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Abdominal and Gastrointestinal Emergencies-3
Dr. Maha Al-Sedik
Pathophysiology
Early liver failure, which may be hallmarked by:
• Portal hypertension
• Deficiencies with coagulation
• Diminished detoxification
Liver Disease: Cirrhosis
Assessment: Jaundice.
Ascites.
Edema.
Portal hypertension.
Oesophgeal varesis.
Hematemesis.
Hepato-splenomegaly.
Common blood tests: ( liver function tests ):
Aminotransferases
Alkaline phosphatase
Albumin
Bilirubin
Management
Prehospital care should be supportive.
Involves bleeding control and medication.
Use lower ends of medication dose range.
Liver Disease: Hepatic Encephalopathy
Pathophysiology: Brain impairment due to diminished liver function.
Underlying causes:
• Increased levels of ammonia due to digestion of
proteins or digestion of blood.
Assessment:
Can range from mild memory loss to coma.
Management:
Mainly supportive
Ensure that LOC status is not from other cause.
Check blood glucose levels.
Assess for trauma and overdose.
Take a medical history.
Obstructive Conditions
Intestines are unable to move material through the
digestive tract.
Two main reasons:
Paralysis of the intestines.
Intestinal lumen diameter obstruction.
Obstructive Conditions
Small-Bowel
Obstruction
Large-Bowel
Obstruction
Small-Bowel Obstruction
Pathophysiology
1. Most often caused by post-operative adhesion.
2. Cancer.
3. Hernias.
4. Foreign bodies.
Assessment:
Signs and symptoms may include:
Nausea and vomiting
Distended abdomen
Absent bowel sounds
Peritonitis signs if bowel has ruptured
Management:
Monitor blood pressure, and perform volume resuscitation.
Antiemetics are indicated.
Large-Bowel Obstruction
Pathophysiology:
Caused by mechanical obstruction by hard stool or tumor.
Imaging studies determine the location and extent of
obstruction.
Once located, can be easily treated.
Assessment
Signs and symptoms may include:
Nausea and vomiting
Distended abdomen
Absent bowel sounds
Peritonitis signs if bowel has ruptured
Management
Same as for small bowel obstruction
Hernia
Pathophysiology
A hernia is the protrusion of an organ through the wall of
the cavity that normally contains it.
To check for an inguinal hernia:
Place fingers on abdomen.
Instruct patient to cough.
Weakness in abdominal wall will present as
bulging.
Caused by any condition that causes intra-abdominal pressure:
Obesity.
Standing for long periods.
Straining during bowel movements due to constipation.
Chronic obstructive pulmonary disease ( chronic cough).
Type
s of
her
nia
acco
rdin
g to
pat
holo
gyReducible
Irreducible or incarcerated
Strangulated
Hernia is pathologically classified into three types:
* Reducible: Hernias can be reducible if the hernia can
be easily manipulated back into place.
* Irreducible or incarcerated: this cannot usually be
reduced manually because adhesions form in the
hernia sac.
* Strangulated: if part of the herniated intestine
becomes twisted or oedematous and causing serious
complications, possibly resulting in intestinal
obstruction and necrosis.
Strangulated hernia
Types of hernia according to site:
• Incisional Herniation. through an area weakened by a scar• Umbilical. Acquired defect above or below the umbilicus• Epigastric. In the midline of abdomen above the umbilicus
caused by a defect in linea alba.• Femoral.• Inguinal.
Management:
• Focus on supportive measures.
• Pain management.
• Assess for sepsis.
Rectal Foreign Body Obstruction
Pathophysiology :
Originates from upper GI tract or anal insertion.
Assessment :
Presents with sudden rectal pain with defecation.
Determine if the rectum has been perforated.
Management
Do NOT attempt to remove object.
Prehospital management should be limited to patient
comfort.
Treat with analgesia if indicated.
Closely monitor vital signs.