Gastro-intestinal tract it's a collective name used to describe the alimentary canal and some accessory organs which are all involved in different digestive processes. The alimentary canal begins at the mouth, passes through the thorax, abdomen, pelvis and ends at the rectum.
The gastro-intestinal tract it can have complications or disorder which can be life threatening or non life threatening, depending on the conditions involved.
Complications such as peptic ulcer, the protective layer is eroded allowing the acid to eat into the organ itself (1), over the course of weeks, months or years. The causes of this condition might be physiological stress, cigarette smoking, alcoholism and cancer. And in the past it was thought to be related to the types of food that people were eating, and it also affects both men and women equally (4). There also different types of ulcers namely; stomach (called gastric ulcer), duodenum (duodenal ulcer), esophagus (esophageal ulcer) (2).
A 29 years old male patient arrived at Dr George Mukhari hospital casualty accompanied by his wife on the 17 of September 2009, complaining of pain on the upper right quadrant and vomiting started the previous night. The patient with acute abdominal pain due to suspected peptic ulceration.
The patient was responsive, able to speak with a GCS of 15/15. History taking (ample) the following was found, (2) medical history: none, surgical history: laparatomy (3) (is an operation, the surgeon makes a cut or incision in the abdomen and usually investigates organs within the abdomen cavity), allergy: none, family history: known, medications: none. OPQRST done and the following detected, onset: previous day, provoking factor: after eating, quality: burning pain, radiation: no, severity: scale of eight, time: since started. The patient was cooperative even though sometimes was restless because of feeling pain until the doctor arrives and ordered that we should give him medication for pain
Vital signs: blood pressure 104/94, pulse 94, respiration rate 18, HGT 6, 3mmol, temperature 36.6 c
Head -to-toe: head and neck; no abnormalities detected, chest; clear equal bilaterally, abdomen; inspection; scar on the abdomen from surgery( laparatomy) and empty stomach on auscultation; no dull sound on percussion and pain on palpation on the right upper quadrant.
The patient was reassured, vital signs were monitored, Iv therapy (Ringers Lactate), was given pain medication and was referred for x-ray and another ringers Bp changed to 124 systolic, morphine 2mg slowly IVI administration post X-Ray.
After administration of Bioscope is not in our protocol, the patient started to feel better nom longer complaining a lot about the pain but still there. There are medications that they use in hospital which we don't use pre-hospital which are effective.
It is sometimes easier and difficult for doctors and sisters to diagnose different disease because of the environment they are working on. Including treatment given to the patient. For them to initiate different kinds of drugs before other drugs that are much effective compare to our first line of drugs.
The sisters and docters were all acting in a professional manner, not violating the patient's right to receive treatment. The doctor explained everything to the wife and patient and made sure they understood what was going on.
- Not all patients with peptic ulcer are going to present with all signs and symptoms, so you must do a proper assessment in order to understand what might be wrong with the patient.
- Post patient's x-ray as the patient was still in pain I asked the doctor if we can give him morphine and he agreed. Morphine was administered and the patient started to feel better.
- The patient was no longer complaining of pain.
- Being able to approach the higher qualified practitioner made me gain confidence in what I have learned.
- This shows that doctors do trust us because he listened to what I was telling him and allowed me to give morphine, even though didn't monitor the patient after.
- Give the pain medication after diagnosing the patient.
Proper assessment must be done correctly and quicker and deal with the problem immediately.
Sense of urgency is needed when you are working with this kind of patients and must make a correct dignosis. Further more you must be careful with your management.
It is possible to make a wrong diagnosis misleading by signs and symptoms, so u must be sure with your diagnosis and if you are not sure don't be ashamed to ask for help. Delaying pain management while the patient is complaining of pain is not good, because it can change the patient's condition next time a person to pay attention to the patient and you must not infringe the patient's rights .
1. Peptic ulcer -Van Der Weyden Mb, Amstrong Rm,Gregory AT(2005) "The Noble Prize in physiology or medicine
2. Laparatomy-www.ICU-USA-Tou.com _exploratomy laparoscopy- Giacolone PL, Vignal J, Laffargue F (2002).
3. F.Halter, Gastrointestinal unit,Inselspita,university hospital,bern Switzerland
4. American Academy of Orthopaedic Surgeons 6th edition- Nancy Caroline.