| Gastritis | inflammation of the lining of the stomach |
| ligament of Treitz | supports the doudenojejunal junction |
| Cullen's sign | ecchymosis in the periumbilical area |
| Grey-Turner's sign | ecchymosis in the flank |
| visceral pain | dull, poorly localized pain that originates in the wall of hollow organs, PT will show location of pain with hand |
| Peritonitis | Inflammation of the peritoneum, which lines the abdo cavity |
| Somatic pain | sharp, localized pain that originates in wall of the body, such as skeletal muscles, PT show be able to point with one finger the location of pain |
| referred pain | pain originates in a region other than where it is felt |
| Structures of the lower GI tract | jejunum, ileum, large intestine, rectum, anus |
| functions of lower GI tract | Absorbing nutrients, reabsorption of water, formation of wastes |
| with severe peritoneal irritation how with PT usually be positioned | will be lying as still as possible usually in the fetal position |
| where does upper GI tract bleeds occur | proximal to the ligament of Treitz |
| when can you administer gravol | if your PT has N/V
>25 and unaltered
Has no allergy or sensitivity to dimenhydrinnate or other antihistamines
did not overdose on antihistamines or anticholinergics or tricycilic antidepressants |
| Conditions that cause upper GI bleeding | Peptic ulcer disease, Gastritis, Esophageal varicies, Mallory-Weiss tear, Esophagitis, Doudenitis |
| S&S > Vary widely, PT may be asymptomatic or may have wide range of abdo complaints including hematemesis. | Gastritis |
| General complaints of Upper GI bleed | Malaise, weakness, syncopal and near syncopal, tachycardia, indigestion |
| Esophageal varices | swollen vein of the esophagus (usually result of portal hypertension ) |
| Common causes of Esophageal varices | Chronic alcohol abuse, ingestion of caustic substances |
| PT is presenting S&S including the following : painless bleeding, hematemesis, dysphagia, burning or tearing sensation, hemodynamic instability, delayed clotting due to force of blood backup and into spleen destroying platelets, classic signs of shock | Esophageal varices |
| Tx for Esophageal varices | Aggressive airway management, aggressive Fluid resuscitation, be prepared to suction frequently |
| Acute Gastroenteritis | Sudden onset of inflammation of stomach and intestines |
| Causes of Acute Gastroenteritis | Alcohol -ETOH- and Drug -Rx- abuse, Tobacco use, aspirin, Stress, Chemotherapy, Ingestion of acidic or alkatic agents, Infection from ingested pathogens(normally fecal-oral) |
| S&S Rapid onset of hematemesis + hematochezia or melena, may complain of diffuse & widespread abdo pain with palpation, tenderness in all quadrants, Fever, General malaise, Sx dehydration, Sx of hypovolemic shock | Acute Gastroenteritis |
| Most common causes of lower GI bleeding | Diverticulosis, Colon lesions (cancer or benign polyps), Rectal lesions( hemorrhoids, anal fistulas anal fissures), Inflammatory bowel disorder (ulcerative colitis, Crohns) |
| Peptic Ulcers | Erosion caused by gastric acid |
| Gastric Ulcers | occur exclusively in the stomach |
| S&S for gastric ulcers | most common in 50yrs working a job with physical activity:
increase pain after eating or on a full stomach |
| S&S of duodenal ulcers | most common in 25-50yrs who are under high stress: increased pain at night or on a empty stomach |
| Management of peptic ulcers | BOMB - high flow O2, Fluid resuscitation, Medication admin: consider histamine blockers (zantac, pepsid) & antacids (Rolaids, Tums) |
| Lower GI tract bleed is located where? | Anywhere distal of the ligament of Trietz |
| how does G. Pylori bacteria play a role in peptic ulcers | it breaks down the barrier and exposes the mucosa to highly acidic fluid which causes peptic ulcers to arise. |
| what is the difference between Crohn's and Ulcerative colitis | Crohn's can affect any part of the gastrointestinal system from mouth to anus, when Ulcerative colitis only affects the colon |
| S&S insidious onset, occasional bloody diarrhea or stool containing mucous, colicky adbo pain usually limited to lower quadrants, N/S, occasional fever or weight loss, restless but hemodynamically stable | Ulcerative colitis |
| What does BOMB stand for | Bed, O2, Monitor, Blanket |
| Crohn's Disease | Idiopathic inflammatory bowel disorder associated with the small intestine |
| S&S > GI bleeding, Recent weight loss, Intermittent abdominal cramping/pain, N/V, Diarrhea, Fever, Flare ups are rapid with severe acute onset of abdo pain, Difficult to differentiate as pain is nonspecific with diffuse tenderness | Crohn's Disease |
| Tx for Crohn's | BOMB, Airway management,Transport to hospital, Usually hemo stable so Tx
is usually pallative |
| Diverticulitis | Inflammation of the diverticulosis : secondary to infection
- Small outpockets that push through the outermost mucosal and
submucosal lining (muscle) secondary to infection, Bleeding or infection |
| Diverticulosis | presence of diverticula, with or without associated bleeding |
| most common cause of lower GI bleeding | Diverticulosis |
| S&S > Pts will complain of localized lower left sided colicky pain (95% of offending diverticula are in the sigmoid colon) - Often called left sided appendicitis - Low grade fever- N/V- Tenderness on palpation -Sx of shock (CPC, tachy) - Bright red and bloody feces (hematochezia)- c/o perception they cannot empty their rectum even after defecation | Diverticulitis |
| Hemorrhoids | Small masses of swollen veins that occur in the anus or rectum |
| what does this Presentation -Limited bright red bleeding and painful stools.
-Consider lower GI bleeding. | Hemorrhoids |
| Bowel Obstruction | blockage of the hollow space within the intestines; Can be catastrophic if not rapidly diagnosed and treated. - The most dangerous result is sepsis. |
| S&S - Diffuse poorly-localized pain –palpation will reveal tenderness, Decreased appetite, Fever, malaise, N/V, wt loss, Peritonitis if ruptures, Maybe shock, May vomit feces if long standing, Maybe distention, Look for surgery scars and ecchymosis | Bowel Obstruction |
| Tx for Bowel Obstruction | BOMB
Fluid resuscitation |
| what are common causes of Bowel obstruction | Hernia – intestine has pushed through muscle wall • most dangerous is strangulate hernia Intussusception Adhesion Volvulus Chronic as in tumour growth or adhesion or |
| what causes hemorrhoids | Idiopathic, from pregnancy, or external may result from heavy lifting |
| Hernia | Protrusion of an organ through its protective sheath |
| what is the most dangerous hernia | strangulate hernia |
| intussusception | condition that occurs when part of the intestine slips into the part just distal to itself |
| adhesion | union of normally separate tissue surfaces by a fibrous band of new tissue |
| volvulus | twisting of intestine on itself |
| Hiatus Hernia | when the esophageal spincter allows the top of the stomach to herniate through the diaphragm into the esophagus |
| S&S of Hiatus hernia | Burning sensation like heart burn, sharp easily localized pain |
| Appendicitis | Inflammation of the vermiform appendix at the juncture of the large and small intestines |
| S&S - Frequently misdiagnosed due to wide variety of presentations
Early
Diffuse colicky pain with nausea and
vomiting, Tenderness and guarding, Often localized to periumbilical region
As the appendix continues to dilate,
Pain migrates to McBurney’s point, Rebound tenderness | Appendicitis |
| Tx for Appendicitis | Recognition and supportive care, Hemodynamically stable as long as appendix hasn’t ruptured
Follow general management guidelines |
| what most often causes Appendicitis | Obstruction of the appendiceal lumen by fecal material. |
| Cholecystitis | Inflammation of the gallbladder |
| Hepatitis | Injury to hepatocytes associated with infection of inflammation |
| HBV | Hepatitis B; Serum hepatitis, Blood borne pathogen, Can stay active in body fluids outside the body for
days, ~310 million carriers worldwide, Effects may be minimal but can also range to severe liver ischemia and necrosis |
| HAV | Hepatitis A; Most common, Infectious hepatitis, Spread by oral-fecal contamination, Self limiting, lasting ~2-8 weeks, Rarely causes severe hepatic injury and thus has a low mortality |
| HCV | Hepatitis C; Pathogen most commonly responsible for spreading hepatitis through blood transfusions
Marked by chronic and often debilitating damage to the liver |
| HDV | Hepatitis D; less common Pathogen is dormant until activated by HBV |
| HEV | Hepatitis E; Waterborne infections, Epidemic in Africa, Mexico and other less-developed nations |
| Presentation of Hepatitis | URQ abdominal tenderness
May radiate into right shoulder
Loss of appetite, weight loss, malaise
Clay-colored stool, jaundice, scleral icterus
Photophobia, nausea/vomiting
May appear jaundiced
May have fever due to infection or tissue necrosis
May reveal liver enlargement |
