GI – GU Review Blended

Lecture Outline

• Introduction to the topic

  • Pathophysiology

  • Exercise-related concerns

Introduction to GI-GU Complaints

• GI-GU complaints are the most frequent cause of ER visits.

• Rising incidence in elderly patients due to:

  • Relaxation of sphincter muscles

  • Fragile stomach lining

  • Decrease in lactase levels

  • Slower motility in the large intestine

  • Increased pharmaceutical use

• Acute emergencies often stem from chronic issues.

Risk Factors for GI Disorders

• Factors contributing to GI issues include:

  • Excessive alcohol consumption

  • Excessive smoking

  • Increased stress

  • Ingestion of caustic substances

  • Poor bowel habits

Distended Veins and Blood Circulation

• Increased pressure in veins leads to distension.

• Causes of pressure build-up may include:

  • Valve damage

  • Conditions like esophageal varices, hemorrhoids, DVTs.

Constipation

• Blockage in the bowel often from:

  • Hard, dry stool

  • Slow transit times (e.g., opioid use or poor diet)

  • Bowel bottlenecks (scar tissue or anatomical issues)

Diverticulitis

• Defined by abnormal pouches in the large intestine. Key symptoms:

  • Abdominal pain

  • Nausea

  • Vomiting

  • Diarrhea or constipation

Types of Abdominal Pain

• Visceral Pain:

  • Dull and poorly localized.

  • Originates from walls of hollow organs.

• Somatic Pain:

  • Sharp, localized pain.

  • Arises from body wall (e.g., skeletal muscles).

• Referred Pain:

  • Perceived in different locations than affected organ.

  • Result of sensory signal mixing.

Causes of Abdominal Pain

• Pain causes include:

  • Inflammation

  • Distension

  • Ischemia

  • Irritation

Distention in the Bowel

• Potential causes of distention:

  • Fluid accumulation (ascites)

  • Air or gas build-up.

Silent Bowel / Ischemic Bowel

• Areas with ischemia appear discolored.

• Lack of perfusion may lead to necrosis, halting muscular contractions and peristalsis.

Physical Assessment Techniques

• Key methods for physical assessment include:

  • Inspection: Look for pulsating masses and distension (red flag).

  • Palpation: Assess all four quadrants, starting far from the pain source.

  • Auscultation: Usually does not yield critical insights.

General Management of GI Issues

• Key management strategies include:

  • Maintain airway and supportive breathing.

  • High-flow oxygen or assisted ventilations.

  • Circulation maintenance and vital sign monitoring.

  • Establish IV access and transport in a comfortable position.

  • Pain management, e.g., using Entonox.

Nitrous Oxide in Pain Management

• Characteristics of Nitrous Oxide:

  • Gaseous analgesic used in EMS.

  • Self-administered as needed (prn).

  • Contraindications include:

    • Poor ability to follow verbal instructions.

    • Intoxication with alcohol or drugs.

    • Head injuries with altered mental states.

    • treatment where 100% O2 needed

    • Suspected pneumothoraxes due to gas diffusion risk.

    • Abdominal pain with suspicion of bowel obstruction.

      • if the abdominal pain is related to a bowel obstruction specifically, that is when you should think of other ways to treat the problem.

    • abdominal trauma

    • pregnant but not in labour

Gastrointestinal System Functions

• The GI system converts food into nutrients and excretes wastes.

• Key structures include:

  • Upper GI tract (mouth to cecum)

  • Lower GI tract (cecum to anus)

  • Accessory organs (liver, gallbladder, pancreas, appendix).

Digestive System Components

• Major digestive structures include:

  • Accessory organs (liver, gallbladder, pancreas)

  • Alimentary canal (esophagus, stomach, small and large intestines).

Functions of the Digestive Tract

• Protects against digestive acids and pathogens.

• Functions include:

  • Ingestion: Entry of food and liquids into the tract.

  • Mechanical Processing: Crushing and mixing food.

  • Digestion: Breakdown into absorbable molecules.

  • Secretion: Mucus secretion from goblet cells.

  • Absorption: Movement of nutrients into the bloodstream.

  • Compaction & Defecation: Dehydration of undigested food and waste elimination.

Peristalsis

• Movement of food through the digestive tract enabled by:

  • Sequential contraction of the muscularis externa.

• Food enters as a bolus, moving along the tract.

Urinary System Overview

• Function: Eliminates excess water, salts, and wastes.

• Components include:

  • Two kidneys (receive 25% of cardiac output).

  • Urinary tract: ureters, bladder, and urethra.

Urine Storage and Transport

• Urinary system responsibilities:

  • Transports, stores, and eliminates urine.

  • Ureters: muscular tubes connecting kidneys to the bladder.

  • Bladder: a hollow organ capable of holding urine.

Urine Volume Normalization

• Normal urine volume: approximately 1200 mL/day.

• Conditions affecting volume:

  • Polyuria: Excessive urine production due to hormonal issues.

  • Oliguria: 50-500 mL/day indicating potential kidney problems.

  • Anuria: 0-50 mL/day, a sign of significant renal failure.

Catheter Usage

• Catheters used in situations such as:

  • Prostate blockage

  • Monitoring fluid output

  • Mobility issues

  • Conducting urine tests.

• Potential concerns:

  • Allergic reactions

  • Urethra injury

  • Urinary infections

  • Blood masking urine tests.

Vocabulary to Know

• Key terms include:

  • Ureter

  • Urethra

  • Polyuria

  • Dysuria

  • Defecation

  • Cullen’s sign

  • Grey Turner’s sign

  • Psoas sign

  • Melena

  • Oliguria

  • Hematuria