Gastroenterological Pathology

History

Nature & course of abdominal symptoms

Associated s/s

Past medical, family & surgical HxMedicationsCould you be pregnant?

Pain

Onset & Duration

Location & Movement

Physical Assessment

See Evaluation Form

Inspection

Auscultations

Percussion

Physical Examination

Palpations

Abdominal Quadrants

Referred Pain

Special Tests

Abdominal Pain Options

Appendicitis Irritable Bowel Syndrome Inguinal Hernia Esophageal Reflux/Indigestion Colitis Ulcer Diarrhea/constipation Gastroenteritis Gastritis Crohn’s Disease Trauma – spleen, liver, hollow viscous

Appendicitis

Pain usually (70%) starts centrally (umbilical region) and moves to Mcburney’s Point

The RLQ becomes tender in 65%-95% of cases

Most common acute surgical condition of the abdomen

Occurs in about 7% of population, between age 10-30 yrs old

Appendicitis: Pathogenesis

Long finger-like process that extends from the inferior tip of the cecum

Obstruction of the narrow lumen initiates the clinical illness

D/T viral illness or fecal obstruction (fecaliths)

Appendicitis

S/S:

Tests:

Tx/Complications:

Appendicitis-Tests

Psoas Sign

Appendicitis - Tests

Obturator Sign

Irritable Bowel Syndrome

Common disorder, cause unknownS/S:

Bleeding, fever, weight loss, and persistent severe pain are NOT s/s of IBS

IBS – cont.

Diagnosis:

TX:

BRAT Diet:

Inguinal Hernia

Definition:

s/s:

Tx: referral to surgeon

Can be difficult to diagnose. Common when born

Ulcers

Excessive secretion of gastric acids, inadequate protection of mucus membrane, stress, heredity, medications

s/s:

Dx:

Tx:

Esophageal Reflux

Malfunction of lower esophageal sphincter, Cause…intrinsic pressure, angle of cardioesphygeal

junction, action of diaphragm, gravity

s/s:

Dx:

Tx:

Diarrhea

Causes: infection, drug-induced, food related, post-surgical, psychological, exercise (runner’s trot)

s/s:

Dx:

Tx:

BRAT diet:

Constipation

Definition:

S/S:

Dx:

Tx:

Gastroenteritis

Definition:

Cause: E. Coli infection, staphlococcal food poisoning, botulism, viral, chemical or drug related

S/S:

Dx:

Tx:

Colitis

Cause: UnknownS/S:

Dx:

Tx:

Crohn’s Disease

Ulcerative colitis

S/S: Will present with a lot of blood in stool, pain

Dx: colonoscopy

Tx: surgical removal of ulcerated portion

Abdominal Trauma

Common sports

Key is immediate recognition, monitoring & management

Protocol when recognized

Abdominal Trauma

Screening tools: Ultrasound: +/-

Diagnostic Peritoneal Lavage: +/-

Computed Tomography: +/-

Splenic Injuries

Most commonly injured organ in abdomen

Deceleration causes a shearing force on vessels and capsule

Blunt trauma to LUQ

Risk of Injury increases c:

Splenic Injuries

S/S:

Tx: avoid surgery if possible

Return to play:

Liver Injuries

2nd most common injured Blunt trauma to RUQ, lower chest from front or

back s/s:

Tx:

Hollow Viscous Injuries

Stomach, small intestine, pancreas,bladderCause:

s/s:

Tx: recognition and referral

Still more options

Are you pregnant?, reproductive diseasesLater chapter/discussion

UTI or bladder infectionCan be secondary to appendicitis

Summary

If fever, bloody stool/urine, pallor, distress, no body movement, unexplained weight loss or severe pain are present, something serious is wrong!!