ch. 19- gastrointestinal and urologic emergencies

what does the abdominal cavity contain?

 Gastrointestinal system

 Genital system

 Urinary system

mcburnery’s point

location of pain/ tenderness in cases of appendicitis

heel drop test, heel tap test

used to assess pain and tenderness of appendicitis and other abdominal conditions

• heel drop: pt stands on toes and drops down onto their heels if pain then positive

• heel tap: pt is supine, elevate their heel 10-20 degrees and firmly strikes it with the palm of their hand

what does injury to solid organ cause?

causes shock and bleeding

injury to hollow organ cause?

causes its contents to leak and contaminate the abdominal cavity

this pain radiates and is hard to locate- viceral

solid organs

liver, spleen, pancreas, kidney, ovaries

hollow organs

gallbladder, stomach, small intestine, large intestine, bladder

liver

• secretes bile and assists in digestion of fats

• filters toxic substances

• creates glucose store

gallbladder

stores bile created by liver

small intestine

• duodenum- responsible for continuing the digestion process, neutralizing stomach acid, and facilitating absorption of essential nutrients

• jejunum- absorbs digestive products, does most of work

• illeum- absorbs nutrients that were not absorbed before and bile acids

RUQ

bile duct, liver, gallbladder

LUQ

stomach, spleen, pancreas

RLQ

appendix

LLQ

intestine, rectum

why do bile acids need to be absorbed by ileum?

so they can be returned to the liver for future use and

vitamin B12 for making nerve cells and red blood cells

colon (large intestine)

food not broken down comes here, water is absorbed, stool is formed

spleen

located in abdomen, no digestive function

male reproductive system

 Testicles

 Epididymis

 Vasa deferens

 Seminal vesicles

 Prostate gland

 Penis

female reproductive system

 Ovaries

 Fallopian tubes

 Uterus

 Cervix

 Vagina

urinary system

• controls discharge of waste materials filtered from blood by kidneys

• bladder is behind pubic symphysis

peritoneum: partial and visceral, what irritates it and what does it cause?

• partial peritoneum lines wall of abdominal cavity

• visceral peritoneum directly covers organs

• peritoneum can be irritated by blood, pus, or bile causing peritonitis

acute abdomen

refers to sudden onset of abdominal pain, associated with sever progressive problems

peritonitis and what does it cause?

inflammation of peritoneum

typically causes ileus

illeus and what does it cause?

• paralysis of muscular contractions

• retained gas and feces causes abdominal distention and stomach empties by emesis (vomiting)

diverticulitis

inflammation of small pockets at weak areas in the walls of gastrointestinal tract muscles, mostly the colon

cholecystitis and what does it cause?

• inflammation of gallbladder

• heart burn after greasy meal, vomiting, right referred shoulder pain

acute appendicitis , pain associated, how to test for it

• inflammation of appendix

• RLQ pain, pain after releasing pressure (rebound tenderness)

• heel tap test, heel drop test

nerves of parietal peritoneum vs visceral peritoneum

• parietal: supplied by the same nerves as skin of abdomen

• visceral: supplied by autonomic nervous system

acute abdomen and causes

sudden onset of severe abdominal pain

• ulcers

• gallstones

• pancreatitis

• appendicitis

• gastrointestinal hemorrhage

• esophagitis

• esophageal varices

• mallory- weiss sydrome

• gastroenteritis

• diverticulitis

• hemorrhoids

ulcers

 Protective mucus layer breaks down, allowing acid to eat into the organ
 May lead to gastric bleeding and peritonitis

gallstones

may form and block its outlet.
 Cause pain
 Lead to cholecystitis

pancreatitis, what causes it, sings and symptoms

 Inflammation of the pancreas

 Caused by obstructing gallstone, alcohol abuse, or other diseases

 pain in LUQ and RUQ quadrants, nausea, vomiting, and abdominal distention.

 Sepsis or hemorrhage may occur.

appendicitis

 Inflammation or infection in the appendix
 Nausea, vomiting, anorexia, fever, chills, rebound tenderness

gastrointestinal hemorrhage

 Bleeding within gastrointestinal tract

 May be acute or chronic

esophagitis

 Lining of the esophagus becomes inflamed by infection or acids from the stomach.

 Pain in swallowing, heartburn, nausea, vomiting, sores in mouth

esophageal varices, signs and symptoms

• bleeding in esophagus

• Fatigue, weight loss, jaundice, anorexia, edema, abdominal pain

• history of ETOH

mallory- weiss syndrome and its principle symptom

• junction of esophagus and stomach tears

• vomiting

gastroenteritis and principle symptom

 Infection from bacterial or viral organisms or caused by noninfectious conditions
 diarrhea

diverticulitis

Fecal matter becomes caught in colon walls, causing inflammation and infection.
 Fever, malaise, body aches, chills

hemorrhoids

 Created by swelling and inflammation of blood vessels surrounding rectum

 Bright red blood during defecation

cystitis (bladder infection)

• also called UTI

• caused by bacterial infection

• becomes serious if infection spreads to kidney

• reports of urgency or frequency of urination

acute kidney failure

 Sudden decrease in kidney function
 Reversible with prompt diagnosis and treatment

what happens when kidneys fail?

uremia

chronic kidney failure

 Irreversible

 Progressive, develops over months/years

 Eventually dialysis or transplant is required.

where does ovary, fallopian tubes, or uterus pain relate to usually?

lower quadrant

gynecologic problems are common cause of acute abdominal pain

AAA, what does pain feel like, what happens to bp

palpable pulsating mass caused by aorta that lies immediately behind peritoneum

ripping, tearing pain

bp less than 10 difference

hernias

Protrusion of an organ or tissue through an opening into a body cavity where it

does not belong

 May not always produce noticeable mass or lump

 Strangulation is a serious medical emergency.

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

primary assessment: ABC and transport decision

 Airway and breathing
 May cause shallow, inadequate respirations
 Circulation
 Ask about blood in vomit or black, tarry stools.
 Check pulses in both feet.
 Transport decision
 Immediate transport is needed if there are signs of significant illness

History taking: SAMPLE

 Nausea and vomiting

 Change in bowel habits and urination

 Weight loss

 Belching or flatulence

 Pain

 Concurrent chest pain

 Other signs or symptoms

secondary assessment: physical examination

• check for tenderness or rigidity

 Normal abdomen is soft and not tender.

 Pain/tenderness: signs of acute abdomen

 Expose and assess abdomen.

 Palpate gently.

secondary assessment: vital signs

 Check respiratory rate and pulse rate.

 Avoid taking a blood pressure in the same arm where a dialysis shunt is.

reassessment

 Frequent reassessment is important.

 Assess interventions, including treatment for shock and emotional support.

 Transport the patient in the most comfortable position.

emergency medical care

• you can not treat causes of acute abdomen

• 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.

dialysis emergencies

Emergency care:

 Manage XABCs. (external bleeding)

 Provide high-flow oxygen if indicated.

 Manage any bleeding from access site.

 Position the patient:

Upright in cases of pulmonary edema

Supine if the patient is in shock

 Transport promptly

dialysis and what can be caused if pt misses a treatment

• only definitive treatment for chronic kidney failure

• filters blood, cleans it of toxins, and returns it to body

• pulmonary edema

dialysis machine function and adverse affects

• functions like normal kidneys

• adverse effects:

 Hypotension
 Dysrhythmias
 Muscle cramps
 Nausea and vomiting
 Hemorrhage from access site
 Infection at access site