasis
-cholecystitis
-acalculus cholecystitis

57

Choleangitis

Inflammation of bile duct

58

Cholelithiasis

Presence of stones in gallbladder

59

Cholecysitis

Inflammation of gallbladder

60

Gall stones

Increased production of bile
Decrease emptying of bile

61

Gallbladder inflammation

Arise from decreased flow of biliary materials
-trauma, sespsis, sickle cell Disease, fasting
Women get cholecystitis two to three times more than men

62

Cholecystitis Assesment

No pain until fatty meal is present (gall bladder releases bile to break down foods)
Then severe RUQ pain

63

Cholecystitis Management

Pain control- morphine and meperidine
Nausea controlled
Fluid replenishment

64

Appendicitis

Inflammation of appendix occurs when fecal matter accumulates in the appendix causing pressure to build and eventually will rupture. Decrease blood flow with pressure and decrease lymph fluid causing decreases in body's ability to fight infection.

65

Appendicitis Assesment

Early- periumbilical pain, nausea, vomiting, low grade fever
Ripe- pain in LRQ (McBurney's point)
Rupture- decrease in pain and tenderness, rebound tenderness, generalized pain

66

Dumphy Sign

RLQ pain with coughing indicative for peritonitis

67

Appendicitis Management

Pain control
Fluid replenishment

68

Diverticulum

A weak area in the colon that begins to have small outcropping that turn into pouches. Condition called diverticulosis.
Adhesions can develop narrowing of colon resulting in constipation.

69

Diverticulitis Assesment

Abdominal Pain localized to the LLQ.
Symptoms- fever, malaise, body ache, nausea, chills
Pain can occur anywhere in colon, thus, resulting in pain presenting as another condition
Fitsulas can occur with colon and bladder

70

Diverticulitis Management

Fluid resuscitation and possible vasopressors

71

Pancreatitis

Caused from "auto digestion of pancreas".
Occurs when tube in pancreas carrying enzymes that break down substances becomes block and starts to break down substances of pancreas leading to inflammation
Main causes are alcohol consumption and gallstones

72

Pancreatitis Assesment

Pain localized to RUQ or epigastric area.
Can be sharp and quite severe.
Radiation of the back is common.
-Nausea, fever, malaise, tachycardia, muscle cramps, hypotension
Tends to cause hypocalcemia which leads to muscle spasms
Hemorrhage can occur if autodigestion is advanced

73

Cullen Sign
Grey Turner Sign

Bruising around umbilicus
Bruising in flanks
-indicative of severe hemorrhage

74

Peritonitis Management

Assess for severe hemorrhage
Fluids resuscitation
Pain control- meperidine

75

Ulcerative Colitis

Caused by inflammation of the colon
Which causes weak spots of the colon forming ulcers

76

Ulcerative Colitis Assesment

Gradual onset of bloody diarrhea, hematochezia (bloody poop), and abdominal Pain, fever, malaise

77

UC Management

Assess degree of hemodynamic stability

78

Irritable Bowel Syndrome

Pain and changes in bowel habits
-hypersensitivity of pain
-hyperresponsiveness of smooth muscles causing diarrhea and cramps (constipation)
-psychiatric causes or IBS causes psychiatric
Can be triggered by stress, large meals, wheat, rye, chocolate and soda

79

IBS Assesment

Pain relieved by bowel movements
-diarrhea, steatorrhea (oily fatty stools that float) or constipation or bloated

80

IBS Management

Supportive
Psychiatric condition may be coexistant
Pain control

81

Crohn Disease

Similar to Ulcerative Colitis, however, the entire GI tract can become involved.
Usually ileum tends to be involved more.
(Last portion of small intestine before joining large intestine)
Unknown cause
Immune system attacks GI tract

82

Crohn's Assesment

Chronic complaint of abdominal pain
Often in RLQ
-rectal bleeding, weight loss, diarrhea, skin problems, and fever

83

Crohn's Management

Volume control
Pain control
Nausea

84

Acute Gastroenteritis

Family of conditions revolving around a central theme of infection with fever, abdominal pain, malaise, nausea and vomiting.
Viruses enter through fecal-oral route and seen when swimming or drinking contaminated water

85

Acute Gastroenteritis Assesment

-GI upset and diarrhea in hours or days of contamination and can last days to weeks or until death
Dehydration and hyponeutremia occurs resulting in death

86

Acute Gastroenteritis Mangement

Analyze degree of fluid deficient
Orthostatic vitals!
Analgesic and Anti-emetics
-control fluids, diarrhea and nausea/vomiting

87

Rectal Abscess

Rectum creates mucus to lubricate feces during defecation.
If ducts become blocked an Abscess can occur.
Blockage allows bacteria to grow and spread around anus

88

Abscess Assesment

Rectal pain that increases with defecation
Fever and rectal drainage

89

Abscess Management

Comfortability
Transport in POC

90

Liver Disease: Cirrhosis

Defined as "liver failure" can be from multiple causes such as drinking, hepatitis, trauma, autoimmune disorder

91

Cirrhosis Assesment

First Phase: joint aches, weakness, fatigue, nausea, vomiting, urticaria and itching
Second Phase: severe damage characterized by alcoholic stools, darkening of urine, jaundice, icteric conjuctiva and ascites.

92

Cirrhosis Management

Drugs given will remain in body much longer due to liver comprimisation
Use lower ends of dose range for liver failure patients
Give medications at longer intervals

93

Liver Disease: Hepatic Encephalopathy

When brain function begins to decline from liver failure.
Ammonia levels rise in body with lever failure, and effect neurons.

94

Small-Bowel Obstruction

Postoperative adhesions most common cause in small intestine

95

SBO Assesment

Abdominal pain with cramping
Increase in pressure from buildup causing increased in peristalsis causing severe cramping

96

Large Bowel Obstruction

Caused by mechanical obstruction or dialate on causing decreased internal diameter

97

LBO Assesment

Abdominal Pain with nausea and vomiting
Record recent Bowel habits

98

Hernia

Protrusion of organ or structure into an adjacent cavity.
Can be felt during a cough by increase abdominal pressure.
COPD related due to constant coughing

99

Hernia Assesment

Reducible: returns to normal place with manipulation
Incarcerated: trapped in new location
Strangulated: Intestine trapped and squeezed until blood supply is diminished
Incisional: from prior surgeries, herniation occurs

100

Hernia Management

Pain control

101

Mesenteric Ischemia

Mesentery artery occluded

102

Gastroschisis

Baby born with bowel outside of the body due to malformation

103

Pyloric Stenosis

Hypertrophy of pyloric Sphincter of stomach