Gastrointestinal and Urological Emergencies

List the abdominal quadrants?

Right Upper Quadrant (RUQ)

Left Upper Quadrant (LUQ)

Right Lower Quadrant (RLQ)

Left Lower Quadrant (LLQ)

List the organs in the Right Upper Quadrant (RRQ)

Liver

Gallbladder

Pancreas

Small Intestine

Right Kidney

List the organs in the Left Upper Quadrant

Stomach

Spleen

Pancreas

Small Intestine

Left Kidney

List the organs in the Right Lower Quadrant (RLQ)

Appendix

Small Intestine

Ureter

Major Arteries and Veins to the right leg sit L

List the organs in the Left lower Quadrant (LLQ)

Colon

Small Intestine

Ureter

Major arteries and veins to the right leg

What organs are along the Midline?

Aorta

Pancreas

Small Intestine

Bladder

Spine

What is visceral pain?

Pain that originates in the internal organs

Description: deep, dull, crampy, pressure-like pain that often comes with nausea and/or vomiting. It is hard for patients to pinpoint an exact location (Not Localized)

Frequency: intermittent or consistence

What is somatic / parietal pain?

Pain that originates from the abdominal lining

Description: sharp and intense pain. It is localized and easy to pinpoint

Frequency: consistent

What is refereed pain?

Visceral pain that is felt felt in a different lactation than where the actual problem originates. Usually dull and hard to pinpoint.

Examples of refereed pain

→ Gallbladder is felt in the right shoulder

→ Spleen is felt in the left shoulder

→ Appendix (early stages) felt over the umbilicus

→ Stomach is felt over the epigastric area

→ Ovary and testicular pain is felt in the lower back

→ Chest pain is felt down the arm

Critical rule regarding females and abdominal pain?

All females of childbearing age with abdominal pain should be treated as a ectopic pregnancy until otherwise proven different

What is ectopic pregnancy?

A pregnancy that occurs outside of the uterus and is a life threatening due to internal bleeding

Symptoms of an ectopic pregnancy?

MUST BE CAREFUL IT CAN MIMIC GI AND UROLOGICAL SYMPTOMS

Symptoms:

→ Severe abdominal pain

→ N/V/D

→ Vaginal bleeding

What does self-limiting mean?

It means it resolves on its own

Two common self limiting illnesses we may be called for?

1.) Gastroenteritis

2.) Food Poisoning

Gastroenteritis

Inflammation of the stomach and intestines that results in nausea, vomiting, diarrhea, and abdominal cramping

Causes: Often Infection

Food poisoning

Illness caused by eating food contaminated with bacteria, viruses, toxins, or parasites that leads to nausea, vomiting, diarrhea, and abdominal cramping.

Is a type of Gastroenteritis

Where is pain associated with appendicitis usually felt?

Right Lower Quadrant (RLQ)

What is rebound tenderness?

Pain felt when pressure is released from the abdomen abruptly

What is McBurney’s point?

A spot in the right lower quadrant (RLQ) ghat is one third of the distance from the right hip to the belly button (umbilicus).

Pain here is often associated with appendicitis

What is cholecystitis (Koh-lee-sis-TY-tis)?

Inflammation of the gallbladder, usually caused by gallstones that results in right upper quadrant (RUQ) abdominal pain. Often comes with nausea and vomiting.

→ chole = bile

→ cyst = sac (gallbladder - because it is the bile sac)

→ -itis = inflammation

So gallbladder inflammation

What is Murphy’s Sign?

Deeply palpitate on the right upper quadrant (RUQ) and have the patient inhale, if they abruptly stop due to pain it is a positive indicator for cholecystitis

What are the four F’s of cholecystitis?

Female

Forty

Fertile

Fat

What is pancreatitis?

Inflammation of the pancreas that causes severe constant upper abdominal pain, often radiating to the back, frequently accompanied by nausea and vomiting

What is hematemesis?

Vomiting blood, which may appear bright red or dark like coffee grounds, it indicates a gastrointestinal bleed

What does coffee ground vomit indicate?

Digested blood indicating a GI bleed

What is esophageal varices

(uh-SOF-uh-JEE-ul) (VAIR-uh-seez)

Abnormally large veins in the esophagus that can rupture and cause severe, life threatening bleeding

What often causes esophageal varices?

(uh-SOF-uh-JEE-ul) (VAIR-uh-seez)

Advanced Liver Disease (cirrhosis) or blood clots

How does esophageal varices usually present?

Large amounts of bright red vomiting

What is an Abdominal Aortic Aneurysm (AAA)?

A weakening or bulging of the abdominal aorta that can rupture and cause life-threatening internal bleeding

Key symptoms of an abdominal aortic aneurysm (AAA)?

Sudden severe tearing abdominal or back pain, pulsating mass, hypotension

When assessing a case involving abdominal what do we last on our physical assessment?

Palpate the problem area

What is the primary treatment glow for an EMT when a case involves abdominal pain?

→ XABCD’s

→ Oxygen

→ Position of comfort

It is primarily supportive care and transport