Chapter 6 Gastroenterology

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Topics

General Pathophysiology, Assessment, and Management Specific Illnesses Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

General Pathophysiology

General Risk Factors – Excessive Alcohol Consumption – Excessive Smoking – Increased Stress – Ingestion of Caustic Substances – Poor Bowel Habits Emergencies – Acute emergencies usually arise from chronic underlying problems.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Abdominal Pain

Types – Visceral – Somatic – Referred Causes – Inflammation – Distention – Ischemia Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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General Assessment

(1 of 2) Scene Size-up and Initial Assessment – Scene clues.

– Identify and treat life-threatening conditions.

Focused History – Obtain SAMPLE history.

– Obtain OPQRST history.

Associated symptoms Pertinent negatives Bledsoe et al.,

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General Assessment

(2 of 2) Physical Exam – General Assessment and Vital Signs – Abdominal Assessment Inspection, auscultation, and palpation Cullen’s sign Grey Turner’s sign Bledsoe et al.,

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General Treatment

Maintain the airway.

Support breathing.

– High-flow, high-concentration oxygen or assisted ventilations.

Maintain circulation.

Monitor vital signs and cardiac rhythm.

Establish IV access.

Transport in position of comfort.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Specific Illnesses

The Gastrointestinal System – Upper Gastrointestinal Tract – Lower Gastrointestinal Tract – Liver – Gallbladder – Pancreas – Appendix Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Upper Gastrointestinal Bleeding

(1 of 2) Causes – Peptic Ulcer Disease – Gastritis – Varix Rupture – Mallory-Weiss Tear – Esophagitis – Duodenitis Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Upper Gastrointestinal Bleeding

(2 of 2) Signs and Symptoms – General abdominal discomfort – Hematemesis and melena – Classic signs and symptoms of shock – Changes in orthostatic vital signs Treatment – Follow general treatment guidelines.

Begin volume replacement using 2 large-bore IVs.

– Differentiate life-threatening from chronic problem.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Esophageal Varices

(1 of 2) Cause – Portal Hypertension Chronic alcohol abuse and liver cirrhosis Ingestion of caustic substances Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Esophageal Varices

(2 of 2) Signs and Symptoms – Hematemesis, dysphagia – Painless bleeding – Hemodynamic instability – Classic signs of shock Treatment – Follow general treatment guidelines.

Aggressive airway management Aggressive fluid resuscitation Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Acute Gastroenteritis

(1 of 2) Cause – Damage to Mucosal GI Surfaces Pathologic inflammation causes hemorrhage and erosion of the mucosal and submucosal layers of the GI tract.

– Risk Factors Alcohol and tobacco use Chemical ingestion (NSAIDs, chemotherapeutics) Systemic infections Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Acute Gastroenteritis

(2 of 2) Signs and Symptoms – Rapid onset of severe vomiting and diarrhea – Hematemesis, hematochezia, melena – Diffuse abdominal pain – Classic signs of shock Treatment – Follow general treatment guidelines.

– Fluid volume replacement.

– Consider administration of antiemetics.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Gastroenteritis

Similar to Acute Gastroenteritis – Long-term mucosal changes or permanent damage Primarily due to microbial infection More frequent in developing countries – Follow general treatment guidelines.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Peptic Ulcers

(1 of 2) Pathophysiology – Erosions caused by gastric acid – Terminology based on the portion of tract affected – Causes: NSAID use Alcohol/tobacco use H. pylori Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Peptic Ulcers

(2 of 2) Signs and Symptoms – Abdominal pain.

– Observe for signs of hemorrhagic rupture.

Acute pain, hematemesis, melena Treatment – Follow general treatment guidelines.

– Consider administration of histamine blockers and antacids.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Lower Gastrointestinal Bleeding

(1 of 2) Pathophysiology – Bleeding distal to the ligament of Treitz – Causes Diverticulosis Colon lesions Rectal lesions Inflammatory bowel disorder Bledsoe et al.,

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Lower Gastrointestinal Bleeding

(2 of 2) Signs and Symptoms – Determine acute vs. chronic.

– Quantity/color of blood in stool.

– Abdominal pain.

– Signs of shock.

Treatment – Follow general treatment guidelines.

Establish IV access with large-bore catheter(s).

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Ulcerative Colitis

Pathophysiology – Causes Unknown Signs and Symptoms – Abdominal Cramping – Nausea, Vomiting, Diarrhea – Fever or Weight Loss Treatment – Follow general treatment guidelines.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Crohn’s Disease

(1 of 2) Pathophysiology – Causes unknown – Can affect the entire GI tract – Pathologic inflammation: Damages mucosa Hypertrophy and fibrosis of underlying muscle Fissures and fistulas Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Crohn’s Disease

(2 of 2) Signs and Symptoms – Difficult to differentiate Clinical presentations vary drastically.

– GI bleeding, nausea, vomiting, diarrhea – Abdominal pain/cramping, fever, weight loss Treatment – Follow general treatment guidelines.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Diverticulitis

Pathophysiology – Inflammation of small outpockets in the mucosal lining of the intestinal tract – Common in the elderly – Diverticulosis Signs and Symptoms – Abdominal pain/tenderness – Fever, nausea, vomiting – Signs of lower GI bleeding Treatment – General treatment guidelines Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Hemorrhoids

Pathophysiology – Mass of swollen veins in anus or rectum – Idiopathic Signs and Symptoms – Limited bright red bleeding and painful stools – Consider lower GI bleeding Treatment – General treatment guidelines Bledsoe et al.,

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Bowel Obstruction

(1 of 5) Pathophysiology – Blockage of the hollow space of the small or large intestines – Hernias Bledsoe et al.,

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Bowel Obstruction

(2 of 5) Pathophysiology – Intussusception Bledsoe et al.,

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Bowel Obstruction

(3 of 5) Pathophysiology – Volvulus Bledsoe et al.,

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Bowel Obstruction

(4 of 5) Pathophysiology – Adhesions Bledsoe et al.,

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Bowel Obstruction

(5 of 5) Pathophysiology – Other Causes Foreign bodies, gallstones, tumors, bowel infarction Signs and Symptoms – Decreased appetite, fever, malaise – Nausea and vomiting – Diffuse visceral pain, abdominal distention – Signs and symptoms of shock Treatment – Follow general treatment guidelines.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Accessory Organ Diseases

GI Accessory Organs – Liver – Gallbladder – Pancreas – Vermiform Appendix Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Appendicitis

(1 of 2) Pathophysiology – Inflammation of the vermiform appendix.

– Frequently affects older children and young adults.

– Lack of treatment can cause rupture and subsequent peritonitis.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Appendicitis

(2 of 2) Signs and Symptoms – Nausea, vomiting, and low-grade fever.

– Pain localizes to RLQ (McBurney’s point).

Treatment – Follow general treatment guidelines.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Cholecystitis

(1 of 2) Pathophysiology – Inflammation of the Gallbladder – Cholelithiasis – Chronic Cholecystitis Bacterial infection – Acalculus Cholecystitis Burns, sepsis, diabetes Multiple organ failure Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Cholecystitis

(2 of 2) Signs and Symptoms – URQ abdominal pain Murphy’s sign – Nausea, vomiting – History of cholecystitis Treatment – Follow general treatment guidelines.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pancreatitis

(1 of 2) Pathophysiology – Inflammation of the Pancreas Classified as metabolic, mechanical, vascular, or infectious based on cause.

Common causes include alcohol abuse, gallstones, elevated serum lipids, or drugs.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pancreatitis

(2 of 2) Signs and Symptoms – Mild Pancreatitis Epigastric pain, abdominal distention, nausea/vomiting Elevated amylase and lipase levels – Severe Pancreatitis Refractory hypotensive shock and blood loss Respiratory failure Treatment – Follow general treatment guidelines.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Hepatitis

(1 of 2) Pathophysiology – Injury to Liver Cells Typically due to inflammation or infection – Types of Hepatitis Viral hepatitis (A, B, C, D, and E) Alcoholic hepatitis Trauma and other causes – Risk Factors Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

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Hepatitis

(2 of 2) Signs and Symptoms – URQ abdominal tenderness – Loss of appetite, weight loss, malaise – Clay-colored stool, jaundice, scleral icterus – Photophobia, nausea/vomiting Treatment – Follow general treatment guidelines.

Use PPE and follow BSI precautions.

Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Summary

General Pathophysiology, Assessment, and Management Specific Illnesses – Upper Gastrointestinal Diseases – Lower Gastrointestinal Diseases – Accessory Organ Diseases Bledsoe et al.,

Paramedic Care Principles & Practice Volume 3: Medical

© 2006 by Pearson Education, Inc. Upper Saddle River, NJ