Ch32 Gastroenterology
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Transcript Ch32 Gastroenterology
Chapter 32
Gastroenterology
Topics
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 Pathophysiology
Pain from hollow organs tends to
be vague and nondescript,
whereas pain from solid organs
tends to be localized.
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
Esophageal Varices
Prehospital placement of
nasogastric tubes should be
avoided in cases of suspected
esophageal varices.
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.
Gastroenteritis
Most cases of gastroenteritis are
viral. Patients with bacterial
gastroenteritis tend to be
considered more ill than those
with viral gastroenteritis.
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
Summary
General Pathophysiology,
Assessment, and Management
Specific Illnesses
Upper Gastrointestinal Diseases
Lower Gastrointestinal Diseases
Accessory Organ Diseases