Gastrointestinal & Hepatic- Biliary Systems

Transcription

1 Critical Thinking #1 Gastrointestinal & Hepatic- Biliary Systems Chapter 5 A baseball player is hit with a pitch in the left upper quadrant. Initially he appears to be fine, but toward the end of the game, he becomes nauseous and starts to vomit. He complains of pain in his left upper quadrant and also pain in his left shoulder extending down his arm. You palpate the abdomen and detect rigidity. Within minutes he becomes light headed, pale and somewhat clammy. His respiration rate has increased; his pulse is weak but rapid. You check his blood pressure and it is 90/60. Critical Thinking #1 What injury or illness do you suspect? What should you do? Critical Thinking #2 The fullback on your junior varsity team is tackled and lands directly on the football. He is complaining of pain in the right upper quadrant? Critical Thinking #2 As you begin your evaluation, what structures might you suspect could be involved? Critical Thinking #3 One of your cross-country athletes reports to the training room to tell you that she noticed blood in her urine this morning? She said it has happened before, but doesn t know if it s anything to be worried about. 1

2 Critical Thinking #3 What questions would you ask to obtain a thorough history? What injury or condition might you suspect? What course of action would you take? Critical Thinking #4 Your starting quarterback reports to the training room after the morning pep rally. He says he doesn t feel well. He is nauseated, but hasn t vomited. You check his temperature and it is 99. He has a test first period and says he really needs to go to class. You give him some pepto-bismol and send him to class. Critical Thinking #4 He comes back to the training room during lunch and says he feels worse. His nausea is worse and now he complains of pain in his right lower quadrant. You check his temperature and it is 100. You palpate his abdomen and find that he has rebound tenderness between the ASIS and the umbilicus. Critical Thinking #4 What injury or illness do you suspect and what would do? Objectives Identify and discuss the organs of the gastrointestinal & hepatic-biliary systems Discuss common traumatic injuries involving the abdomen signs & symptoms management Discuss common illnesses involving the upper GI signs & symptoms management Gastrointestinal System Upper GI Esophagus Stomach ingests & digests food 2

3 Gastrointestinal System Lower GI Small intestine Large intestine Rectum Anus Hepatic-Biliary System Liver Gall bladder absorbs nutrients & water expels the waste products produced during digestion Other Organs Spleen Pancreas Abdominal Quadrants UR UL LL LR Abdominal Quadrants UR Liver Gallbladder Abdominal Quadrants UL Stomach Spleen Pancreas 3

4 Abdominal Quadrants LL Descending colon Sigmoid colon Abdominal Quadrants LR Appendix Ascending colon Small intestine Occur more often in solid organs than hollow Why? Implications for sports injuries? Solar plexus contusion wind knocked out Spasm of diaphragm, contusion of celiac plexus Signs & symptoms Shortness of breath (temporary inability to breath) Anxiety Tender abdomen over diaphragm Solar plexus contusion Management Calm the athlete Loosen clothing or equipment around abdomen Encourage athlete to breath slowly (short inspirations, long expirations) by breathing in through nose & out through mouth Evaluate for possible internal injury Spleen Left upper quadrant Located beneath 9-11th ribs Stores platelets and other blood cells Filters blood 4

5 Splenomegaly Enlarged spleen Infectious mononucleosis Epstein-Barr virus Increased risk of injury when the spleen is enlarged Spleen Signs & symptoms Shock Nausea Vomiting LUQ rigidity Abdominal pain Referred pain to left shoulder (Kerr s sign) Spleen Management Any suspicion of spleen injury warrants immediate referral Any suspicion of enlarged spleen warrants restriction from contact sports Liver Increased risk of injury when enlarged Hepatitis Danger: the spleen is capable of splinting itself and then re-rupturing days or weeks later Liver Signs & symptoms Abdominal pain Right upper quadrant pain/tenderness Upper GI signs nausea vomiting Liver Management Immediate referral 5

6 Illnesses/Conditions of GI System General Signs & Symptoms Nausea Vomiting Abdominal pain Abdominal rigidity Loss of appetite Night pain or symptoms Diarrhea Constipation Bloody stool Jaundice Dyspepsia Gastroesophageal reflux (GERD) Gastritis Gastroenteritis Dyspepsia Indigestion or heartburn S & S: Uncomfortable burning under sternum Management: dietary changes OTC meds (antacids) Gastroesophageal Reflux Acid from stomach enters the esophagus usually triggered by certain kinds of foods S & S: similar to indigestion Management: dietary changes OTC/RX meds Gastroesophageal Reflux Can lead to hiatal hernia May also lead to esophageal cancer Occurs in stomach or duodenum Gastric juices digest the submucosal layers of tissue 6

7 Seen in athletes under psychological & physiological stress Can occur following extended use of NSAIDs S & S: Pain in upper or middle abdomen Pain may radiate to thoracic spine, chest & neck Night pain is common Vomiting of blood (coffee ground appearance) [perforation] Management: Avoidance of irritating food OTC meds (antacids) Referral to physician Prescription meds (antibiotics) Gastritis Inflammation resulting in the erosion of the entire mucosa of the stomach Signs & symptoms Nausea Vomiting Vague upper abdominal pain Gastritis Management Avoidance of irritating food OTC meds (antacids) Referral to physician Prescription meds (antibiotics) Gastroenteritis Inflammation of the mucosal lining of the stomach Stomach flu 7

8 Gastroenteritis S & S: Vomiting Watery diarrhea Headache Stomach cramps Fever Gastroenteritis Management: Prevent dehydration Meds Antiemetics PeptoBismol Phenergan Amend, Kytril, Zofran Antidiarrheals Immodium PeptoBismol Pain Patterns Upper GI Questions? 8