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.