WEEK 9 - Gastrointestinal Conditions

GIT system

oesophagus, lungs, ribs, diaphragm, liver, stomach, spleen, pancreas, duodenum, jejunum, kidney, colon, ileum, vermiform appendix and rectum.

solid orogans

liver, spleen, pancreas

hollow organs

stomach, gallbladder, duodenum, small intestines, cacum, colon

abdominal regions

- R) hypochondriac region, epigastric region, L) hypochondriac region

- R) lumbar region, umbilical region, L) lumbar region

- R) iliac region, hypogastric region, L) iliac region

abdominal quadrants

RUQ, LUQ, RLQ, LLQ

visceral vs somatic pain

- visceral = deep-seated, dull pain from hollow viscera or capsule of solid organs, poorly localised, falls along midline

- somatic parietal = pain becomes localised over time over organ involved, pain sharper in intensity, constant, guarding, rigidity, decreased movement

peritonitis

inflammation of membrane lining the abdomen wall and covering abdominal organs

signs and referred pain

- uchrs sign = splenic rupture

- mcburneys point = appendicitis

- murphys sign = gallbladder/liver

- psods sign = appendicitis

abdominal examination coponents

skin, weight, confusion, inspect flanks, size & shape, inspect, palpate, percussion, auscultation, apetite & peritoneal inflammation, obstipation, constipation, diarrhoea

special tests

murphys sign, mcburneys point, rovsing sign

diarrhoea - 4 basic mechanisms

1) increased intestinal secretion (liquid - infectious)

2) increased osmotic load (large - lactose intolerance

3) abnormal intestine mobility (many small vol stools - colon cancer)

4) decreased intestinal absorption (fattu + pale + smelly - steatorrhea)

DDX of abdoinal pain

inflammatory/infections, vascular, perforation, obstruction, pressure

acute abdomen

syndrome characterised by pain, shock and rigid abdomen, which constitutes an acute surgical emergency

role of kidney

filtration of blood, influences BP, regulates blood PH, produces hormones (e.g. renin, VD)

AKI

acute kidney injury = abrupt and sustained decrease in kidney function (reduced GFR, increased creatine)

causes of hyperkalaemia

renal failure, cellular potassium release and drug-induced

centres that control BP

renal control, CV control, vasomotor centre, endogenous hormones, neurological system

hyperkalaemia AV CPG treatment

escalate care (MICE, clinician), Mx as per other conditions (shock, hyperglycaemia, adrenal insufficiency), Tx to nearest ED with ICU, if distance is prohibitive, Tx to nearest ED with early notification

suspected gastroenteritis AV CPG treatment (Tx and stay at home)

Tx = ED

Stay at home = self care advice and HIS, refer pt. to pharmacist for further med advice, refer pt. to GP for review if symptoms do not improve > 48 house/pt. recently returned form overseas/temp >40, confirm that pt. understands advice