Wis Pemicu 4 GI-Abdominal Pain

8/12/2019 Wis Pemicu 4 GI-Abdominal Pain

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Inflammatory disease with pain include:

peptic ulcer

appendicitis diverticulitis

IBD

infectious enterocolitis

Intraabdominal

gallstone disease

pancreatitis

Noninflammatory visceral mesentric ischemi

neoplasia


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Acute Peritonitis

Is an inflammation of the peritoneum

May localized or diffuse in location, acute or

chronic in natural history, infectious or

aseptic in pathogenesis.

Acute peritonitis is associated with decrease

intestinal and motor activitydistention of

the intestinal lumen with gas and fluid


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Etiology

Infectious agent

Penetrating wound

Foreign object that is/becomes infected


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Clinical Feature

Acute abdominal pain

Tenderness

Location of the pain depends on the

underlying causes and wether the

inflammation is localized or generalized

Tachycardia, hypotension, and sign of

dehydration are common


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Therapy and Prognosis

Relies on rehydration

Correction of electrolyte abnormalities

Antibiotics

Surgical correction of underlying defect


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Appendicitis

Sign and Symptom

Pain to the right lower quadrant

Tenderness to palpation, rebound

tenderness is often present

Anorexia

Visceral pain mild,often cramping lasting 4-6

h

Temperature usually normal but if >38,3c,

leucocytosis suggest perforation


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Enlarge lymphoid associated

viral infection, accumulation

and inspissated of fecal

arround vegetable fiber, worm,

tumor

Obstuct the lumen

Appendicitis


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DD of Appendicitis

Periumbilical

Appenciditis

Small bowel obstruction

Gastroenteritis

Mesentric ischemia

Right Lower Quadrant

Gastrointestinal causes Gynecologic causes

appendicitis ovarian tumor/torsion

inflammatory bowel

disease

pelvic inflammatory

diseaseright-sided diverticulitis Renal causes

gastroenteritis pyelonephritis

inguinal hernia perinephritic abcess

nephrolithiasis


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Ulcerative Colitis

Is a mucosal disease that usually involves

the rectum and extends proximally to involve

all or part of the colon.


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Sign and Symptoms:

Diarrhea

Rectal bleeding

Tenesmus

Passage of mucus

Crampy


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Examination

Platelet count

Erythrocyte sedimentation rate (ESR)

Decrease Hb

CRP

Sigmoidoscopy


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ChronsDisease

Can affect any part of the G.I Tract fromthe mouth to the anus


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IBS

Is functional bowel disordercharacterized by abdominal pain or

discomfort and altered bowel habits in

the absence of detectable structural

abnormalities.


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Diagnostic Criteria for Irritable Bowel Syndr.

Recurrent abdominal pain or discomfort at least 3

days/month in the last 3 months associated withtwo or more of the following:

1.improvement with defecation

2.Onset associated with a change in frequencyof stool

3.Onset associated with a change in form stool


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Diverticulitis

Inflammation of a diverticulum Related to the retention of particulate

material within the diverticular sac and the

formation of a fecalith


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1. Perforated diverticulitis with a confinedparacolic abscess

2. Perforated diverticulitis that has closed

spontaneously with distant abscessformation

3. Noncommunicating perforated diverticulitis

with fecal peritonitis4. Perforation and free communication with

the peritoneumfecal peritonitis

Classification of Diverticulitis


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Classification of Diverticulitis


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Sign and Symptoms

1. Fever

2. Anorexia3. Left lower quadrant abdominal pain

4. Obstipation


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Risk factors

increasing age

constipation

a diet that is low in dietary fiber content

or high in fat

high intake of meat and red meat


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Diagnosis

Colonoscopy are the most used test fordiagnosis.

X-ray

CT MRI.


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1. Proximal diversion of the fecal stream with

an ileostomy or colostomy and sutured

omental patch with drainage2. Resection with colostomy and mucus

fistula or closure of distal bowel with

formation of a Hartmanspouch

3. Resection with anastomosis

(coloproctostomy)

4. Resection with anastomosis and diversion

(coloproctostomy with loop

ileostomy/colostomy)


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Therapy Non-Farmaco

1.Eat fiber enriched diet that include 30gof fiber each day

2.Avoid nuts and popcornobstruct the

lumen of a diverticulum Farmaco

1.Antimicrobial(trimethoprim/sulfamethoxazole,ciprofloxacin+metronidazole)

2.Third generation penicillin (IVpiperacillin/oral penicillin) 7-10 d

Wis Pemicu 4 GI-Abdominal Pain

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