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Def = an abnormality of the circulatory system that results in inadequate
organ perfusion and tissue oxygenation.
ovolemia is the cause of shock in most trauma patients
ATLS
Pathophysiology :
Early circulatory responses to blood loss are com- pensatory and include
progressive vasoconstriction of cutaneous, muscle, and visceral
circulation to preserve blood flow to the kidneys, heart & brain.
Therapy :
(A&B) Supplementary oxygen is provided to maintain oxygen
saturation at greater than 95%.
UrinaryCatheterization :
Bladder catheterization allows for assessment of the urine for hematuria
(indicating the retroperitoneum may be a significant source of blood
loss) and con- tinuous evaluation of renal perfusion by monitoring
urinary output.
MASSIVE TRANSFUSION
COAGULOPATHY
onhemorrhagic shock (cardiogenic)
Uncommon
Difficult to distinguish from those in hypovolemic shock, as both
groups can manifest tachycardia, cutaneous vasoconstriction,
impaired urinary output, decreased systolic pressure, and
narrow pulse pressure.
ACUTE ABDOMINAL PAIN
DEFINITION
Refers to any acute intra & extra
abdominal disease processes. Many
cases require urgent surgical
management, although some can be
managed nonsurgically.
Abdominal pain is pain that is felt in the
abdomen
LOCATION
Obturator
sign
LAB EXAMINATION
CBC WBC
WBC count > 10,500 cells/mm3
Neutrophilia greater than 75%
CRP test
Urinalysis
Abdominal x-ray
CT scan of the abdomen:
Very good test for diagnosing appendicitis
Ultrasound of the abdomen
MRI scan of the abdomen
May be helpful in diagnosing acute appendicitis
in the pregnant female.
EMERGENCY
DEPARTMENT CARE
Treatment guidelines for patients with suspected acute
appendicitis
Patients with suspected appendicitis should not receive
anything by mouth
Administer parenteral analgesic and antiemetic as needed for
patient comfort
Consider ectopic pregnancy in women of childbearing age, and
obtain a qualitative betahuman chorionic gonadotropin (beta-
hCG)
Administer intravenous antibiotics to those with signs of
septicemia and to those who are to proceed to laparotomy
Nonsurgical treatment of appendicitis
Anecdotal reports describe the success of intravenous
antibiotics in treating acute appendicitis in patients without
access to surgical intervention (eg, submariners, individuals on
ships at sea)
Preoperative antibiotics
decreasing postoperative wound infection rates
APPENDICITIS TREATMENT: SURGERY
Surgery to remove the appendix is
called an appendectomy
The two types of appendectomy
include:
Open appendectomy:
An incision is made in the right lower abdomen
and the appendix is removed through the
incision.
Laparoscopic appendectomy:
A small incision is made in the umbilicus and
the surgeon uses a flexible fiberoptic scope to
remove the appendix through the small
incision.
COMPLICATION
Abses periappendicitis
Septikemia
Mucocele
Peritonitis
Peritonitis
Acute Peritonitis
inflammation of the peritoneum
Maybe localized or diffuse in location,acute and chronic in
natural history, and infectious or aseptic in pathogenesis
infectious(primary peritonitis or spontaneus) and is usually
related to a perforated viscus (and calledsecondary
peritonitis)
Associated :
with decreased intestinal motor activity
resulting in distention of the intestinal lumen with gas and fluid
(adynamic ileus)
Accumulation of fluid in the bowel and oral intakerapid
intravascular volume depletioncardiac, renal, and other
systems.
Caused by the entry of
2 Major Types Secondary
bacteria or enzymes into
the peritoneum from the
gastrointestinal or biliary
tract.
Primary
Caused by the spread of an This can be caused due to
infection from the blood & an ulcer eating its way
lymph nodes to the through stomach wall or
peritoneum.Very rare < 1% intestine when there is a
rupture of the appendix or
a ruptured diverticulum.
Usually occurs in people who
have an accumulation of fluid
Also, it can occur due to an
in their abdomens (ascites).
intestine to burst or injury
to an internal organ which
The fluid that accumulates bleeds into the internal
creates a good environment cavity.
for the growth of bacteria.
Conditions Leading to Secondary
Bacterial Peritonitis
Perforations of bowel Perforations or leaking of other
Trauma, blunt or penetrating organs
Inflammation Pancreaspancreatitis
Appendicitis Gallbladdercholecystitis
Diverticulitis Urinary bladdertrauma, rupture
Peptic ulcer disease Liverbile leak after biopsy
Inflammatory bowel disease Fallopian tubessalpingitis
Iatrogenic Bleeding into the peritoneal cavity
Endoscopic perforation
Anastomotic leaks Disruption of integrity of peritoneal
Catheter perforation cavity
Vascular Trauma
Embolus Continuous ambulatory peritoneal dialysis
Ischemia (indwelling catheter)
Obstructions Intraperitoneal chemotherapy
Adhesions Perinephric abscessIatrogenic
Strangulated hernias postoperative, foreign body
Volvulus
Intussusception
Neoplasms
Ingested foreign body, toothpick, fish
bone
acute abdominal pain and tenderness, usually with fever
Bowel sounds are usually but not always absent.
Tachycardia, hypotension, and signs of dehydration are
common
Localized peritonitis is most common in
uncomplicated appendicitis and diverticulitis, and
physical findings are limited to the area of inflammation
Generalized peritonitis is associated with widespread
inflammation and diffuse abdominal tenderness and
rebound.
Rigidity of the abdominal wall is common in both
localized and generalized peritonitis
Clinical Features
Leukocytosis and marked acidosis are common
laboratory findings.
Plain abdominal films dilation of large and small
bowel with edema of the bowel wallFree air under
the diaphragm perforated viscus.
CT and/or ultrasonography presence of free fluid or
an abscess.
When ascites is present, diagnostic paracentesis
with cell count (>250 neutrophils/L is usual in
peritonitis), protein and lactate dehydrogenase
levels, and culture is essential.
In elderly and immunosuppressed patients, signs of
peritoneal irritation may be more difficult to detect.
Management
Rehydration
Correction of electrolyte
abnormalities
Antibiotics
Surgical correction of the underlying
defect
Prognosis
Mortality rates are <10% for
uncomplicated peritonitis associated
with a perforated ulcer or ruptured
appendix or diverticulum in an
otherwise healthy person.
Mortality rates of40% have been
reported for elderly people, those
with underlying illnesses, and when
peritonitis has been present for >48
h.
GASTROENTERITIS
Gastroenteritis definiton
Gastroenteritis is a common
condition where the stomach and
intestines become inflamed. It is
usually caused by a viral or bacterial
infection.
Gastroenteritis is an inflammation of
the lining of the intestines caused by
a virus, bacteria or parasites
The two main symptoms of
gastroenteritis arediarrhea and
vomiting.
etiology
virus
infection bacteria
parasites
Gastroenteriti
s
etiology
Malabsorption
mixture food
poison
(chemical)
Pathogenesis of
infectious diarrhea
classification
infection
etiology
Non-
infection
acute
diarrhea Time
Chronic
Secretori
Mechanis k
m
osmotic