1. Abdominal and Gastrointestinal Emergencies-3
Dr. Maha Al-Sedik

2. Liver Disease: Cirrhosis
Pathophysiology
Early liver failure, which may be hallmarked by:
Portal hypertension
Deficiencies with coagulation
Diminished detoxification

4. Assessment: Jaundice. Ascites. Edema. Portal hypertension.
Oesophgeal varesis.
Hematemesis.
Hepato-splenomegaly.

5. Common blood tests: ( liver function tests ):
Aminotransferases
Alkaline phosphatase
Albumin
Bilirubin

6. Management
Prehospital care should be supportive.
Involves bleeding control and medication.
Use lower ends of medication dose range.

7. 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.

9. 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.

10. Obstructive Conditions
Intestines are unable to move material through the digestive tract.
Two main reasons:
Paralysis of the intestines.
Intestinal lumen diameter obstruction.

11. Obstructive Conditions
Small-Bowel Obstruction
Large-Bowel Obstruction

13. Small-Bowel Obstruction
Pathophysiology
Most often caused by post-operative adhesion.
Cancer.
Hernias.
Foreign bodies.

14. Assessment: Signs and symptoms may include: Nausea and vomiting
Distended abdomen
Absent bowel sounds
Peritonitis signs if bowel has ruptured

15. Management: Monitor blood pressure, and perform volume resuscitation.
Antiemetics are indicated.

16. 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.

17. 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

18. To check for an inguinal hernia: Place fingers on abdomen.
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.

19. Standing for long periods.
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).

20. Types of hernia according to pathology
Reducible
Irreducible or incarcerated
Strangulated

21. Hernia is pathologically classified into three types:
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.

22. Strangulated hernia

25. 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.

26. Management:
Focus on supportive measures.
Pain management.
Assess for sepsis.

27. 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.

28. Management
Do NOT attempt to remove object.
Prehospital management should be limited to patient comfort.
Treat with analgesia if indicated.
Closely monitor vital signs.