Gastrointestinal and Urologic Emergencies

National EMS Education Standard Competencies

  • Medicine

    • Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient.

  • Abdominal and Gastrointestinal Disorders

    • Anatomy, presentations, and management of shock associated with abdominal emergencies.
    • Recognition of gastrointestinal bleeding.

  • Genitourinary/Renal

    • Blood pressure assessment in hemodialysis patients.
    • Assessment and management of complications related to:
    • Renal dialysis.
    • Urinary catheter management (not insertion).
    • Kidney stones.

Introduction to Abdominal Pain

  • Abdominal pain is a common complaint; however, the cause is often difficult to determine.
  • As an EMT:
    • Focus on recognizing life-threatening problems rather than determining the exact cause of abdominal pain.

Anatomy and Physiology of the Abdomen

  • The abdominal cavity contains:
    • Gastrointestinal system
    • Genital system
    • Urinary system
  • Composed of solid and hollow organs:
    • Solid organs:
    • Liver, spleen, pancreas, kidneys.
    • Hollow organs:
    • Gallbladder, stomach, intestines, bladder.
  • Solid organs can cause shock and bleeding if injured; hollow organs can leak contents and contaminate the abdominal cavity.

The Gastrointestinal System

  1. Function: Responsible for digestion; begins with mastication (chewing) of food.
  2. Main Structures:
    • Stomach: Main digestive organ, uses gastric juices.
    • Liver: Secretes bile, filters toxins, stores glucose.
    • Gallbladder: Reservoir for bile.
    • Small Intestine: Divided into 3 parts:
      • Duodenum: Mixes digestive juices.
      • Jejunum: Main site of absorption; does most of the work.
      • Ileum: Absorbs nutrients and vitamin B12.
    • Colon (Large Intestine): Absorbs water and forms stool.
    • Spleen: No digestive function.

The Genital System

  • Male Reproductive System:
    • Testicles, epididymis, vasa deferentia, seminal vesicles, prostate gland, penis.
  • Female Reproductive System:
    • Ovaries, fallopian tubes, uterus, cervix, vagina.

The Urinary System

  • Function: Controls waste discharge filtered from blood by kidneys.
  • Components:
    • Two kidneys (solid organs).
    • Ureters connect kidneys to bladder.
    • Bladder empties urine through the urethra.
    • Normal urine output is 1.5 to 2 L per day.

Pathophysiology of Abdominal Disorders

  • The abdominal cavity is lined with peritoneum:

    • Parietal peritoneum lines walls.
    • Visceral peritoneum covers organs.

  • Foreign materials (e.g. blood, pus) can irritate the peritoneum leading to peritonitis.

  • Acute Abdomen: Refers to sudden onset of abdominal pain, often indicating severe issues.

  • Common issues:

    • Peritonitis: inflammation of the peritoneum causing ileus (paralysis of contractions).
    • Diverticulitis: Inflammation of small pockets in muscle walls.
    • Cholecystitis: Inflammation of gallbladder.
    • Acute Appendicitis: Inflammation/infection in appendix.

Causes of Acute Abdomen

  1. Ulcers: Erosion of protective mucus layer, can lead to gastric bleeding and peritonitis.
  2. Gallstones: Blockage may lead to cholecystitis.
  3. Pancreatitis: Inflammation of pancreas causing upper abdominal pain, nausea, vomiting.
  4. Appendicitis: Nausea, vomiting, fever; requires surgical intervention.
  5. Esophagitis: Inflammation of esophagus by infection or acid leading to pain in swallowing, nausea, etc.
  6. Diverticulitis: Inflammation from trapped fecal matter.
  7. Cystitis: Urinary tract infection, can lead to serious kidney infection if not treated.

Urinary System Details

  • Kidneys: crucial for maintaining homeostasis; failure leads to uremia. Acute kidney failure can improve with treatment; chronic is irreversible.

Scene Size-up and Assessment

  • Scene Safety: Always ensure safety and precautions.
  • Gather information regarding mechanism of injury or illness, note any violence potential.
Primary Assessment
  • Check Airway and Breathing: Can be affected in abdominal cases, leading to shallow breaths.
  • Circulation: Inquire about blood in vomit or stools, monitor pulse.
History Taking
  • Use SAMPLE for patient history:
    • Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to current condition.
Secondary Assessment
  • Physical Examination: Assess abdomen for tenderness, rigidity.
  • Vital Signs: Monitor closely, noting any irregularities and how they may affect treatment decisions.
Reassessment
  • Frequent reassessment for severity and effectiveness of interventions is crucial.
  • Comfort measures and proper positioning aid assessment.

Emergency Medical Care Principles

  • Focus on providing comfort and managing shock effects.
  • Monitor oxygen levels as low-flow may alleviate nausea and anxiety.