1. Gastroenterological Pathology

2. History Nature & course of abdominal symptoms Associated s/s Past medical, family & surgical Hx Medications Could you be pregnant?

3. Pain Onset & Duration Location & Movement

4. Physical Assessment See Evaluation Form Inspection Auscultations Percussion

5. Physical Examination Palpations Abdominal Quadrants Referred Pain Special Tests

6. Abdominal Pain Options Appendicitis Irritable Bowel Syndrome Inguinal Hernia Esophageal Reflux/Indigestion Colitis Ulcer Diarrhea/constipation Gastroenteritis Gastritis Crohn’s Disease Trauma – spleen, liver, hollow viscous

7. Appendicitis Pain usually (70%) starts centrally (umbilical region) and moves to Mcburney’s Point The RLQ becomes tender in 65%-95% of cases Most common acute surgical condition of the abdomen Occurs in about 7% of population, between age 10-30 yrs old

8. Appendicitis: Pathogenesis Long finger-like process that extends from the inferior tip of the cecum Obstruction of the narrow lumen initiates the clinical illness D/T viral illness or fecal obstruction (fecaliths)

9. Appendicitis S/S: Tests: Tx/Complications:

10. Appendicitis-Tests Psoas Sign

11. Appendicitis - Tests Obturator Sign

12. Irritable Bowel Syndrome Common disorder, cause unknown S/S: Bleeding, fever, weight loss, and persistent severe pain are NOT s/s of IBS

13. IBS – cont. Diagnosis: TX: BRAT Diet:

14. Inguinal Hernia Definition: s/s: Tx: referral to surgeon Can be difficult to diagnose. Common when born

15. Ulcers Excessive secretion of gastric acids, inadequate protection of mucus membrane, stress, heredity, medications s/s: Dx: Tx:

16. Esophageal Reflux Malfunction of lower esophageal sphincter, Cause…intrinsic pressure, angle of cardioesphygeal junction, action of diaphragm, gravity s/s: Dx: Tx:

17. Diarrhea Causes: infection, drug-induced, food related, post- surgical, psychological, exercise (runner’s trot) s/s: Dx: Tx: BRAT diet:

18. Constipation Definition: S/S: Dx: Tx:

19. Gastroenteritis Definition : Cause: E. Coli infection, staphlococcal food poisoning, botulism, viral, chemical or drug related S/S: Dx: Tx:

20. Colitis Cause: Unknown S/S: Dx: Tx:

21. Crohn’s Disease Ulcerative colitis S/S: Will present with a lot of blood in stool, pain Dx: colonoscopy Tx: surgical removal of ulcerated portion

22. Abdominal Trauma Common sports Key is immediate recognition, monitoring & management Protocol when recognized

23. Abdominal Trauma Screening tools: Ultrasound: +/- Diagnostic Peritoneal Lavage: +/- Computed Tomography: +/-

24. Splenic Injuries Most commonly injured organ in abdomen Deceleration causes a shearing force on vessels and capsule Blunt trauma to LUQ Risk of Injury increases c:

25. Splenic Injuries S/S: Tx: avoid surgery if possible Return to play:

26. Liver Injuries 2 nd most common injured Blunt trauma to RUQ, lower chest from front or back s/s: Tx:

27. Hollow Viscous Injuries Stomach, small intestine, pancreas,bladder Cause: s/s: Tx: recognition and referral

28. Still more options Are you pregnant?, reproductive diseases Later chapter/discussion UTI or bladder infection Can be secondary to appendicitis

29. Summary If fever, bloody stool/urine, pallor, distress, no body movement, unexplained weight loss or severe pain are present, something serious is wrong!!