Chapter 32 Gastroenterology PDF

Division 4 Medical Emergencies * Chapter 32 Gastroenterology Topics ´ General Pathophysiology, Assessment, and Management ´ Specific Illnesses General Pathophysiology ´ General risk factors ´ Excessive alcohol consumption ´ Excessive smoking ´ Increased stress ´ Inge...

Division 4 Medical Emergencies * Chapter 32 Gastroenterology Topics ´ General Pathophysiology, Assessment, and Management ´ 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 (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 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 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. Specific Illnesses ´ The Gastrointestinal System ´ Upper gastrointestinal tract ´ Lower gastrointestinal tract ´ Liver ´ Gallbladder ´ Pancreas ´ Appendix Upper Gastrointestinal Bleeding (1 of 2) ´ Causes ´ Peptic ulcer disease ´ Gastritis ´ Varix rupture ´ Mallory-Weiss tear ´ Esophagitis ´ Duodenitis 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. Esophageal Varices (1 of 2) ´ Cause ´ Portal hypertension ´ Chronic alcohol abuse and liver cirrhosis ´ Ingestion of caustic substances 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 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 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. Chronic 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 (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 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. Lower Gastrointestinal Bleeding (1 of 2) ´ Pathophysiology ´ Bleeding distal to the ligament of Treitz ´ Causes ´ Diverticulosis ´ Colon lesions ´ Rectal lesions ´ Inflammatory bowel disorder 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 two large-bore catheters. Ulcerative Colitis ´ Pathophysiology ´ Causes unknown ´ Signs and symptoms ´ Abdominal cramping ´ Nausea, vomiting, diarrhea ´ Fever or weight loss ´ Treatment ´ Follow general treatment guidelines. 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 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.  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 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 Bowel Obstruction (1 of 5) ´ Pathophysiology ´ Blockage of the hollow space of the small or large intestines ´ Hernias Bowel Obstruction (2 of 5) ´ Pathophysiology ´ Intussusception Bowel Obstruction (3 of 5) ´ Pathophysiology ´ Volvulus  Bowel Obstruction (4 of 5) ´ Pathophysiology ´ Adhesions 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. Accessory Organ Diseases ´ GI accessory organs ´ Liver ´ Gallbladder ´ Pancreas ´ Vermiform appendix 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. 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.  Cholecystitis (1 of 2) ´ Pathophysiology ´ Inflammation of the gallbladder ´ Cholelithiasis ´ Chronic cholecystitis ´ Bacterial infection ´ Acalculus cholecystitis ´ Burns, sepsis, diabetes ´ Multiple organ failure Cholecystitis (2 of 2) ´ Signs and symptoms ´ URQ abdominal pain ´ Murphy’s sign ´ Nausea, vomiting ´ History of cholecystitis ´ Treatment ´ Follow general treatment guidelines. 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. 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. 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 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. Summary ´ General Pathophysiology, Assessment, and Management ´ Specific Illnesses