GASTROINTESTINAL + INFECTION

Created by

Georgia Hammond

Cards (39)

What do you listen for?
audible sounds (gurgling, rumbling, normal digestion)
auscultate = bowel sounds
How are you feeling the abdomen?
palpate - superficial and then deep
What are you feeling for?
pain/tenderness
rebound pain
masses
guarding
rigidity
What are some common symptoms associated with GI abnormalities?
nausea/vomit
diarrhoea
fever
constipation
distenion
pain (localised, generalised, diffuse)
What pain relief can you give for abdo pain?
methoxy
ondansetron
paracetamol
ibuprofen
What can you use to assess pain?
SOCRATES:
S = site
O = onset
C = character (quality)
R = radiates
A = associated symptoms
T = time
E = exacerbating factors
S = severity
What is APPENDICITIS?
inflammation of the appendix
Common causes:
trapped faecal matter
infection
Presentation:
pain in umbilical area
moves to RLQ
nausea/vomit
fever
guarding
rigid RLQ
Treatment:
methoxy
ondansetron
transport to ED
What is RENAL CALCULI?
kidney stones
Common causes:
high salt or sugar intake
dehydration
acidic food or drink
random
Presentation:
colic pain
immense pain
flank pain
haematuria
painful urination
fever
nausea/vomit
Treatment:
methoxy
ondansetron
back for IV
transport to ED
What is a BOWEL OBSTRUCTION?
blockage of small or large intestine (partial or complete)
Causes:
scar tissue
hernia
inflammation
impacted faecal matter
Presentation:
nausea/vomit
abdo pain
distension
inability to pass gas or BM
Small intestine:
large frequent vomits
intermittent + localised pain
Large intestine:
intermittent vomits
continuous + diffuse pain
Treatment:
methoxy
ondansetron
back up IV
transport to ED
What is PERITONITIS?
inflammation of the peritoneum
Causes:
infection
bowel strangulation
ruptured appendix
Presentation:
severe abdo pain
continuous pain
rigid + distension
signs of sepsis/septic shock
Treatment:
methoxy
ondansetron
back up IV
transport to ED
What is GI BLEEDS?
bleeding within the GI system (upper + lower)
Causes:
upper = peptic ulcers, oesophageal disorders, cancer AVM
lower = diverticulitis, cancer, haemorrhoids
Presentation:
upper = haematemesis, coffee-ground vomit, melena
lower = haematochezia
Treatment:
methoxy
ondansetron
back up
transport to ED
What is GORD?
gastro-oesophageal reflux disease
Causes:
weakening of the muscle between the stomach and oesophagus
Presentation:
nausea/vomit
chest pain
epigastric pain
burning in oesophagus
cough, tooth decay, hoarse voice, throat pain
Treatment:
ondansetron
positioning
transport to ED
What is CHOLEYCYSTITIS?
inflammation of the gall bladder
Causes:
gall stones that block bile from exiting gall bladder
Presentation:
severe pain in RUQ
writhing pain
tight band feeling
pain in shoulder/back
increased pain when deep breathing
bloating
nausea/vomit
fever
Treatment:
methoxy
ondansetron
back up
transport to ED
What is a HERNIA?
internal organs are pushed through a weak spot in muscle or tissue
hiatal = stomach
umbilical = intestines
Causes:
weakened muscles
Presentation (umbilical)
swelling/bulge
pain
pain during activity
Presentation (specific hiatal)
no swelling/bulge
epigastric/chest pain
heartburn
difficulty swallowing
Treatment:
methoxy
ondansetron
back up
transport to ED
What is GASTRITIS?
inflammation of the lining of the stomach
Causes:
infection (viral but can be bacterial)
Presentation:
nausea/vomit
upper abdo pain
fever
dehydration
Treatment:
low pain = generally no analgesia
ondansetron
transport if red flags present
What is NOROVIRUS?
highly infectious virus that affects stomach/intestines
outbreaks in shared living areas are common
Causes:
viral infection
Presentation:
nausea
vomiting/diarrhoea
fever
abdo pain
headache
malaise
Treatment:
ondansetron
transport of red flags present
What are some differentials to APPENDICITIS?
perforated appendix
ectopic pregnancy
testicular torsion
gastritis
norovirus
What are some differentials to RENAL CALCULI?
pyelonephritis
appendicitis
ectopic pregnancy
testicular torsion
What are some differentials to BOWEL OBSTRUCTION?
appendicitis
gastritis
norovirus
What are some differentials to CHOLECYSTITIS?
renal calculi
gastritis
norovirus
What are some differentials for GORD?
myocardial ischaemia
myocardial infarction
cholecystitis
What should you look for in vomit?
coffee grounds
bright red blood
yellow/green
faeculent vomit
projectile
What is DEHYDRATION?
looks dry
white/cracked tongue
increased skin turgor
history of exposure to environment causes or reduced fluids
nausea/vomit
signs of shock
What are the characteristics of a AAA?
triad = pulsating mass, HoTN, severe abdo/back pain
impending rupture = tearing pain in back, abdo or side
common with HTN, atherosclerosis, obesity, older males and smokers
grows slowly without symptoms but as it grows can feel a pulsating mass
signs of rupture = diaphoresis, tachycardia, HoTN, decreased GCS
What are the characteristics of PANCREATITIS?
occurs when the pancreas becomes inflamed as a result of gall stones or heavy alcohol use
some other causes can be infection, cancer, trauma and metabolic disorders
Presentation:
pain in UQ with radiation to the back. Abdo tender to palpate
nausea/vomit
severe cases = SIRS
What are the characteristics of PERITONITIS?
peritoneum becomes infected with bacteria or fungi
can also be from pelvic inflammatory disease, pancreatitis and Chron's
Signs + symptoms:
loss of appetite
nausea
dull + aching abdo
can progress to severe discomfort
infective signs (fever, rigors, vomit)
decreased urine and BM
can lead to septic shock
What are the characteristics of APPENDICITIS?
can present with gradual onset of dull cramping or aching
pain progresses to RLQ and becomes sharp/intense
Symptoms:
nausea/vomit
poor appetite
fever + signs of infection
rupture = VERY BAD
Where would you find McBurney's Point?
1/3 of the way between the R iliac crest and umbilicus
What are the characteristics of CHOLECYSTITIS?
inflammation of the gallbladder
Risk factors:
age
females
obesity
pregnancy
high fat diet
oral contraceptive pill
drug use
3 factors contributing to creation:
abnormalities in bile
stasis of bile
inflammation of gallbladder
Signs + symptoms:
acute RUQ pain
radiation to back or R shoulder
fever
jaundice
nausea/vomit
murphy's sign
What are the characteristics of GI BLEEDS?
Causes:
peptic ulcers
tears/trauma to oesophagus
diverticulitis
cancer to colon, stomach or oesophagus
haemorrhoids
Ask about vomit/BM
May have postural BP changes
May show signs of compensatory shock
What are the characteristics of a BOWEL OBSTRUCTION?
Intestines become completely or partially blocked
Causes:
tumors, FB, impacted stool, twisting
paralytic ileus (dramatic slowing of normal peristaltic movements)
Symptoms:
pain, cramping + abdo swelling
severe constipation or diarrhoea
vomiting
late sign = faecal vomiting
What are the characteristics of an ECTOPIC PREGNANCY?
egg may attach to a fallopian tube, abdo cavity or cervix = no room = rupture and bleed
Symptoms:
sharp waves of pain in abdo, pelvis, shoulder or neck
severe pain on one side of the abdo
light to heavy bleeding
dizziness/fainting
signs of shock
bradycardia
periumbilical bruising
What are the characteristics of a UTI?
more common in women
Upper + lower
Signs + symptoms:
cystitis = pain in suprapubic region
pyelonephritis = flank pain
confusion
increased urge to urinate, pain and blood
may be large/small amounts, pale/dark + strong smell
pain or burning sensation when urinating
vomit/nausea
can lead to sepsis
What are the characteristics of URINARY RETENTION?
more common in elderly men
can be from obstructive causes (kidney stones, cancers)
non-obstructive causes (pelvic injuries, post-childbirth, brain or SCI)
Signs + symptoms:
pain, discomfort, anxiety
distension
poor or intermittent stream
straining but difficulty passing
dribbling or slow output
can lead to UTI's and kidney injury
What is ACUTE RENAL FAILURE?
Is a reversible syndrome where there is a sudden and almost complete loss of kidney function over a period of hours-days. Results when the kidneys cannot remove metabolic waste or perform regulatory functions. Substances build up leading to disruption in endocrine and metabolic function
What are the different causes of ACUTE RENAL FAILURE?
Pre-renal:
hypoperfusion (drop in BP) from haemorrhage (GI losses), STEMI, HF and vasodilation
Intrarenal:
direct damage to the kidneys
infections
medications (NSAIDs, ACE inhibitors, diuretics)
trauma
blood transfusions
Postrenal:
obstruction somewhere distal to the kidneys
Clinical manifestations:
decreased urinary ouput
oedema
nausea/vomit
fatigue
SOB
What is CHRONIC RENAL FAILURE?
Is progressive and irreversible destruction of renal function
What are common causes of CHRONIC RENAL FAILURE?
poorly controlled diabetes
HTN
chronic/recurrent pyelonephritis
polycystic kidney disease
infections, medications and vascular disorders
Clinical manifestations:
HTN due to Na and water retention from RAAS
HF and oedema from fluid overload
nausea/vomit
reduced LOC, agitation, confusion, seizures
hyperkalaemia
What is DIALYSIS?
A treatment for chronic kidney disease that replaces the kidneys role. It filters out waste and fluid that would usually be excreted in urine.
What are the different types of DIALYSIS?
Haemodialysis:
blood is removed from the body, filtered through a machine and then back into the body
Peritoneal dialysis:
fluid inserted through a peritoneal catheter
fluid is inserted and sits in the peritoneal space, waste products are exchanged over a few hours and then the fluid is drained.