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!!
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