Transcript Document
Gastroenterology
Sections
General Pathophysiology, Assessment, and Treatment
Specific Illnesses
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.
Abdominal Pain
Types
Visceral
Somatic Referred
Causes
Inflammation Distention Ischemia
General Assessment
Scene Size-up & Initial Assessment
Scene clues.
Identify and treat life-threatening conditions.
Focused History & Physical Exam
Focused History
Obtain SAMPLE History.
Obtain OPQRST History.
• Associated symptoms • Pertinent negatives
General Assessment
Physical Exam
General assessment and vital signs Abdominal assessment
• Inspection, Auscultation, and Palpation • Cullen’s Sign • Grey-Turner’s Sign
General Treatment
Maintain the airway.
Support breathing.
High-flow oxygen or assisted ventilations.
Maintain circulation.
Monitor vital signs and cardiac rhythm.
Establish IV access.
Transport in position of comfort.
Specific Illnesses
The Gastrointestinal System
Upper Gastrointestinal Tract
Lower Gastrointestinal Tract Liver Gallbladder Pancreas Appendix
Upper Gastrointestinal Bleeding
Causes
Peptic Ulcer Disease Gastritis Varix Rupture Mallory-Weiss Tear Esophagitis Duodenitis
Upper Gastrointestinal Bleeding
Signs & 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.
Esophageal Varices
Cause
Portal Hypertension
Chronic alcohol abuse and liver cirrhosis
Ingestion of caustic substances
Esophageal Varices
Signs & Symptoms
Hematemesis, Dysphagia
Painless Bleeding Hemodynamic Instability Classic Signs of Shock
Treatment
Follow General Treatment Guidelines.
Aggressive Airway Management
Aggressive Fluid Resuscitation
Acute Gastroenteritis
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
Acute Gastroenteritis
Signs & 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.
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.
Peptic Ulcers
Pathophysiology
Erosions caused by gastric acid.
Terminology based on the portion of tract affected.
Causes:
NSAID Use Alcohol/Tobacco Use
H. pylori
Peptic Ulcers
Signs & 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.
Lower Gastrointestinal Bleeding
Pathophysiology
Bleeding distal to the ligament of Treitz Causes
Diverticulosis Colon lesions Rectal lesions Inflammatory bowel disorder
Lower Gastrointestinal Bleeding
Signs & 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).
Ulcerative Colitis
Pathophysiology
Causes Unknown Signs & Symptoms
Abdominal Cramping
Nausea, Vomiting, Diarrhea
Fever or Weight Loss Treatment
Follow general treatment guidelines.
Crohn’s Disease
Pathophysiology
Causes unknown.
Can affect the entire GI tract.
Pathologic inflammation:
Damages mucosa.
Hypertrophy and fibrosis of underlying muscle.
Fissures and fistulas.
Crohn’s Disease
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.
Diverticulitis
Pathophysiology
Inflammation of small outpockets in the mucosal lining of the intestinal tract.
Common in the elderly.
Diverticulosis.
Signs & Symptoms
Abdominal pain/tenderness.
Fever, nausea, vomiting.
Signs of lower GI bleeding.
Treatment
General treatment guidelines.
Hemorrhoids
Pathophysiology
Mass of swollen veins in anus or rectum.
Idiopathic.
Signs & Symptoms
Limited bright red bleeding and painful stools.
Consider lower GI bleeding.
Treatment
General treatment guidelines.
Bowel Obstruction
Pathophysiology
Blockage of the hollow space of the small or large intestines
Hernias
Bowel Obstruction
Pathophysiology
Intussusception
Bowel Obstruction
Pathophysiology
Volvulus
Bowel Obstruction
Pathophysiology
Adhesions
Bowel Obstruction
Pathophysiology
Other Causes
Foreign bodies, gallstones, tumors, bowel infarction Signs & Symptoms
Decreased Appetite, Fever, Malaise
Nausea and Vomiting Diffuse Visceral Pain, Abdominal Distention
Signs & Symptoms of Shock Treatment
Follow general treatment guidelines.
Accessory Organ Diseases
GI Accessory Organs
Liver Gallbladder Pancreas Vermiform Appendix
Appendicitis
Pathophysiology
Inflammation of the vermiform appendix.
Frequently affects older children and young adults.
Lack of treatment can cause rupture and subsequent peritonitis.
Appendicitis
Signs & Symptoms
Nausea, vomiting, and low-grade fever.
Pain localizes to RLQ (McBurney’s point).
Treatment
Follow general treatment guidelines.
Cholecystitis
Pathophysiology
Inflammation of the Gallbladder
Cholelithiasis Chronic Cholecystitis
Bacterial infection
Acalculus Cholecystitis
Burns, sepsis, diabetes
Multiple organ failure
Cholecystitis
Signs & Symptoms
URQ Abdominal Pain
Murphy’s sign
Nausea, Vomiting History of Cholecystitis
Treatment
Follow general treatment guidelines.
Pancreatitis
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.
Pancreatitis
Signs & 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
Hepatitis
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
Hepatitis
Signs & 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
Gastroenterology
General Pathophysiology, Assessment, and Management
Specific Illnesses
Upper Gastrointestinal Diseases Lower Gastrointestinal Diseases Accessory Organ Diseases