Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper...

Bledsoe et al., Essentials of Paramedic Care: Division 1V© 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Division 4Medical Emergencies


Chapter 32Gastroenterology


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 IllnessesThe 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


Aggressive airway managementAggressive 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 factorsAlcohol 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.


Gastroenteritis

Similar to acute gastroenteritis– Long-term mucosal changes or

permanent damagePrimarily 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 useAlcohol/tobacco useH. 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


Establish IV access with large-bore catheter(s).


Ulcerative Colitis

Pathophysiology– Causes unknown

Signs and symptoms– Abdominal cramping– Nausea, vomiting,

diarrhea– Fever or weight loss



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



DiverticulitisPathophysiology– Inflammation of

small outpockets in the mucosal lining of the intestinal tract

– Common in the elderly

– DiverticulosisSigns 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



Pathophysiology– Intussusception



Pathophysiology– Volvulus


Pathophysiology– Adhesions




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



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).



Cholecystitis (1 of 2)

Pathophysiology– Inflammation of the

gallbladder– Cholelithiasis– Chronic cholecystitis

Bacterial infection

– Acalculus cholecystitis

Burns, sepsis, diabetesMultiple organ failure


Cholecystitis (2 of 2)

Signs and symptoms– URQ abdominal pain

Murphy’s sign

– Nausea, vomiting– History of cholecystitis



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/vomitingElevated amylase and lipase levels

– Severe pancreatitisRefractory hypotensive shock and blood lossRespiratory failure



Hepatitis (1 of 2)

Pathophysiology– Injury to liver cells

Typically due to inflammation or infection

– Types of hepatitisViral 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


Use PPE and follow BSI precautions.


Summary

General Pathophysiology, Assessment, and Management

Specific Illnesses

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper...

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