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Gastroenterological Pathologies

Gastroenterological Pathologies. Chapter 2. Abdominal Pain – Tough Calls. Symptoms are often very confusing Symptoms can often be secondary signs to the real issue History is the most critical issue as well as specific note keeping Secondary signs are often the only vitals that we can go on.

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Gastroenterological Pathologies

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  1. Gastroenterological Pathologies Chapter 2

  2. Abdominal Pain – Tough Calls • Symptoms are often very confusing • Symptoms can often be secondary signs to the real issue • History is the most critical issue as well as specific note keeping • Secondary signs are often the only vitals that we can go on

  3. What Should be Asked? • Pain history – use your pain scale • Ensure athlete is honest with you – this comes from their comfort and confidence in YOU • Previous surgery? – appendectomy • Taking any meds? NSAIDS • Ulcer • Menstrual regularity • STD’s

  4. Completing the Physical Exam • Is the family MD involved? • If a minor – talk with parents • Gender issues – protect yourself

  5. Anatomy • GI Tract • Mouth, esophagus, stomach, SI, LI, rectum, anus • Upper GI – to ingest and digest • Lower GI – absorb nutrients/water & expel waste

  6. The 4 Quadrants Spleen Liver Stomach Gall Bladder Pancreas LI SI Appendix Bladder

  7. Referred Pain • Upper GI • similar to heart pain • Substernal pain from esophagus • Lower GI • Intestinal blockage – constipation • Appendicitis – radiating pain from ASIS to umbilicus • Liver • Upper right quadrant and right shoulder

  8. Referred Pain cont. • Gallladder • T8 dermatone – right scapula: sharp & stabbing • Heartburn • Pancreas • Mid & lower back, possibly left shoulder

  9. Special Tests • Obturator Sign • Supine • Flex hip to 90 degrees • ER hip • Positive if pain presents with ER – irritation of Obturator Muscle • Psoas Sign • Side-lying, painful side up • Flex knee and extend hip • Positive sign if pain presents with hip extension

  10. Etiology • Blunt trauma • Organ rupture • Poor diet • Herniation

  11. Assessment • Check ABCs • Palpate the 4 quadrants • Look for rigidity • Rebound tenderness • Hollow or dull sound • Bowel Sounds - Stethoscope

  12. Abdominal Injuries • Kidney Contusion • Etiology: blow to the back, rigidity • S/S: shock, nausea, vomiting, hematuria, referred pain • Management: instruct athlete to urinate 2 – 3 times – check color • Refer immediately if discolor or significant rigidity

  13. Liver Contusion • Etiology – blunt trauma, blow to the rib cage (an be worsened if disease present – such as ?) • S/S – hemorrhaging, shock, referred pain to right scapula/shoulder or anterior aspect of left chest • Management – life threatening, refer to MD/hospital

  14. Diarrhea • Etiology – irregular diet, irritation of intestine, gastrointestinal infection, food poisoning, drug use, psychogenic factors • S/S – cramping, nausea, frequent bowel movements, dehydration, loss of appetite, weakness • Management – bland foods, clear liquids, limit dairy products – some OTC meds

  15. Appendicitis • Etiology – can be chronic or acute, brought on by fecal obstruction, lymph swelling. Most common in males between 15 – 25. Can be confused with gastric pain, bacterial infection if rupture present • S/S – pain in lower abdomen, low grade fever, nausea, pain on right side, tenderness at McBurney’s Point • Management – surgical removal

  16. Scrotal Contusion • Etiology – blunt trauma • S/S – hemorrhage, effusion, muscular spasm • Management – place on back and push knees to chest, place in seated position – lift 3-4 inches off ground and DROP (to reduce spasm), cryotherapy (protect with layer of towel), protection from further trauma

  17. Contusion to Female Genitalia • Etiology – direct trauma • S/S – edema, reddness • Management – cryotherapy (protect with layer of towel), protection from further trauma

  18. Spleen Rupture • Etiology – rare disorder, direct blow to UL quadrant, infection (mono) • S/S – history of bow, rigidity, shock, nausea, vomiting, Kehr’s Sign • Management – medical emergency

  19. Hernia • Etiology – rupture in abdominal visera, can be congenital or acquired • S/S – pain with Valsalva or even mild hip movement, protrusion in inguinal area • Management – surgical repair

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