Transcript Document

Gastroenterology
Sections
 General Pathophysiology,
Assessment, and Treatment
 Specific Illnesses
General Pathophysiology
 General Risk Factors
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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
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Peptic Ulcer Disease
Gastritis
Varix Rupture
Mallory-Weiss Tear
Esophagitis
Duodenitis
Upper Gastrointestinal
Bleeding
 Signs & Symptoms
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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
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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
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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
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Diverticulosis
Colon lesions
Rectal lesions
Inflammatory bowel disorder
Lower Gastrointestinal
Bleeding
 Signs & Symptoms
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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
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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
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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
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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