Gastroenterology

chapter 30 Gastroenterology




COMMON PRESENTATIONS



ACUTE ABDOMINAL PAIN1,2


Acute abdominal pain is pain of recent onset, which can vary in severity from mild and self-limiting to severe and life-threatening. Episodes may resolve spontaneously or require medical assessment and intervention. It is important to assess the site, chronicity, severity and nature of the pain and any associated signs and symptoms.


The patient’s general condition and the urgency of intervention will need to be assessed before investigations are arranged. If the patient is haemodynamically stable and there are no signs of sepsis, judiciously selected investigations may be arranged in the community setting. In an emergency or potential emergency situation, it may well be prudent to transfer the patient to hospital and have investigations carried out there.



Nature of pain






Abdominal guarding is a significant sign, due to reflex contraction of muscles in the abdominal wall in response to stimulation of pain fibres of the same dermatome.







GENERALISED ABDOMINAL PAIN


Severe generalised abdominal pain requires rapid and accurate assessment, resuscitation and transfer to hospital.


Signs of serious abdominal pathology include generalised peritonitis with rebound, guarding and absence of bowel sounds. Signs of shock (tachycardia, hypotension, oliguria, peripheral vasoconstriction) may be evident if there has been dehydration, haemorrhage or severe allergic reaction.


Consider:













LOCALISED ACUTE ABDOMINAL PAIN











CONSTIPATION


Constipation refers to difficulty in passing small, hard stools. If a patient presents with ‘constipation’, it is important to find out exactly what they mean. Question the patient about their bowel motions’ frequency, volume, colour and consistency, and the presence or absence of blood. Lifestyle factors are also an important contributor to or exacerbating factor for constipation.


While the cause of constipation may be a simple matter of diet, drug side effect or behavioural bowel habit, constipation may be an indication of a serious underlying disorder.







DIARRHOEA


Diarrhoea refers to frequent loose or watery stools. History taking should include duration and severity of symptoms and systemic features (fever, myalgia, malaise, arthralgia), and presence of blood or mucus in the stool.



Acute diarrhoea


Patient should be questioned about pain, stool frequency, colour and consistency, presence of blood, and incidence of vomiting.










Investigation













Bacterial gastroenteritis


Nausea, vomiting, diarrhoea and abdominal pain are common to most. Neurological, hepatic and renal complications can also occur. Rapid onset (hours) after ingestion of contaminated food suggests a pre-formed toxin, while a longer incubation period (1–3 days) suggests a bacterial or viral cause.


Pathogens include: enterotoxigenic Escherichia coli, Campylobacter, Salmonella, Shigella, Entamoeba histolytica, Clostridium perfringens, Bacillus cereus, Vibrio parahaemolyticus.



Enterotoxigenic E. coli

A leading cause of traveller’s diarrhoea. Adheres to the gut wall and produces enterotoxins.


Symptoms



Treatment






Jun 3, 2017 | Posted by in GENERAL SURGERY | Comments Off on Gastroenterology

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