GI Emergency.pptx

GI Emergency  Acute Abdominal pain More adult patients visit the ED for abdominal pain, cramps, or spasms” than for any other chief complaint Ask about previous episodes of similar abdominal pain, diagnostics, and treatments. Review previous medical records occupation, p...

GI Emergency  Acute Abdominal pain More adult patients visit the ED for abdominal pain, cramps, or spasms” than for any other chief complaint Ask about previous episodes of similar abdominal pain, diagnostics, and treatments. Review previous medical records occupation, possible toxic exposures, and living circumstances (homeless, dwelling heat source, running water, living alone, other family members ill with similar.symptoms) Obtain a clear description of the pain itself (OP2 QRST2 : onset, provocative/palliative factors, quality, radiation, associated symptoms, timing,  Acute Abdominal Pain : Physical examination inspect for distension, scars, Hernias Palpate for tenderness, masses, guarding , rebound tenderness& also do pelvic & rectal exam if indicated. Auscultate for bowel sound Laboratory test: CBC ,LFT , Electrolytes , lipase , urinalysis ,& B- Hcg Imaging :Abd / pelvic U/S for gall bladder, liver ,gynecological issues CT scan for bowel obstruction ,perforation & vascular issues X-ray to detect free air (pneumoperitoneum), bowel obstruction  Treatment analgesia : provide pain relief e.g opioid like morphine Anti emetic e.g. ondansetron IV fluid Antibiotics in case of (peritonitis , diverticulitis cholecystitis ) :Identify causes & initiate treatment Appendicitis : surgery Bowel obstruction : nasogastric decompression Perforated ulcer :surgical intervention Pancreatitis : supportive care Ectopic pregnancy :Gynecological emergency  Diarrhea Acute diarrhea is the sudden onset of an increase in the normal water content of stool, results in an increased frequency of stools from three or more times daily to.more than 20 bowel movements in a 24-hour period Maybe acute less than 14 days or chronic more than 2 weeks May result from : infection ,medications & other medical condition  Diarrheal disease History : duration , frequency ,consistency , associated symptoms , fever , pain , wt. loss, recent travel , food intake , antibiotic use Pre existing medical condition like ( IBS , Celiac disease) Examine for sign of dehydration ,distention ,tenderness Investigate by stool analysis & culture Fluid & electrolyte replacement : ORS IV fluid for sever , continuous losses & pt cannot tolerate oral intake like ringer lactate or normal saline Antibiotics : sever bacterial disease , c.difficile Anti motility agent : loperamide Do not use antimotility agents in the subset of patients with bloody diarrhea or suspected inflammatory diarrhea Probiotics are safe and beneficial when used alongside.rehydration therapy Common causes of diarrhea Viral GE is the most common cause Bacterial : Salmonella ,Shigella , E.coli , campylobacter , vibrio cholera Parasitic : Giardia lamblia , entamoeba histolytica Antibiotic – associated diarrhea caused by C.difficile  Upper GI Bleeding Upper GI bleeding is any GI bleeding originating proximal to the ligament of Treitz i.e from esophagus ,stomach , duodenum It is potentially life threatening condition, requiring. evaluation & management The primary goals in UGIB management are to stabilize the pt , identify the source & treat the underlying. cause : Causes of UGIB Peptic ulcer : the most common cause (gastric & duodenal ulcers ) Esophageal varices : common in pt with liver cirrhosis & portal HTN Mallory- weiss syndrome: mucosal tear at gastroesophageal junction due to sever vomiting Malignancy  Initial stabilization : ABCD approach Admit to monitor bed & monitor vital signs closely A: ensure the airway is patent ,especially in massive bleeding & or Altered mental status consider intubation for airway protection B:administer Oxygen C: please at least 2 large bore 18G canulae , begin IV , fluid normal saline or lactated Ringer Consider Blood transfusion if Hb