Abdominal and Gastrointestinal Emergencies-3 Dr. Maha Al-Sedik Dr. Maha Al-Sedik.
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Transcript of Abdominal and Gastrointestinal Emergencies-3 Dr. Maha Al-Sedik Dr. Maha Al-Sedik.
![Page 1: Abdominal and Gastrointestinal Emergencies-3 Dr. Maha Al-Sedik Dr. Maha Al-Sedik.](https://reader035.fdocuments.us/reader035/viewer/2022062221/56649dd95503460f94acf8bd/html5/thumbnails/1.jpg)
Abdominal and Gastrointestinal Emergencies-3
Dr. Maha Al-Sedik
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Pathophysiology
Early liver failure, which may be hallmarked by:
• Portal hypertension
• Deficiencies with coagulation
• Diminished detoxification
Liver Disease: Cirrhosis
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Assessment: Jaundice.
Ascites.
Edema.
Portal hypertension.
Oesophgeal varesis.
Hematemesis.
Hepato-splenomegaly.
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Common blood tests: ( liver function tests ):
Aminotransferases
Alkaline phosphatase
Albumin
Bilirubin
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Management
Prehospital care should be supportive.
Involves bleeding control and medication.
Use lower ends of medication dose range.
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Liver Disease: Hepatic Encephalopathy
Pathophysiology: Brain impairment due to diminished liver function.
Underlying causes:
• Increased levels of ammonia due to digestion of
proteins or digestion of blood.
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Assessment:
Can range from mild memory loss to coma.
Management:
Mainly supportive
Ensure that LOC status is not from other cause.
Check blood glucose levels.
Assess for trauma and overdose.
Take a medical history.
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Obstructive Conditions
Intestines are unable to move material through the
digestive tract.
Two main reasons:
Paralysis of the intestines.
Intestinal lumen diameter obstruction.
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Obstructive Conditions
Small-Bowel
Obstruction
Large-Bowel
Obstruction
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Small-Bowel Obstruction
Pathophysiology
1. Most often caused by post-operative adhesion.
2. Cancer.
3. Hernias.
4. Foreign bodies.
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Assessment:
Signs and symptoms may include:
Nausea and vomiting
Distended abdomen
Absent bowel sounds
Peritonitis signs if bowel has ruptured
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Management:
Monitor blood pressure, and perform volume resuscitation.
Antiemetics are indicated.
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Large-Bowel Obstruction
Pathophysiology:
Caused by mechanical obstruction by hard stool or tumor.
Imaging studies determine the location and extent of
obstruction.
Once located, can be easily treated.
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Assessment
Signs and symptoms may include:
Nausea and vomiting
Distended abdomen
Absent bowel sounds
Peritonitis signs if bowel has ruptured
Management
Same as for small bowel obstruction
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Hernia
Pathophysiology
A hernia is the protrusion of an organ through the wall of
the cavity that normally contains it.
To check for an inguinal hernia:
Place fingers on abdomen.
Instruct patient to cough.
Weakness in abdominal wall will present as
bulging.
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Caused by any condition that causes intra-abdominal pressure:
Obesity.
Standing for long periods.
Straining during bowel movements due to constipation.
Chronic obstructive pulmonary disease ( chronic cough).
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Type
s of
her
nia
acco
rdin
g to
pat
holo
gyReducible
Irreducible or incarcerated
Strangulated
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Hernia is pathologically classified into three types:
* Reducible: Hernias can be reducible if the hernia can
be easily manipulated back into place.
* Irreducible or incarcerated: this cannot usually be
reduced manually because adhesions form in the
hernia sac.
* Strangulated: if part of the herniated intestine
becomes twisted or oedematous and causing serious
complications, possibly resulting in intestinal
obstruction and necrosis.
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Strangulated hernia
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Types of hernia according to site:
• Incisional Herniation. through an area weakened by a scar• Umbilical. Acquired defect above or below the umbilicus• Epigastric. In the midline of abdomen above the umbilicus
caused by a defect in linea alba.• Femoral.• Inguinal.
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Management:
• Focus on supportive measures.
• Pain management.
• Assess for sepsis.
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Rectal Foreign Body Obstruction
Pathophysiology :
Originates from upper GI tract or anal insertion.
Assessment :
Presents with sudden rectal pain with defecation.
Determine if the rectum has been perforated.
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Management
Do NOT attempt to remove object.
Prehospital management should be limited to patient
comfort.
Treat with analgesia if indicated.
Closely monitor vital signs.
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