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Gastroenterological Pathology

Gastroenterological Pathology. History . Nature & course of abdominal symptoms Associated s/s Past medical, family & surgical Hx Medications Could you be pregnant?. Pain. Onset & Duration Location & Movement. Physical Assessment. See Evaluation Form Inspection Auscultations

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Gastroenterological Pathology

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  1. Gastroenterological Pathology

  2. History • Nature & course of abdominal symptoms • Associated s/s • Past medical, family & surgical Hx • Medications • Could you be pregnant?

  3. Pain • Onset & Duration • Location & Movement

  4. Physical Assessment • See Evaluation Form • Inspection • Auscultations • Percussion

  5. Physical Examination • Palpations • Abdominal Quadrants • Referred Pain • Special Tests

  6. 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

  7. 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

  8. 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)

  9. Appendicitis • S/S: • Tests: • Tx/Complications:

  10. Appendicitis-Tests • Psoas Sign

  11. Appendicitis - Tests • Obturator Sign

  12. Irritable Bowel Syndrome • Common disorder, cause unknown • S/S: • Bleeding, fever, weight loss, and persistent severe pain are NOT s/s of IBS

  13. IBS – cont. • Diagnosis: • TX: • BRAT Diet:

  14. Inguinal Hernia • Definition: • s/s: • Tx: referral to surgeon • Can be difficult to diagnose. Common when born

  15. Ulcers • Excessive secretion of gastric acids, inadequate protection of mucus membrane, stress, heredity, medications • s/s: • Dx: • Tx:

  16. Esophageal Reflux • Malfunction of lower esophageal sphincter, • Cause…intrinsic pressure, angle of cardioesphygeal junction, action of diaphragm, gravity • s/s: • Dx: • Tx:

  17. Diarrhea • Causes: infection, drug-induced, food related, post-surgical, psychological, exercise (runner’s trot) • s/s: • Dx: • Tx: • BRAT diet:

  18. Constipation • Definition: • S/S: • Dx: • Tx:

  19. Gastroenteritis • Definition: • Cause: E. Coli infection, staphlococcal food poisoning, botulism, viral, chemical or drug related • S/S: • Dx: • Tx:

  20. Colitis • Cause: Unknown • S/S: • Dx: • Tx:

  21. 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

  22. Abdominal Trauma • Common sports • Key is immediate recognition, monitoring & management • Protocol when recognized

  23. Abdominal Trauma • Screening tools: • Ultrasound: +/- • Diagnostic Peritoneal Lavage: +/- • Computed Tomography: +/-

  24. 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:

  25. Splenic Injuries • S/S: • Tx: avoid surgery if possible • Return to play:

  26. Liver Injuries • 2nd most common injured • Blunt trauma to RUQ, lower chest from front or back • s/s: • Tx:

  27. Hollow Viscous Injuries • Stomach, small intestine, pancreas,bladder • Cause: • s/s: • Tx: recognition and referral

  28. Still more options • Are you pregnant?, reproductive diseases • Later chapter/discussion • UTI or bladder infection • Can be secondary to appendicitis

  29. 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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