EMT Ch. 19: Gastrointestinal and Urological

When performing a secondary assessment, where do you want to avoid taking blood pressure?

in the same arm where a dialysis shunt is

dialysis shunt

A surgically created connection between an artery and a vein, allowing for easy access to the bloodstream for dialysis treatment.

Can an EMT treat causes of acute abdomen?

No, but can take steps to comfort and lessen effects of shock, such as applying low-flow O2 to decrease nausea and anxiety

What is the only definitive treatment for chronic kidney failure or chronic renal disease?

Dialysis

Dialysis

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

If a patient misses dialysis treatment, what can occur?

pulmonary edema

What are some adverse effects of dialysis?

• Hypotension

• Dysrhythmias

• Muscle cramps

• Nausea and vomiting

• Hemorrhage from access site

• Infection at access site

When treating a dialysis patient, what should you first do and then proceed with?

1. Manage XABCs

2. Provide high-flow O2 if indicated

3. Position the patient (upward for pulmonary edema or supine for shock)

4. Transport

Where does the kidney lay?

in the retroperitoneal space

Which of the following is NOT. solid organ?

• liver

• kidney

• spleen

• gallbladder

gallbladder

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:

• peritonitis.

• pancreatitis.

• appendicitis.

• cholecystitis.

peritonitis

MOST patients with an acute abdomen present with

tachycardia

Which of the following signs or symptoms would you be LEAST likely to find in a patient with an acute abdomen?

• Rapid, shallow breathing

• Soft, nondistended abdomen

• Tachycardia and restlessness

• Constipation or diarrhea

Soft, nondistended abdomen

Anorexia

A condition in which a person experiences a loss of appetite

Cystitis

the medical term for inflammation of the bladder, often causing pain and frequent urination.

If a hernia is incarcerated and the contents are so greatly compressed that circulation is compromised, the hernia is said to be:

• reducible.

• ruptured.

• strangulated.

• congenital.

strangulated

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:

• rapid transport to the hospital.

• firm palpation of the abdomen.

• placing him in a sitting position.

• oxygen at 4 L/min via nasal cannula.

rapid transport to the hospital.

In which position do most patients with acute abdominal pain prefer to be transported?

On their side, with their knees flexed

What 3 systems does the abdominal cavity make up?

The gastrointestinal, urinary, and reproductive/genital systems.

What happens if perforation of a hollow organ occurs?

It leads to the spillage of its contents into the abdominal cavity which contaminates

What is the gastrointestinal system responsible for?

digestion

When does digestion begin?

when food is chewed

Solid versus hollow organs— Function?

Solid organs are dense and involved involved in metabolism/filtration/secretion/hormone production

Hollow organs have a space for storing + transporting materials

Solid versus hollow organs— Examples?

Solid organs include: the liver, spleen, pancreas, kidneys, and ovaries (in women)

Hollow organs include: the stomach, small and large intestines, gallbladder

Solid versus hollow organs— What happens if you have damage to them?

Solid organs BLEED; Hollow organs LEAK

Stomach

the main (hollow) organ of the digestive system, contains gastric juices that break down food

Liver—Function?

a solid organ that aids in digestion by secreting bile, filtering toxic substances, creating glucose stores, and producing necessary substances for blood clotting + immune function

Gallbladder

a hollow organ that is a reservoir for bile

What 3 sections does the small intestine consist of?

1. Duodenum: where digestive juices from the pancreas and liver mix

2. Jejunum: absorbs digestive products

3. Ileum: absorbs nutrients that weren’t absorbed + absorbs bile aids & vitamins for nerve cells & RBCs

Colon (large intestine)

a hollow organ where water is absorbed and stool is formed

What are key organs in the Right Upper Quadrant (RUQ)?

Liver (right lobe), Gallbladder, Right kidney, Duodenum (first part of small intestine), Pancreas (head), Bile ducts, Right adrenal gland

What are common conditions associated with the Right Upper Quadrant (RUQ)?

Cholecystitis (gallbladder inflammation) Gallstones, Hepatitis, Liver abscess, Duodenal ulcers, Kidney stones/infections

What are key organs in the Left Upper Quadrant (LUQ)?

Spleen, Stomach, Left kidney, Pancreas (body/tail), Descending colon, Left adrenal gland

What are common conditions associated with the Left Upper Quadrant (LUQ)?

Splenic rupture/enlargement, Gastritis/stomach ulcers, Pancreatitis, Left kidney stones/infections, Aortic aneurysm

What are key organs in the Right Lower Quadrant (RLQ)?

Appendix, Cecum (Beginning of large intestine), Right ovary & fallopian tube (in females), Right ureter (the tube that carries urine from the kidney to the bladder), Ascending colon

What are common conditions associated with the Right Lower Quadrant (RLQ)?

Appendicitis, Ovarian Cysts (in females), Right kidney stones/infections, UTI’s

What are key organs in the Left Lower Quadrant (LLQ)?

Sigmoid colon (Part of large intestine), Left ovary & fallopian tube (in females), Left ureter, Descending colon

What are common conditions associated with the Left Lower Quadrant (LLQ)?

Diverticulitis (inflammation/infection of the diverticula in the colon), Left kidney stones/infections, Ectopic pregnancy (in females), Constipation

How much urine does a normal adult form per day?

1.5-2 L

What is the abdominal cavity lined by?

the peritoneum (parietal lines the walls of the abdominal cavity; the visceral covers the organs)

What does “acute abdomen” refer to?

sudden onset of abdominal pain

Peritonitis—Definiton?

inflammation of the peritoneum, usually due to a ruptured abdominal organ, that usually causes ileus

Ileus—Definition?

paralysis of muscular contractions causing bowel backup, usually caused by peritonitis

What 2 types of nerves supply the peritoneum?

1. Parietal peritoneum: supplied by somatic nerves (the same nerves that supply the skin of the abdomen & are easy to localize pain)

2. Visceral peritoneum: supplied by autonomic nerves.

Ulcers—Definition, Causes, Signs/Symptoms, Management

Definition: Open sores on the inner lining of the stomach or upper part of the small intestine

Causes: Overactivity of stomach acid, Chronic use of anti-inflammatory drugs (NSAIDs)

Signs/Symptoms: Burning stomach pain, Possible bleeding, Nausea, Vomit, Heartburn

Management: Provide comfort, avoid oral intake, transport for medical evaluation.

Gallstones—Definition, Signs/Symptoms

Definition: Solid particles that form and block the gallbladder outlet, which can lead to cholecystitis (inflammation of the gallbladder if blockage is not relieved)

Signs/Symptoms: Sudden severe pain in the RUQ, nausea, vomiting, pain in the back or right shoulder blade.

Pancreatitis—Definition, Causes, Signs/Symptoms

Definition: Inflammation of the pancreas

Causes: Often related to gallstones or chronic alcohol use

Signs/Symptoms: Severe abdominal pain in the UPPER quadrants that radiates to the back

Appendicitis—Definition, Signs/Symptoms

Definition: Inflammation/infection  of the appendix, a small pouch connected to the large intestine.

Signs/Symptoms: Pain starting around the umbilicus, moving to the RLQ, Nausea, Vomiting, Lack of appetite

Gastrointestinal hemorrhage—Definiton

Excessive bleeding within the gastrointestinal tract which may be acute or chronic

Esophagitis—Definition, Signs/Symptoms

Definition: Inflammation of the esophagus by infection of stomach acids

Signs/Symptoms: Pain with swallowing, Feeling of something stuck in throat, Heartburn, Nausea, Vomiting, Mouth sores

Example: GERD

Esophageal varices—Definition

Increased amount of pressure within blood vessels surrounding esophagus, often a result of liver failure

Mallory-Weiss syndrome

Junction between the esophagus and the stomach tears, often caused by coughing or vomiting

Gastroenteritis

Inflammation/infection of the stomach and intestines caused by a combination of diarrhea, nausea, and vomiting

Diverticulitis

Inflammation/infection of the diverticula in the colon caused by lack of.fiber leading to solid stool; Abdominal pain localized in the LLQ

Hemorrhoids

Swollen and inflamed blood vessels surrounding the rectum that may cause bleeding during pooping

Cystitis

Bladder inflammation, AKA a UTI, often caused by a bacterial infection

Signs: Blood in urine, frequent urination

Acute kidney failure

sudden decrease in kidney failure that is reversible with prompt diagnosis & treatment

Chronic kidney disease

Progressive and irreversible damage of kidney function that will eventually require treatment with dialysis or transplant

Behind the peritoneum

Abdominal Aortic Aneurysm (AAA)—Definition, Signs/Symptoms, Treatment

Definition: A bulge or tear in the wall of the aorta.

Signs: Tearing sensation in the back, tachycardia, and sweaty skin.

Treatment: Rapid transport, monitor vitals, and manage shock.

Reducible hernia

hernias that post little risk and can be pushed back into the body cavity

Incarcerated hernia

hernia that CANNOT be pushed back in and is compressed by surrounding body tissue

Strangulated hernia

hernia that occurs when blood supply to the herniated tissue is compromised by the compressed surrounding tissue, leading to tissue death.

How do the kidneys help regulate blood pressure?

by removing sodium and water from the body

An important aspect in treatment of a patient with severe abdominal pain is to:

provide emotional support en route to the hospital

A 35-year-old obese woman is complaining of localized pain in the RUQ with referred pain to the right shoulder. The MOST likely cause of her pain is:

acute cholecystitis

A young female presents with costovertebral angle tenderness. She is conscious and alert with stable vital signs. Which of the following organs is MOST likely causing her pain?

Kidney

When assessing a patient with abdominal pain, you should:

palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.

How does insulin function the body?

enables glucose to enter the cells

What is ketone production the result of?

fat metabolization when glucose if unavailable