Chapter 19- Gastrointestinal and Urologic Emergencies

Which of the following conditions is more common in women than in men? Pancreatitis Cystitis Hepatitis Cholecystitis

Cystitis

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: esophageal varices. acute pancreatitis. Mallory-Weiss tear. esophagitis.

Mallory-Weiss tear.

A 35-year-old obese woman is complaining of localized pain in the right upper quadrant with referred pain to the right shoulder. The MOST likely cause of her pain is: appendicitis. pancreatitis. acute cystitis. acute cholecystitis.

acute cholecystitis.

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: place the patient in a sitting position and transport at once. vigorously palpate the abdomen to establish pain severity. administer oxygen and prepare for immediate transport. request a paramedic unit to give the patient pain medication.

administer oxygen and prepare for immediate transport.

Older patients with abdominal problems may not exhibit the same pain response as younger patients because of: chronic dementia, which inhibits communication. age-related deterioration of their sensory systems. progressive deterioration of abdominal organ function. interactions of the numerous medications they take.

age-related deterioration of their sensory systems.

A 60-year-old female presents with a tearing sensation in her lower back. Her skin is sweaty, and she is tachycardic. The EMT should suspect: kidney stones. aortic aneurysm. strangulated hernia. acute pancreatitis.

aortic aneurysm.

Pain that radiates to the right lower quadrant from the umbilical area, nausea and vomiting, and lack of appetite are MOST indicative of: pancreatitis. appendicitis. cholecystitis. gastroenteritis.

appendicitis.

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: transport him in a supine position. assess his blood pressure to determine perfusion adequacy. be alert for signs and symptoms of shock. determine the exact location and cause of his pain.

be alert for signs and symptoms of shock.

You are transporting a 49-year-old male with "tearing" abdominal pain. You are approximately 30 miles away from the closest hospital. During your reassessment, you determine that the patient's condition has deteriorated significantly. You should: continue transporting and alert the receiving hospital. immediately perform a rapid physical examination. assist his ventilations with a bag-valve mask. consider requesting a rendezvous with an ALS unit.

consider requesting a rendezvous with an ALS unit.

Esophageal varices MOST commonly occur in patients who: have uncontrolled diabetes. consume a lot of alcohol. have a history of esophagitis. have weak immune systems.

consume a lot of alcohol.

Chronic renal failure is a condition that: occurs from conditions such as dehydration. is often caused by hypertension or diabetes. can be reversed with prompt treatment. causes dehydration from excessive urination.

is often caused by hypertension or diabetes.

Injury to a hollow abdominal organ would MOST likely result in: leakage of contents into the abdominal cavity. pain secondary to blood in the peritoneum. profound shock due to severe internal bleeding. impairment in the blood's clotting abilities.

leakage of contents into the abdominal cavity.

You respond to the residence of a 70-year-old male who complains of weakness and severe shortness of breath. His wife tells you that he is a dialysis patient, but has missed his last two treatments. After applying oxygen, you auscultate his lungs and hear diffuse rhonchi. The patient is conscious, but appears confused. His blood pressure is 98/54 mm Hg, his pulse rate is 120 beats/min and irregular, and his respirations are 24 breaths/min and labored. You should: leave him in a sitting position, keep him warm, and prepare for immediate transport. place him in a supine position, elevate his lower extremities, and transport at once. perform a detailed secondary assessment and then transport him to a dialysis center. treat for shock and request a paramedic unit to respond to the scene and assist you.

leave him in a sitting position, keep him warm, and prepare for immediate transport.

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

lie on their side with their knees drawn into the abdomen.

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

The MOST common and significant complication associated with an acute abdomen is: internal bleeding. high fever. peritonitis. severe pain.

peritonitis.

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.

protect her airway from aspiration.

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

provide emotional support en route to the hospital.

Functions of the liver include: secretion of bile and filtration of toxic substances. absorption of nutrients and toxins. release of amylase, which breaks down starches into sugar. production of hormones that regulate blood sugar levels.

secretion of bile and filtration of toxic substances.

Patients with acute abdominal pain should not be given anything to eat or drink because: digestion prevents accurate auscultation of bowel sounds. substances in the stomach increase the risk of aspiration. food will rapidly travel through the digestive system. it will create referred pain and obscure the diagnosis.

substances in the stomach increase the risk of aspiration.