11 Gastrointestinal ………………………………………..ppt

Gastrointestinal

1. GASTROINTESTINAL DISORDERS
RENAL/UROLOGY DISORDERS
EMERGENCY MEDICAL TECHNICIAN - BASIC

2. Gastrointestinal System

3. Gastrointestinal Emergencies
GI system includes from the mouth to anus and all parts in
between
Risk factors for disease (usually self-induced)
excessive alcohol consumption
excessive smoking
increased stress
ingestion of caustic substances
poor bowel habits
Pain is the hallmark of acute abdominal problems
visceral, somatic, or referred

4. Visceral Pain
Caused by inflammation, distention (inflation of the organ),
or ischemia (inadequate blood flow)
Pain vague, dull, or crampy
Is generally diffuse and difficult to localize
Examples (most often hollow organs)
gallbladder (cholecystitis)
appendix (appendicitis)
Presentation (from sympathetic stimulation)
nausea & vomiting
diaphoresis
tachycardia

5. Somatic Pain

Produced by bacterial or chemical irritation of nerve
fibers in the peritoneum (peritonitis)
Is usually constant and localized to a specific area
Often described as sharp or stabbing

Examples
ruptured appendix
perforated ulcer
inflamed pancreas

Peritonitis can lead to sepsis & death

6. Somatic Pain
Presentation
Patient often hesitant to move
Lies on their back or side with legs flexed to
prevent additional pain from stimulation of
the peritoneal area
Often exhibits involuntary guarding of the
abdomen
Rebound tenderness often noted during the
physical examination

7. Referred Pain

Pain in a part of the body considerably removed from the
tissues that cause the pain
Results from neural pathways from various organs
passing thru or over a region where the organ was
initially formed in fetal stage
Examples
diaphragm injury refers pain to neck or shoulders
dissecting abdominal aneurysm refers pain between shoulder
blades
appendicitis refers pain to periumbilical area
gallbladder refers pain to right shoulder

8. Referred Pain: Anterior View

9. Referred Pain: Posterior View

10. Disease Entities
Upper GI Disease:

Gastroenteritis

Gastritis

Peptic ulcer disease
Lower GI Disease:

Colitis

Crohn’s disease

Diverticulitis

Bowel obstruction
Other Organ Disease:
Appendicitis
Cholecystitis
Pancreatitis
Acute hepatitis

11. Gastroenteritis

Inflammation of the stomach and intestines that accompanies
numerous GI disorders

Causes:
bacteria or viral infections, chemical toxins, and other
conditions

Signs and symptoms:
anorexia (loss of appetite), nausea, vomiting,
abdominal pain

Management
supportive

12. Gastroenteritis
EMT personnel who are working in disaster areas
should observe the following guidelines:
Avoid patient contact if you are ill
Know the source of water supplies or drink hot
beverages brisk-boiled or disinfected
Avoid habits that facilitate fecal-oral/mucous
membrane transmission (keep your hands away
from your mouth and nose)
Observe BSI precautions, especially gloves
Practice diligent handwashing procedures

13. Peptic Ulcer Disease
Erosions in the GI tract from gastric acid
Duodenal ulcers - most frequently in proximal
duodenum
most common 25-50 years old & in those under
stress
pain at night when stomach empty
Gastric ulcers - in the stomach
more common over 50 years old & in jobs of
physical activity
usually no pain at night; pain on full stomach

14. Peptic Ulcer Disease
Causes of peptic ulcer disease
H. pylori infection (treated with antibiotics)
Nonsteroidal anti-inflammatory drug use
aspirin, Motrin, Advil
Acid stimulating products
alcohol, nicotine
Acid secreting tumor
Zollinger-Ellison syndrome

15. Colitis
An inflammatory condition of the large intestine
characterized by severe diarrhea and ulceration of
the mucosa of the intestine (ulcerative colitis)
Incidence - most often 20-40 year olds
Cause is unknown
Signs and symptoms
Nausea, vomiting, weight loss
Significant pain - cramping & colicky
Grossly bloody stools or stool containing mucus

16. Crohn’s Disease
A chronic, inflammatory bowel disease thought to be of
autoimmune etiology, usually affecting the ileum, the colon,
or both structures
Exact cause unknown
Most prevalent in: white females, those under stress, and in
the Jewish population
The diseased segments associated with Crohn’s disease may
be separated by normal bowel segments or skip areas
Formation of fistulas from the diseased bowel to the
anus, vagina, skin surface, or to other loops of
bowel are common

17. Crohn’s Disease

Signs and symptoms:
GI bleeding
frequent diarrhea
abdominal cramping
diffuse abdominal pain
nausea/vomiting/diarrhea
fever and chills
weakness, anorexia, weight loss

18. Diverticulitis

A diverticulum is a sac or pouch that develops in the wall of
the colon
Common development with advancing years
Associated with diets low in fiber

Diverticulitis is inflammation of diverticula

Signs and symptoms:
Fever, anorexia, nausea, lower left sided pain,
bright-red rectal bleeding

Complications:
Hypovolemic shock and sepsis

19. Bowel Obstruction

A partial or complete blockage of the large or small
intestines

Causes:
adhesions, hernias, fecal impaction, polyps, tumors

Signs and symptoms:
decreased appetite, nausea and vomiting, diffuse
abdominal pain, constipation, and abdominal
distention

If untreated can lead to death

20. Appendicitis

A common abdominal emergency that occurs when the
opening between the lumen of the appendix and the
cecum is obstructed by fecal material or from
inflammation from viral or bacterial infection

Signs and symptoms:
early abdominal pain is diffuse, colicky, & in
periumbilical area (later RLQ), abdominal tenderness
& guarding, nausea, vomiting,
chills, low-grade fever, anorexia

If ruptured, risk of peritonitis

21. Cholecystitis

Inflammation of the gallbladder, most often associated with
the presence of gallstones

Incidence
more common in women 30-50

Signs & symptoms
pain, often colicky, in RUQ with referral to right shoulder
pain often after high fat content meal
nausea, vomiting common
pale, cool, clammy skin (sympathetic response)

Giving Morphine may increase spasms

22. Pancreatitis

Inflammation of the pancreas

Alcoholism causes 80% of cases in USA

Signs and symptoms:
severe abdominal pain
localized to LUQ or referred to back or epigastric area
nausea and uncontrolled vomiting & retching
abdominal tenderness and distention
fever, tachycardia, diaphoresis
sepsis & shock possible, 30-40% mortality

23. Acute Hepatitis
Inflammation of the liver
Signs & symptoms related to severity of disease
Associated with the sudden onset of malaise,
weakness, anorexia, intermittent nausea and
vomiting, and dull right upper quadrant pain or
referral to right shoulder
Usually followed within 1 week by the onset of
jaundice of skin & sclera, dark urine, clay colored
stool

24. Risk Factors for Hepatitis A
Spread by fecal-oral route
Health care practice without BSI precautions
Household or sexual contact with an infected person
Living in an area with HAV outbreak
Traveling to developing countries
Poor handwashing hygiene practice especially after
toileting
Disease often self-limiting, lasts 2-8 weeks, low
mortality rate

25. Risk Factors for Hepatitis B

“Serum hepatitis” transmitted as bloodborne pathogen
- can stay active in body fluids outside body for days
Health care practice without BSI precautions
Infant born to HBV infected mother
Engaging in sex with infected partners and/or multiple
partners
Drug use by injection
Patients receiving hemodialysis

Incidence  with vaccine use

26. Risk Factors for Hepatitis C
Health care practice without BSI precautions
Blood transfusion recipients before July 1992
Engaging in sex with infected partners and/or multiple
partners
Drug use by injection
Patients receiving hemodialysis

#1 reason for liver transplant need
in USA

Currently no vaccine

27. Abdominal Pain - What Could It Be?

Naval area
small intestine
appendix

Upper middle abdomen
(called “epigastric” area)
stomach disorders

Left upper quadrant
uncommon area for pain
colon, stomach, spleen, pancreas

Right upper quadrant
gallbaldder, liver

Lower middle abdomen
colon disorder
for women: UTI, PID

Lower left abdomen
lower colon

Lower right abdomen
colon, appendicitis

Right shoulder
gallbladder

Between shoulder blades
pancreas

28. Assessing Abdominal Pain

Onset - when did it begin

Provocation/palliation - what makes the pain
worse/better

Quality - described in the patient’s own words

Region/radiation - if the patient can use one finger the
pain is localized; if the patient rubs their hands over
the general entire abdomen it is diffuse

Severity - on a scale of 0-10 (0 being no pain and 10
being the worse)

Time - how long has the pain been present?

29. Management GI Problems
Majority of care is supportive and aimed at treating
signs and symptoms presented
Position of comfort with ability to protect airway in
the case of vomiting
Abdominal pain control - need to contact medical
control for medication orders
IV to replace fluid loss (vomiting, diarrhea, internal
hemorrhage)
Shock (hypovolemic, septic) possible and then
aggressive care & rapid transport required

30. Renal/ Urology System
Functions of the urinary system
maintains blood volume
maintains proper balance of water, electrolytes and pH
retains key compounds in the bloodstream
excretes waste
controls arterial blood pressure
Leading causes of end-stage renal failure
poorly controlled diabetes
uncontrolled or inadequately controlled  B/P

31. Renal Calculus (Kidney Stones)

32. Renal Calculus
Crystal aggregation in kidney’s collecting system
Severe pain due to movement of stone through
the urinary system
Kidney stones recognized as one of the most
painful of human problems
Pain starts subtle and quickly escalates

33. Kidney Stone
Pain starts vague over 1 flank & quickly becomes
sharp in flank and radiating down and toward
groin
Patient agitated, uncomfortable, restless
Skin cool, pale, clammy
B/P and heart rate elevated due to pain
Nausea & vomiting due to pain

34. Management Kidney Stones
Majority of care is supportive and aimed at treating
signs and symptoms presented
Position of comfort with ability to protect airway in
the case of vomiting
Flank pain - need to contact medical control for
medication orders (ie: morphine)
(Abdominal/Flank Pain SOP)
If patient is unstable with B/P <100mmHg, establish
IV sites and give fluid challenge (200 ml increments)

35. Prevention Strategies for Renal
Calculus
Increase water consumption
Take daily supplements of Vitamin B6 and magnesium (to
reduce formation of oxalates)
Avoid foods that raise uric acid levels (ie: anchovies, sardines)
Reduce uric acid by eating a low-protein diet
Limit salt intake to reduce the level of calcium oxalate in the urine
Avoid foods containing calcium oxalate (ie: chocolate, celery,
grapes, strawberries, beans, asparagus)