Chapter 18 - Gastrointestinal and Urologic Emergencies

A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale and she is tachycardic. The EMT should suspect: - acute pancreatitis. - Mallory-Weiss tear. - esophageal varices. - esophagitis.

A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale and she is tachycardic. The EMT should suspect: - acute pancreatitis. *- Mallory-Weiss tear.* - esophageal varices. - esophagitis.

Peritonitis may result in shock because: - intra-abdominal hemorrhage is typically present. - fluid shifts from the bloodstream into body tissues. - severe pain causes systemic dilation of the vasculature. - abdominal distention impairs cardiac contractions.

Peritonitis may result in shock because: - intra-abdominal hemorrhage is typically present. *- fluid shifts from the bloodstream into body tissues.* - severe pain causes systemic dilation of the vasculature. - abdominal distention impairs cardiac contractions.

Rebound tenderness is a result of what? - Peritoneal irritation - Esophageal varices - GERD - Ileus

Rebound tenderness is a result of what? *- Peritoneal irritation* - Esophageal varices - GERD - Ileus

You are assessing a patient reporting pain in the lower left quadrant of his abdomen. Rearrange the quadrants into the correct sequence in which they should be palpated. - Upper Left - Lower Right - Upper Right - Lower Left

- Lower Right - Upper Right - Upper Left - Lower Left *You should palpate in a clockwise direction beginning with the quadrant after the one the patient indicates is tender or painful, ending with the quadrant the patient indicates is tender or painful.*

A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to: - give her high-flow supplemental oxygen. - keep her supine and keep her warm. - protect her airway from aspiration. - rapidly transport her to the hospital.

A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to: - give her high-flow supplemental oxygen. - keep her supine and keep her warm. *- protect her airway from aspiration.* - rapidly transport her to the hospital.

A 47-year-old male presents with severe abdominal pain of 3 hours' duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to: - determine the exact location and cause of his pain. - assess his blood pressure to determine perfusion adequacy. - transport him in a supine position. - be alert for signs and symptoms of shock.

A 47-year-old male presents with severe abdominal pain of 3 hours' duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to: - determine the exact location and cause of his pain. - assess his blood pressure to determine perfusion adequacy. - transport him in a supine position. *- be alert for signs and symptoms of shock.*

A 59-year-old male presents with sudden-onset severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should: - vigorously palpate the abdomen to establish pain severity. - place the patient in a sitting position and transport at once. - administer oxygen and prepare for immediate transport. - request a paramedic unit to give the patient pain medication.

A 59-year-old male presents with sudden-onset severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should: - vigorously palpate the abdomen to establish pain severity. - place the patient in a sitting position and transport at once. *- administer oxygen and prepare for immediate transport.* - request a paramedic unit to give the patient pain medication.

A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain? - Pancreas - Kidney - Liver - Gallbladder

A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain? - Pancreas *- Kidney* - Liver - Gallbladder

An important aspect in the treatment of a patient with severe abdominal pain is to: - encourage the patient to remain in a supine position. - give 100% oxygen only if signs of shock are present. - administer analgesic medications to alleviate pain. - provide emotional support en route to the hospital.

An important aspect in the treatment of a patient with severe abdominal pain is to: - encourage the patient to remain in a supine position. - give 100% oxygen only if signs of shock are present. - administer analgesic medications to alleviate pain. *- provide emotional support en route to the hospital.*

For a patient with a gastrointestinal complaint, it is MOST important for the EMT to _________. - determine the cause of the patient's complaint - avoid transporting the patient if the condition is minor - identify whether the patient requires rapid transport - perform all interventions prior to transport

For a patient with a gastrointestinal complaint, it is MOST important for the EMT to _________. - determine the cause of the patient's complaint - avoid transporting the patient if the condition is minor *- identify whether the patient requires rapid transport* - perform all interventions prior to transport

In cholecystitis, where is the patient likely to feel referred pain? - Left lower quadrant - Around the navel - Right shoulder - Right upper quadrant

In cholecystitis, where is the patient likely to feel referred pain? - Left lower quadrant - Around the navel *- Right shoulder* - Right upper quadrant

Most patients with abdominal pain prefer to: - lie in a supine position with their knees in a flexed position. - sit in a semi-Fowler position with their knees slightly bent. - sit fully upright because it helps relax the abdominal muscles. - lie on their side with their knees drawn into the abdomen.

Most patients with abdominal pain prefer to: - lie in a supine position with their knees in a flexed position. - sit in a semi-Fowler position with their knees slightly bent. - sit fully upright because it helps relax the abdominal muscles. *- lie on their side with their knees drawn into the abdomen.*

Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called: - visceral pain. - remote pain. - referred pain. - radiating pain.

Pain that may be perceived at a distant point on the surface of the body, such as the back or shoulder, is called: - visceral pain. - remote pain. *- referred pain.* - radiating pain.

Urinary tract infections are more common in ____________. - active adults - women - sedentary adults - men

Urinary tract infections are more common in ____________. - active adults *- women* - sedentary adults - men

What is it called when a patient tenses his abdominal muscles during your assessment? - Rebound tenderness - Tetany - Splinting - Guarding

What is it called when a patient tenses his abdominal muscles during your assessment? - Rebound tenderness - Tetany - Splinting *- Guarding* *Guarding is involuntary muscle contractions (spasm) of the abdominal wall in an effort to protect the inflamed abdomen.*

What is the medical term for blood in the vomit? - Melena - Hematemesis - Cholecystitis - Uremia

What is the medical term for blood in the vomit? - Melena *- Hematemesis* - Cholecystitis - Uremia

When assessing a patient with abdominal pain, you should: - visually assess the painful area of the abdomen, but avoid palpation because this could worsen his or her condition. - observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles when palpated. - ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific area. - palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.

When assessing a patient with abdominal pain, you should: - visually assess the painful area of the abdomen, but avoid palpation because this could worsen his or her condition. - observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles when palpated. - ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific area. *- palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.*

When assessing a patient's abdomen, what is the best position to place the patient in? - Fowler - Prone - Supine - Trendelenburg

When assessing a patient's abdomen, what is the best position to place the patient in? - Fowler - Prone *- Supine* - Trendelenburg

Which of the following does NOT produce upper intestinal bleeding? - Esophageal varices - Ulcerative colitis - Esophagitis - Mallory-Weiss tear

Which of the following does NOT produce upper intestinal bleeding? - Esophageal varices *- Ulcerative colitis* - Esophagitis - Mallory-Weiss tear

Which of the following helps filter the blood and has no digestive function? - Stomach - Spleen - Small intestine - Large intestine

Which of the following helps filter the blood and has no digestive function? - Stomach *- Spleen* - Small intestine - Large intestine

Which of the following is a sign of peptic ulcer disease? - Vomiting - Diarrhea - Cystitis - Melena

Which of the following is a sign of peptic ulcer disease? - Vomiting - Diarrhea - Cystitis *- Melena*

Which of the following is correct about the secondary assessment for a high-priority patient? - Never perform a secondary assessment on a high-priority patient. - You may not have time to complete a secondary assessment. - Never contact medical direction before completing the secondary assessment. - The secondary assessment must be performed prior to transport.

Which of the following is correct about the secondary assessment for a high-priority patient? - Never perform a secondary assessment on a high-priority patient. *- You may not have time to complete a secondary assessment.* - Never contact medical direction before completing the secondary assessment. - The secondary assessment must be performed prior to transport.

Which of the following may help reduce your patient's nausea? - Low-flow oxygen - Cricoid pressure - Oral glucose - Positive-pressure ventilation

Which of the following may help reduce your patient's nausea? *- Low-flow oxygen* - Cricoid pressure - Oral glucose - Positive-pressure ventilation

Which of the following organs lies in the retroperitoneal space? - Pancreas - Gallbladder - Liver - Spleen

Which of the following organs lies in the retroperitoneal space? *- Pancreas* - Gallbladder - Liver - Spleen

Which of the following statements is true about acute renal failure? - Can be reversed with prompt diagnosis and treatment - Often caused by diabetes or hypertension - Requires dialysis or a kidney transplant - Kidney tissue shrinks and function diminishes over a period of years

Which of the following statements is true about acute renal failure? *- Can be reversed with prompt diagnosis and treatment* - Often caused by diabetes or hypertension - Requires dialysis or a kidney transplant - Kidney tissue shrinks and function diminishes over a period of years *Acute renal failure is a sudden decrease in function. It occurs from a variety of causes including hemorrhage, dehydration, trauma, shock, sepsis, heart failure, medications, drug abuse, and kidney stones. Acute renal failure can be reversed with prompt diagnosis and treatment.*

Which of the following statements regarding dialysis is correct? - Patients who miss a dialysis treatment often present with weakness. - Acute hypertension is a common adverse effect of dialysis. - The purpose of dialysis is to help the kidneys retain salt and water. - Hemodialysis is effective but carries a high risk of peritonitis.

Which of the following statements regarding dialysis is correct? *- Patients who miss a dialysis treatment often present with weakness.* - Acute hypertension is a common adverse effect of dialysis. - The purpose of dialysis is to help the kidneys retain salt and water. - Hemodialysis is effective but carries a high risk of peritonitis.

Which of the following statements regarding the acute abdomen is correct? - The parietal peritoneum is typically the first abdominal layer that becomes inflamed or irritated. - An acute abdomen almost always occurs as the result of blunt trauma to solid abdominal organs. - The most common cause of an acute abdomen is inflammation of the gallbladder and liver. - The initial pain associated with an acute abdomen tends to be vague and poorly localized.

Which of the following statements regarding the acute abdomen is correct? - The parietal peritoneum is typically the first abdominal layer that becomes inflamed or irritated. - An acute abdomen almost always occurs as the result of blunt trauma to solid abdominal organs. - The most common cause of an acute abdomen is inflammation of the gallbladder and liver. *- The initial pain associated with an acute abdomen tends to be vague and poorly localized.*

You are assessing a 76-year-old man complaining of severe tearing pain radiating into his lower back. He is hypotensive and tachycardic. Which of the following should you suspect? - AAA - Cystitis - Diverticulitis - Gallstones

You are assessing a 76-year-old man complaining of severe tearing pain radiating into his lower back. He is hypotensive and tachycardic. Which of the following should you suspect? *- AAA* - Cystitis - Diverticulitis - Gallstones *Tearing pain radiating into the lower back, hypotension, and tachycardia are signs of an AAA.*

You are assessing a patient reporting severe pain in his upper left and right abdominal quadrants radiating to the back. The patient reports that the pain got worse right after he ate lunch an hour ago. He also has nausea and vomiting, abdominal distention, and tenderness. Based on these signs and symptoms, which of the following conditions do you suspect? - Appendicitis - Diverticulitis - Esophagitis - Pancreatitis

You are assessing a patient reporting severe pain in his upper left and right abdominal quadrants radiating to the back. The patient reports that the pain got worse right after he ate lunch an hour ago. He also has nausea and vomiting, abdominal distention, and tenderness. Based on these signs and symptoms, which of the following conditions do you suspect? - Appendicitis - Diverticulitis - Esophagitis *- Pancreatitis*

Your patient complains of abdominal pain that occurs mostly at night or after eating fatty foods. You should suspect ____________. - cholecystitis - kidney stones - a hernia - appendicitis

Your patient complains of abdominal pain that occurs mostly at night or after eating fatty foods. You should suspect ____________. *- cholecystitis* - kidney stones - a hernia - appendicitis

Your patient complains of chronic "burning" stomach pain that improves after eating. You should suspect: - peptic ulcer disease. - pneumonia. - kidney stones. - aortic aneurysm.

Your patient complains of chronic "burning" stomach pain that improves after eating. You should suspect: *- peptic ulcer disease.* - pneumonia. - kidney stones. - aortic aneurysm.

________ is the paralysis of the muscular contractions that normally propel material through the intestine. - Acute abdomen - Emesis - Ileus - Peritonitis

________ is the paralysis of the muscular contractions that normally propel material through the intestine. - Acute abdomen - Emesis *- Ileus* - Peritonitis