EMT Chapter 18 GI and Urology emergencies
Small intestine: Jejunum
"Absorbs" digestive products -Does most of the work
Diverticulitis
"Fecal matter" becomes "caught in colon" walls, -causing "inflammation and infection".
Acute kidney failure
"Sudden" decrease in kidney function
rebound tenderness in
"appendicitis" is a result of "peritoneal irritation"
UTI (cystitis) caused by?
"bacterial" infection
positioning: A patient with "pancreatitis" may
"lie curled up" on one side.
Small intestine: Duodenum
-"Digestive juices" from "pancreas and liver" mix -Pancreas releases "amylase, bicarbonate, and insulin"
Adverse effects of dialysis:
-"Hypo"tension -Muscle cramps -Nausea and vomiting -Hemorrhage from access site -Infection at access site
pain with appendicitis
-"initially" more "generalized", -dull, -diffuse -may center in the umbilical area. -Pain "later" localizes to the "RLQ"
hernias result from
-A "congenital defect", such as around the umbilicus -A "surgical wound" that has failed to heal properly -A natural "weakness in an area", such as in the groin
"Serious hernia" signs and symptoms:
-A formerly reducible mass that is no longer reducible -Pain at the hernia site -Tenderness when the hernia is palpated -Red or blue skin discoloration
"Circulation": GI/Urology emergencies
-Ask about blood in "vomit or black, tarry stools". -Check pulses in both arms.
Kidney "stones" can grow over time and cause blockage.
-Crystallized chemicals in the urine - Blockage can lead to swelling. - Pain is caused by the stone moving within the "ureter".
sxs of Esophageal varices
-Fatigue, -weight loss, -jaundice, -anorexia, -edema, -abdominal pain
Diverticulitis sxs?
-Fever, -malaise, -body aches, -chills
large intestine/colon
-Food that is not broken down comes here. -Peristalsis moves waste through the intestines.- -Water is absorbed. -Stool is formed.
Reassessment (GI/Urology)
-Frequent reassessment is important. -Assess interventions, including treatment for shock and emotional support. -Transport the patient in the most comfortable position.
Abdominal cavity contains which systems?
-GI -Genital -Urinary -Made up of solid and hollow organs
"Hollow" organs: in the abd?
-Gallbladder -Stomach -Small intestine -Large intestine -Urinary bladder
Causes of peptic ulcers:
-Helicobacter pylori infection -Chronic use of nonsteroidal anti-inflammatory drugs -Alcohol and smoking
"Solid" organs: in the abd cavity?
-Liver -Spleen -Pancreas -Kidneys -Ovaries
Spleen
-Located in abdomen -No digestive function -Part of lymphatic system
Dialysis- Emergency care:
-Manage ABCs -Provide high-flow oxygen if indicated -Manage bleeding from the access site -Position -Transport promptly
Mechanism of injury/nature of illness for GI and urology emergencies
-May be the "result of violence" -"Pale and sweating" patient with tearing pain may have an AAA -Characteristic "odor" of gastrointestinal bleeding
"SAMPLE history", addressing the following areas: (GI/Urology emergencies)
-Nausea and vomiting -Change in bowel habits and urination -Weight loss -Belching or flatulence -Pain -Concurrent chest pain -Other signs or symptoms
sxs of ulcer
-Nausea, -vomiting, -belching, and -heartburn are common symptoms. - Some ulcers heal without intervention.
secondary assessment: physical exam
-Normal abdomen is soft and not tender. -Pain/tenderness: signs of acute abdomen -Expose and assess abdomen. -*Palpate gently*
Female reproductive system:
-Ovaries -Fallopian tubes -Uterus -Cervix -Vagina
Sxs of esophagitis
-Pain in swallowing, -heartburn, -nausea, -vomiting, -sores in mouth
Digestion begins when food is put into the mouth and chewed.
-Salivary glands secrete saliva and begin to break food down. -Food is then swallowed. -Food travels down the esophagus to the stomach.
The liver assists in digestion.
-Secretes bile and aids in digestion of fats -Filters toxic substances -Creates glucose stores
signs and symptoms of pancreatitis
-Severe pain in "upper left and right quadrants", -often radiating to the back -pain is worse after eating. -Nausea -Vomiting -Abdominal distention -Tenderness
Rupture of varices is far more sudden.
-Sudden onset of discomfort in throat -Severe difficulty swallowing -Vomiting of bright red blood - Hypotension -Signs of shock *can also be gradual and take years for pt to experience sxs*
Male reproductive system:
-Testicles -Epididymis -Vasa deferentia -Seminal vesicles -Prostate gland -Penis
Take steps to provide comfort and "lessen effects of shock".
-Treat for shock even when obvious signs are not apparent. *Low-flow oxygen* may *decrease nausea and anxiety*.
appendicitis Can cause tissues to die, causing an
-abscess, -peritonitis, or -shock
kidneys regulate?
-acidity -blood pressure
The gallbladder can rupture in severe cases. pain includes
-constant, severe pain -right upper or midabdominal region -may refer to the right upper back, flank, or shoulder area
abdominal aortic aneurysm (AAA).
-difficult to detect -Use extreme caution when assessing or detecting AAA.
spleen- lymphatic system
-filtering blood -Develops RBCs -Blood reservoir -Produces antibodies
small intestine: ilium
-future absorption -Absorbs "bile acids" so they can be returned to the liver for future use and "vitamin B12" for making nerve cells and red blood cells
Treatment for AAA includes
-high-flow oxygen -rapid transport. -If the patient has signs of shock, place him or her supine -Do not vigorously palpate the patient's abdomen; doing so may cause the aneurysm to rupture.
Causes of peritonitis include
-infection -blunt or penetrating abdominal trauma
cholecystitis sxs include
-nausea, -vomiting, -indigestion, -bloating, -gas, and -belching.
pancreatitis Caused by
-obstructing gallstone, -alcohol abuse, or -other diseases
Lower quadrant pain may relate to problems with? females
-ovaries, -fallopian tubes, or -uterus.
parietal peritoneum: nerve perceives?
-pain, -touch, -pressure, -heat, -cold -Can easily identify and localize a point of irritation
The peritoneum also covers the organs of the abdomen.
-parietal -visceral
Two different types of nerves supply the peritoneum.
-parietal -visceral
Signs and symptoms of an acute abdomen
-rapid and shallow breathing, -a tense and distended abdomen, -tachycardia, -restlessness, and -constipation or diarrhea.
"hollow" organs include the
-stomach -intestines -gallbladder
since you retain gas and feces during ileus?
-stomach emptying through vomiting (emesis).
how do MOs enter body and cause gastroenteritis
-through contaminated food or water -Can also be caused by noninfectious conditions such as "adverse medication reactions"
People at higher risk for developing cholecystitis include
-women, -older adults, -obese people, and -people of Scandinavian, -Native American, and -Hispanic descent.
gallstone pain sxs may appear?
30 minutes after a fatty meal and at night.
The visceral peritoneum is supplied by the
ANS
Inflammation or infection in the appendix
Appendicitis -bend knees with this type of pt
Esophageal varices causes?
Capillary network in the esophagus leaks.
____ is a severe, intermittent cramping pain.
Colic
Hemorrhoids
Created by swelling and "inflammation of blood vessels" surrounding "rectum"
____ is the medical term for inflammation of the urinary bladder.
Cystitis
___ is the only definitive treatment for chronic kidney failure.
Dialysis -Some services transport patients to and from dialysis centers.
______ is a condition in which small pouches in the colon (large intestine) become inflamed.
Diverticulitis
Occurs when the amount of pressure within the blood vessels surrounding the esophagus increases
Esophageal varices
Lining of the esophagus becomes inflamed by infection or acids from the stomach.
Esophagitis -GERD
The stomach is the main organ of the digestive system.
Gastric juices break down food.
condition in which the sphincter between the esophagus and the stomach opens, allowing stomach acid to move up into the esophagus
Gastroesophageal reflux disease (GERD) -Can cause a burning sensation within the chest (heartburn)
Determine whether the patient can relax the abdominal wall on command.
Guarding and rigidity may be present.
___ is the paralysis of the muscular contractions that normally propel material through the intestine.
Ileus
Diverticulitis
Inflammation in small pockets at weak areas in the muscle walls
Mallory-Weiss syndrome
Junction between "esophagus and stomach" *tears*
There are two kidneys, one on each side of the body. location?
Lie on the "posterior muscular wall of the abdomen behind the peritoneum" in the "retroperitoneal" space
acute GI hemorrhage
May be shorter term and "more severe"
___ is inflammation of the kidney.
Nephritis
Bicarbonate is also produced in the pancreas
Neutralizes stomach acid in duodenum
Inflammation of the pancreas
Pancreatitis
ileus
Paralysis of muscular contractions -that normally propel material through the intestine
referred pain
Patients will not be able to describe exactly where the pain is. *visceral peritoneum pain*
_____ movement- moves urine to the bladder.
Peristalsis
Inflammation of peritoneum
Peritonitis
Chronic kidney failure
Progressive, develops over "months/years" -Eventually "dialysis or transplant" is required. -Irreversible
vital signs- check
RR and pulse
____ hernias pose little risk and can be pushed back into the body cavity.
Reducible
what may occur with pancreatitis?
Sepsis or hemorrhage may occur. -Look for fever or tachycardia.
____ position in case of "pulmonary edema" for pt that has "dialysis emergency"
Sitting up
ureters
Small, hollow, muscular tubes
____ position if patient is in shock
Supine
Reports of urgency and frequency of urination, Indicative of?
UTI
____ join each kidney to the bladder.
Ureters
Controls discharge of certain waste materials filtered from blood by the kidneys
Urinary system
uremia
Waste product (urea) remains in blood.
A 34-year-old woman with a recent history of pelvic inflammatory disease presents with acute severe abdominal pain. Her abdomen is distended and *diffusely* tender to palpation. Based on your findings thus far, you should suspect: a. peritonitis. b. pancreatitis. c. appendicitis. d. cholecystitis.
a. peritonitis.
A 70-year-old man presents with an acute onset of severe, tearing abdominal pain that radiates to his back. His BP is 88/66 mm Hg, pulse rate is 120 beats/min, and respirations are 26 breaths/min. Treatment for this patient should include: a. rapid transport to the hospital. b. firm palpation of the abdomen. c. placing him in a sitting position. d. oxygen at 4 L/min via nasal cannula.
a. rapid transport to the hospital.
Severe, tearing abdominal pain that radiates to the back is typical of an
abdominal aortic aneurysm (AAA);
You cannot treat causes of
acute abdomen.
Gynecologic problems are a common cause of ______ pain.
acute abdominal
which kidney failure is reversible with prompt dx and tx
acute kidney failure
Which of the following signs or symptoms would you be LEAST likely to find in a patient with an acute abdomen? a. Rapid, shallow breathing b. Soft, nondistended abdomen c. Tachycardia and restlessness d. Constipation or diarrhea
b. Soft, nondistended abdomen
retroperitoneal space located
behind the peritoneum -often the cause of acute abdominal pain
The gallbladder is a reservoir for
bile.
Gastrointestinal hemorrhage
bleeding within the GI tract -acute or chronic
Dialysis filters
blood, -cleans it of toxins, -and returns it to body. -The dialysis machine functions much like normal kidneys.
pancreas also releases amylase.
breaking down starches into sugar
ulcer pain described as
burning, gnawing pain in the stomach that subsides or diminishes immediately after eating
In which position do most patients with acute abdominal pain prefer to be transported? a. Sitting, with their head elevated 45° b. Supine, with their legs elevated 12 inches c. On their side, with their knees flexed d. Fowler's position, with their legs straight
c. On their side, with their knees flexed -takes pressure of abd
If a hernia is incarcerated and the contents are so greatly compressed that circulation is compromised, the hernia is said to be: a. reducible. b. ruptured. c. strangulated. d. congenital.
c. strangulated.
Gallstones may form, and if the blockage does not pass, it can lead to severe inflammation of the gallbladder, called
cholecystitis. -Condition in which the wall of the gallbladder is inflamed
Which of the following is NOT a solid organ? a. Liver b. Kidney c. Spleen d. Gallbladder
d. Gallbladder -"hollow" organ that concentrates and stores bile, which is produced by the liver.
A condition in which a person experiences a loss of appetite is called: a. ileus. b. colic. c. emesis. d. anorexia.
d. anorexia.
MOST patients with an acute abdomen present with: a. dyspnea. b. diarrhea. c. hypotension. d. tachycardia.
d. tachycardia.
Principal symptom: "gastroenteritis"
diarrhea
The pain caused by peritonitis is typically
diffuse (widespread)
Gastrointestinal system- responsible for?
digestion process
positioning: A patient with "appendicitis" may
draw up the "right knee".
Hernias may not always produce
noticeable mass or lump
AAA commonly occurs in
older patients—with HTN
which organs lie in the retroperitoneal space.
pancreas, kidneys, and ovaries
The ____ peritoneum "lines the walls" of the abdominal cavity.
parietal
The abdominal cavity is lined by a membrane called the?.
peritoneum
The aorta lies immediately behind the
peritoneum (area around abd organs)
The presence of foreign material (blood, pus, bile, pancreatic juice, amniotic fluid) can irritate the peritoneum, causing?
peritonitis
test rebound tenderness by
pressing down gently and firmly on abdomen -Patient will feel "pain" when the "pressure is released".
Ulcers
protective layer of mucus erodes, allowing acid to eat into the organ.
If the patient misses dialysis treatment, _____ can occur.
pulmonary edema
Ileus: paralysis of the muscular contractions causes?
retained gas and feces cause abdominal distention.
High "RR and pulse" with signs of shock may indicate
septic or hypovolemic shock.
abd pain may cause ______ respirations
shallow, inadequate
Injury to a "solid" organ can cause?
shock and bleeding.
The parietal peritoneum is supplied by the same nerves that supply the
skin of the abdomen.
The kidneys are ____ organs.
solid
The liver, spleen, and kidney are all ___ organs.
solid
pancreas secretes enzymes that break down
starches, fats, and proteins.
"Acute abdomen" refers to the
sudden onset of abdominal pain. -Often associated with severe, progressive problems
Place the patient in ___ position when examining the abd
supine -with legs drawn up and flexed at the knees.
If a patient has a dialysis shunt in his or her arm, avoid
taking a blood pressure in the same arm as the shunt to avoid damaging it.
Lower gastrointestinal bleeding occurs between
the upper part of the "small intestine and the anus".
kidneys Rid the body of
toxic waste
The liver, stomach, and small intestine are all found within the
true (anterior) abdomen.
Hematemesis is frequently seen in patients with ____ gastrointestinal bleeding.
upper
When the kidneys fail, ____ results.
uremia
The bladder empties to the outside of the body through the
urethra.
Cystitis (bladder infection) is common, and is also called?
urinary tract infection (UTI)
Nerves are far less able to localize sensation. _____ peritoneum
visceral
The ____ peritoneum "covers the organs" of the abd
visceral
Mallory-Weiss syndrome-Principal symptom:
vomiting
Transport decision: GI/urology emergencies
Immediate transport is needed if there are signs of significant illness.
____ hernias cannot be pushed back in and are compressed by surrounding body tissue.
Incarcerated
Gastroenteritis
Infection from bacterial or viral organisms or caused by noninfectious conditions
—an inflammation of the thin membrane that lines the abdominal cavity—typically presents with acute abdominal pain.
Peritonitis
___ can cause "ileus and abdominal pain".
Pneumonia -especially in lower lungs
___ of an incarcerated hernia is a serious medical emergency.
Strangulation -Blood supply is compromised by the compressed surrounding tissue
"Weak areas" at aorta behind peritoneum can result in
abdominal aortic aneurysm (AAA).
breathing with acute abd pain
increased respirations-tachypnea
Regulates the amount of glucose in the bloodstream
insulin
Breach of a "hollow" organ causes
its contents to leak and contaminate the abdominal cavity.
UTI: Becomes serious if infection spreads to
kidneys
appendicitis, pancreatitis, and cholecystitis (inflammation of the gallbladder) typically present with pain that is
localized to a particular area.
Acute appendicitis- pts temp?
may be within normal limits.
lower GI bleeding Often manifests as
melena -dark tarry stools
Peritonitis is frequently associated with
nausea and vomiting. -loss of bodily fluid into the abdominal cavity. -tachycardia and HTN -look for signs of shock
primary assessment
-ABCs -transport decision
Normal adult forms _______L of urine per day.
1.5 to 2
Cholecystitis
Gallbladder inflammation
chronic GI hemorrhage
May be longer duration and "less severe"
Male: Urethra passes from the ______ of the bladder through the penis.
anterior base
The ___________ lies in the retroperitoneal space. a. liver b. pancreas c. stomach d. small intestine
b. pancreas
cholecystitis can cause which sx?
fever
sx that may be present with diverticulitis?
fever
kidneys-Control balance of
fluid and electrolytes
Female: Urethra opens at the _____of the vagina.
front
storage pouch for digestive juices and waste from the liver.
gallbladder
ulcer: If the erosion is severe, it can lead to
gastric bleeding.
Peptic ulcers affect men and women equally but occur more frequently in the
geriatric population.
Muscles of the abdominal wall may become "rigid involuntarily"= This "boardlike muscle spasm" is called
guarding
Bright red blood during defecation: indicative of?
hemorrhoids
Protrusion of an organ or tissue through an opening into a body cavity where it does not belong
hernia
blood flow in the kidneys
high
The ureters, bladder, and urethra are ____ organs.
hollow
Kidneys: Play a major role in maintaining
homeostasis -Eliminate "waste" from "blood"
Primary risk factors for Mallory-Weiss syndrome
i. Alcoholism ii. Eating disorders
Signs and symptoms: Appendicitis
i. Nausea and vomiting ii. Anorexia iii. Fever iv. Chills v. Rebound tenderness
Peritonitis typically causes?
ileus
The urinary bladder is located
immediately "behind" the "pubic symphysis".
"High" RR with a "normal" pulse rate and BP may indicate
improper ventilations.