Chapter 19: Gastrointestinal and Urologic Emergencies (Block 3)

peritoneum

bag that holds organs

solid organs

liver, kidney, ovary, spleen pancreas

hollow organs

leak

gallbladder, ureter, large intestine, fallopian tubes, urinary bladder, stomach, small intestine, uterus

upper right quadrant

liver

upper left quadrant

spleen and stomach

what happens if hollow organs are ruptured

irritation and infection occurs

what do solid organs do

bleed

stomach acid

hydrochloric acid + pepsin

what happens in duodenum

chemical digestion, pancreatic juice

bile coming from liver—>digests lipids

liver

secretes bile

filters

stores glycogen

produces substances

gallbladder

stores bile and digests lipids

pancreas

secretes pancreatic juice (digests all of the macros)

jejunum

absorbs most nutrients

ileum

absorbs leftovers

colon (large intenstine)

absorbs water and remaining 5% nutrients

spleen

filters out old red blood cells, blood reservoir, produces antibodies

kidneys

filter toxin, water, electrolytes

urinary bladder

posterior to pubic symphysis

why is drinking too much water really fast bad

dilution of sodium (hyponatremic)

cells are swollen with water

acute abdomen

onset or gradual pain

sudden onset pain, tachycardia

if someone has acute abdomen pain, as a EMT you

do not need to determine the exact cause

should be able to recognize a life-threatening problem and act

mesentary

provides blood to intestines

the most fragile/easily damaged part of organs

peritoneum

peritonitis

s&s

inflammation of peritoneum

abdominal pain, tenderness, guarding, muscle spasm, illeus (decreased bowel sounds)

peristalsis

muscular contractions

ileus

when muscle contractions stop

visceral pain

internal organ pain (hollow)

difficulty to localize pain, deep pain

parietal pain

Pain from irritation of the parietal peritoneum

• somatic nerves

Uses the same nerves as the skin and muscles

easier to localize

patient can point to exactly where it hurts

referred pain

pain in a separate location than the origin

diverticulitis

s&s

inflammation of diverticula (pouch in large intestine)

nausea, fever, bloating, vomiting, LLQ pain, constipation

diverticula

small pouches that bulge outward from the wall of the large intestine (colon)

cholecystitis

s&s

inflammation of gallbladder, usually from gallstones (bile-bladder inflammation)

general GI distress, provoked by fats, fever, pain in right shoulder

acute appendicitis

s&s

risks

tx

inflammation of appendix

general GI s/s

rebound tenderness

in RLQ and naval pain

fever

becoming sepsis or infection of other local tissue by rupturing

take to hospital

rebound tenderness

no pain when palpating in but pain when releasing

why does acid not burn through stomach

mucous membrane, secretes bicarb that prevents it

ulcers (peptic ulcer disease-PUD)

risks

protective layer of mucus lining erodes in the stomach and duodenum, allowing acid to eat into an organ

chronic NSAID use

pancreatitis

causes

s&s

inflammation of pancreas

obstructing gallstone, alcohol abuse, or other diseases

pain upper left/right quadrant which may radiate to back, n/v, ABD distention, and tenderness

esophagitis

cause

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

gastroesophageal reflux disease (GERD)

esophageal varices

s&s

risks

portal hypertension

jaundice, nausea, pain, bloating

• if varices ruptures, hematemesis (bright red), melena, shock

overdosing

hypertension

varices

swollen, twisted veins from hypertension

melena

dark black stool from blood after digestion

hematemesis

vomiting blood

portal hypertension

high blood pressure in the liver bc blood is not filtered out

mallory-weiss syndrome

risk factors

s&s

junction between the esophagus and the stomach tears causing severe bleeding

alcoholism, eating disorders (binging/purging), things that cause people to vomit a lot

hematemesis, melena, coughing, shock

hemorrhoids

causes

swelling and inflammation of blood vessels surrounding the rectum, not life threatening

results from conditions that increases pressure on the rectum or irritation of the rectum

cystitis (bladder infection)

s&s

risks

bacterial infection aka urinary tract infection (UTI)

lower abdominal pain, urgency and frequency in urination with pressure and pain around the bladder

blood in urine could cause sepsis or reach kidneys

failing kidney s&s

pain in flank, UTI, pain in kidney, sepsis

kidney stones

s&s

can lead to kidney dysfunction and uremia

painful urination

hematuria

pain in flanks, radiating to groin

vomiting

fever

uremia

kidney failure leading to toxin buildup in blood

hematuria

blood in the urine

acute kidney failure (aka acute renal failure)

cause

sudden decrease in kidney

hemorrhage, dehydration, trauma, shock, sepsis, heart failure, medications, drug abuse, and kidney stones

reversible prompt diagnosis and treatment

risks of kidney failure in general

hypoxia

dehydration

trauma

getting hit in kidney

shock

sepsis

infection from UTI

drug abuse

chronic kidney failure (aka chronic renal failure)

causes

how long does it take to develop

progressive and irreversible damage

hypertension and diabetes

develops over months to years, eventually dialysis is required

definitive treatment for chronic kidney failure

dialysis either at home or at dialysis centers that EMT transport to

what does dialysis do

filters blood, cleans it of toxins, and return it to the body

what happens if a patient misses a dialysis treatment

weakness and pulmonary edema

conditions become progressively worse

hernia

s&s

protrusion of an organ through an opening into a body cavity where it does not belong

congenital defect, surgery wound that has failed to heal, natural weakness in an area, such as in the groin

when is a hernia not dangerous and dangerous

not: may not always produce a noticeable mass or lump

yes: if it has discoloration

serious hernia s&s

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

SIR Hernia

strangulated: blood supply cut off from hernia

incarcerated: hernia trapped outside peritoneal cavity

reducible: hernia moves back into peritoneal cavity

DR GERM

distention

rigidity

guarding

evisceration

rebound tenderness

masses