Ch. 19 Gastrointestinal and Urologic Emergencies

what does the liver do?

• assists in digestion

• secretes bile

• filters toxic substances produced by digestion

• creates glucose stores

• produces substances necessary for blood clotting and immune function

what does the gallbladder do?

• it’s a reservoir for bile

small intestine

colon (large intestine)

• food not broken down and used moves into the colon as a waste product

• water is absorbed and stool is formed

urinary system

a normal adult forms ____ to ____ of urine per day

1.5 to 2 L

peritoneum

• covers the organs of the abdomen

• parietal peritoneum: lines the walls of the abdominal cavity

• visceral peritoneum: covers the organs

• the presence of foreign material can irritate the peritoneum, causing peritonitis

acute abdomen

• the sudden onset of abdominal pain

• often associated with severe, progressive problems requiring medical attention

ileus

paralysis of muscular contractions that normally propel material through the intestine

peritonitis

• any foreign material, such as blood, pus, bile, pancreatic juice, or amniotic fluid, can cause irritation of the peritoneum

• can cause: ileus; diverticulitis; cholecystitis; acute appendicitis

• usually associated with nausea and vomiting

• fever may or may not be present

emesis

vomiting

diverticulitis

inflammation in small pockets at weak areas in the muscle walls of intestines

cholecystitis

inflammation of the gallbladder

nerves that supply the peritoneum

• parietal peritoneum: same nerves that supply the skin of the abdomen

  • these nerves can easily identify and localize a point of irritation

• visceral peritoneum: the autonomic nervous system

  • these nerves are less able to identify and localize pain

referred pain

• results from: the connection between the body’s 2 separate nervous systems

• description: pain felt in an area of the body other than the area where the cause of pain is located

common causes of acute abdomen

• ulcers

• gallstones

• pancreatitis

• appendicitis

• gastrointestinal hemorrhage

• esophagitis

• esophageal varices

• Mallory-Weiss syndrome

• gastroenteritis

• diverticulitis

• hemorrhoids

ulcers

• protective later of the mucous lining erodes, allowing acid to eat into the organ

• common causes: Helicobacter pylori bacteria; chronic use of NSAIDs

• signs/symptoms: gnawing pain in the stomach; nausea, vomiting; belching; heartburn

• complications: hematemesis; melena; peritonitis

gallstones

• may form and block the outlet from the gallbladder

  • if blockage is not relieved, inflammation can occur

• signs/symptoms: constant, severe pain in the right upper or midabdominal region that may refer to the right upper back, shoulder, or flank; nausea, vomiting; indigestion; bloating; gas; belching

pancreatitis

• inflammation of the pancreas

• common causes: an obstructing gallstone; alcohol abuse

• signs/symptoms: severe pain in the upper left and right quadrants that can radiate to the back; nausea, vomiting; abdominal distension; tenderness

• complications: sepsis or hemorrhage

appendicitis

• inflammation or infection in the appendix

• signs/symptoms: initial pain that is generalized, dull, and diffuse, which may center in the umbilical area; pain later localizes to the RLQ; may have referred pain; nausea, vomiting; anorexia; fever, chills; rebound tenderness

• complications: abscess; peritonitis; shock

gastrointestinal hemorrhage

• symptom of another disease, not a disease itself

• may be acute or chronic

• location: upper or lower gastrointestinal tract

• common causes: esophagitis; esophageal varices; Mallory-Weiss tear; inflammation; diverticulosis; diverticulitis; cancer; hemorrhoids

• signs/symptoms: hematemesis; melena; bright red stools

esophagitis

• occurs when the lining of the esophagus becomes inflamed by infection or acids from the stomach

• gastroesophageal reflux disease (GERD)

• signs/symptoms: pain with swallowing and feeling like there is something stuck in his or her throat; heartburn; nausea, vomiting; sores in the mouth

gastroesophageal reflux disease (GERD)

• the sphincter between the esophagus and the stomach opens, allowing stomach acid to move up into the esophagus

• also referred to as acid reflux disease

• signs/symptoms: burning sensation in chest; nausea, vomiting; sores in the mouth

esophageal varices

• amount of pressure within blood vessels surrounding the esophagus increase - result of liver failure

• common causes: alcohol in industrialized countries; viral hepatitis in developing countries

• pts will initially show signs of liver disease

• rupture of varices is far more sudden

  • signs/symptoms: sudden onset discomfort in the epigastric region or sternum; difficulty swallowing; vomiting of bright red blood; hypotension; signs of shock

  • complications: significant blood loss

Mallory-Weiss syndrome

• junction between the esophagus and the stomach tears

• common causes: violent coughing or vomiting

• signs/symptoms: signs of shock; upper abdominal pain; hematemesis; melena

gastroenteritis

• can be caused by infection or by noninfectious conditions

• signs/symptoms: diarrhea with blood and/or pus; abdominal cramping; nausea, vomiting; fever; anorexia

• complications: dehydration and shock

diverticulitis

• lack of fiber in the diet causes the consistency of stools to become more solid, requiring more intestinal contractions and increasing pressure in the colon

• bulges in the colonic walls result from increased intestinal contractions

  • fecal matter becomes caught in the bulges, allowing bacteria to collect, and resulting in inflammation and infection

• signs/symptoms: abdominal pain localized more in the LLQ

• complications: perforation of the intestinal wall leading to severe infection and shock

hemorrhoids

• created by swelling and inflammation of blood vessels surrounding the rectum

• common causes: conditions that increase pressure on the rectum or irritation of the rectum

• signs/symptoms: painless, bright red bleeding during defecation

cystitis

• bladder inflammation, aka UTI

• common causes: bacterial infection

• signs/symptoms: midline lower abdominal pain; blood in the urine; an urgency and frequent urination; pressure and pain around the bladder

• complications: kidney infection

kidneys

• play a major role in maintaining homeostasis

• eliminate waste from the blood

• when kidneys fails → uremia results

• kidney stones can form and cause blockage

acute kidney failure

• sudden decrease in function

• common causes: hemorrhage; dehydration; trauma; shock; sepsis; heart failure; medications; drug abuse; kidney stones

• reversible with prompt diagnosis and treatment

chronic kidney failure

• progressive and irreversible damage

• common causes: diabetes; hypertension

• signs/symptoms: lethargy; nausea; headaches; cramps; edema in the extremities and face; seizures; coma

• will eventually require treatment with dialysis

• the pts have an increased risk of heart failure and cardiac arrest

kidney stones

• can grow over time, and if a stone passes into the ureter, it can cause a blockage

• pressure will build up behind the kidney stone and cause swelling in the kidney

• pts may initially report vague discomfort in the flank, but the pain can become intense and radiate to the groin

• pts are often agitated and restless

• may report nausea and vomiting

female reproductive organs

abdominal aortic aneurysm (AAA)

• pulsating mass may be felt - difficult to detect

• back pain with a tearing sensation

• use extreme caution on these pts

hernia

• description: protrusion of an organ or tissue through a hole or opening into a body cavity where it does not belong

• common causes: congenital defects; a surgical wound that has failed to heal; a natural weakness in an area such as the groin

• may not always produce a noticeable mass or lump

• reducible hernia: pose little risk, can be pushed back into cavity

• incarcerated hernia: cannot be pushed back, compressed by surrounding body tissue

  • blood supply is compromised

• serious signs/symptoms: a formerly reducible mass is no longer reducible; pain at the hernia site; tenderness when the hernia is palpated; red or blue skin discoloration over the hernia

SAMPLE history

• nausea and vomiting

• changes in bowel habits

• urination

• weight loss

• belching or flatulence

• pain

• other signs or symptoms

• concurrent chest pain

treatment for acute abdomen

• treat the pt for shock even when obvious signs are not apparent

• position pts who are vomiting to maintain a patent airway

• providing low-flow oxygen may decrease nausea and anxiety

adverse effects of dialysis

• hypotension

• dysrhythmias

• chest pain

• muscle cramps

• nausea and vomiting

• hemorrhage from the access site

• infection at the access site

management of a dialysis pt

1. manage the XABCs

2. provide high-flow oxygen if indicated

3. manage any bleeding

4. position the pt sitting up in case of pulmonary edema or supine if the pt is in shock

5. transport promptly

strangulation

complete obstruction of blood circulation in a given organ as a result of compression or entrapment; an emergency situation causing death of tissue

uremia

• severe kidney failure resulting in the buildup of waste products within the blood

• eventually brain functions will be impaired