chapter 19

GI and Urologic Emergencies

• GI and urologic emergencies are often overlooked, but can be serious.

Anatomy and Physiology

• Major Organs in Abdominal Cavity:
  • Spleen: Upper left abdomen.
  • Liver: Upper right abdomen (contains an "r" to remember it's on the right).
  • Large and small intestines: Lower abdomen.
  • Stomach: Center.
  • Pancreas: Produces insulin and glucagon.
  • Kidneys: Back sides of the body.
• Organ Types:
  • Hollow organs: Stomach, bladder.
  • Solid organs: Liver, Spleen, Kidneys, Pancreas.
• Bleeding Potential:
  • Spleen and liver have the highest bleeding potential.
• Kidney Pain:
  • Lower back pain can indicate kidney problems.
• GI System Function:
  • Digests food, extracts energy, and eliminates waste
• Digestion Process:
  • Chewing: Saliva starts breakdown.
  • Swallowing: Esophagus to stomach.
  • Stomach: Stomach acid churns and breaks down food.
  • Small Intestine: Nutrient absorption.
  • Expulsion: Waste elimination.
• Liver Function:
  • Filters out toxins. Liver disease can cause medication overdose due to impaired metabolism.
• Gallbladder:
  • Stores blood and bile; can develop gallstones causing blockages and pain.
• Male Reproductive System Issues:
  • Torsion: Very painful, requires surgery.
• Female Reproductive System Issues:
  • Ectopic pregnancies: Life-threatening.
  • UTIs: More common in females due to shorter urethras.
• Urinary System:
  • Maintains blood pressure and pH balance. Kidneys can remove excess sugar in diabetic emergencies.
  • Kidneys: Close to the back, potential for injury in trauma.
  • Ureters: Connect kidneys to bladder.
  • Urethra: From bladder to outside.
  • Urine Output: Two liters a day indicates the amount of water intake needed.
• Abdominal Cavity Structure:
  • Pericardial Sac: Bag around the heart.
  • Peritoneum: Lines the abdominal wall.
  • Visceral Peritoneum: Covers organs.
• Peritonitis:
  • Inflammation of the peritoneum due to foreign material (blood, pus from ruptured appendix).

Acute Abdomen and Related Conditions

• Acute Abdomen:
  • Any abdominal issue that doesn't seem right; difficult to pinpoint exact cause due to complex pain receptors.
• Iliac:
  • Paralysis of stomach or intestines causing backup and vomiting; can lead to dehydration.
• Diverticulitis:
  • Inflammation causing pain; history is helpful but not definitive.
• Gallbladder Attack:
  • Sharp pain due to gallstones.
• Pain Receptors:
  • Two types of pain receptors make pinpointing abdominal pain difficult.
  • Visceral peritoneum connects to the nervous system, sometimes providing more detailed pain information.
• Ulcers:
  • Irritation of the stomach lining; treated with acid-reducing medication.
  • Can become bleeding ulcers; avoid aspirin.
• Pancreatitis:
  • Inflammation of the pancreas, often related to alcohol abuse or gallstones.
  • Causes upper left and right quadrant pain, nausea, and vomiting.
  • Can lead to sepsis, bleeding, and life-threatening conditions.
• Appendicitis:
  • May not cause fever until rupture.
  • Causes pain, nausea, and vomiting.
• GI Bleeds:
  • Blood in emesis or stool; can be black (old blood) or bright red (fresh blood).
  • Can be life-threatening depending on severity.
    Esophagitis:
  • Inflammation of the esophagus due to stomach acid irritation.
• Esophageal Varices:
  • Inflamed blood vessels around the esophagus; can cause pain, weight loss, fatigue.
  • Bleeding can be life-threatening.
• Mallory Weiss Syndrome:
  • Tears at the junction of esophagus and stomach, causing peritonitis and vomiting.
• Gastroenteritis:
  • "Stomach bug" with bacterial or viral cause; diarrhea.
• Diverticulitis:
  • Inflammation, lots of pain
    Hemorrhoids
  • Painful but usually not life threatening
• Bladder Infections (UTIs):
  • Bacterial infection more common in women due to shorter urethra.
  • Treated with antibiotics; symptoms include frequent and painful urination.
• Kidney Stones:
  • Super painful. Diet and dehydration are major causes

Kidney Issues

• Kidney's maintaining homeostasis is important.
• Chronic Kidney Disease:
  • Develops over time.
• Acute Kidney Failure:
  • Results from trauma, sepsis, or medical emergencies.
  • May require dialysis.
• Risk Factors for Kidney Issues:
  • Geriatrics, diabetes.
• Dialysis:
  • Treatment for chronic kidney failure, filtering blood multiple days a week for hours at a time.

Reproductive and Vascular Emergencies

• Ectopic Pregnancies:
  • Pregnancies outside the uterus; life-threatening, lower abdominal pain.
• Aortic Dissection/Aneurysm:
  • Leakage or dissection of the aorta; requires hospital intervention.
  • May feel a pulse in a new lump.

Hernias

• Hernias:
  • Organ protrudes out of place
  • Can become emergencies if blood flow is cut off which requires surgery

Assessment and Treatment

• Assessment:
  • History (SAMPLE, OPQRST).
    Safe:
    Is the scene safe?
• Medical vs Trauma:
  • Abdominal injuries can occur from trauma such as spleen or liver lacerations.
  • Motorcyclists and children with lap belts are at higher risk.
• Initial Assessment:
  • General impression, C-spine consideration, ABCs/CABs, identify and treat life threats.
  • Full body assessment (DCAP-BTLS).
• Abdominal Assessment:
  • Palpate each quadrant, starting furthest from pain.
  • Note if pain increases on palpation or release, note redness or bruising.
• Vomiting:
  • Check vomitus for blood and ask about red or purple liquids consumed.
• Bathroom Habits:
  • Inquire about diarrhea, bleeding, and urination color.
• Vitals
  • Always important with assessment.
    *Don't stop assessment with sample and OPRST. It may take digging to figure out patient issues.
• ALS:
  • ALS can give medication for pain as well as nausea and vomiting
  • Remember to make sure vitals are stable. A two out of ten pain that they are nonchalant about means ALS isn't always necessary.
    Document
    *Document everything including if they say it's a 10 out of 10 but are doing well and talking the whole time.
    *Children
    *Always be mindful of a childs safety seat.