Gastroenterology
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Transcript of Gastroenterology
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GastroenterologyGastroenterology
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SectionsSections General Pathophysiology,
Assessment, and Treatment Specific Illnesses
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General General PathophysiologyPathophysiology 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.
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AbdominAbdominal Painal Pain Types
Visceral Somatic Referred
Causes Inflammation Distention Ischemia
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General General AssessmentAssessment 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
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General General AssessmentAssessment Physical Exam
General assessment and vital signs Abdominal assessment
• Inspection, Auscultation, and Palpation• Cullen’s Sign• Grey-Turner’s Sign
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General TreatmentGeneral 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.
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Specific IllnessesSpecific Illnesses The
Gastrointestinal System Upper
Gastrointestinal Tract
Lower Gastrointestinal Tract
Liver Gallbladder Pancreas Appendix
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Causes Peptic Ulcer Disease Gastritis Varix Rupture Mallory-Weiss Tear Esophagitis Duodenitis
Upper Upper Gastrointestinal Gastrointestinal
BleedingBleeding
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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.
Upper Upper Gastrointestinal Gastrointestinal
BleedingBleeding
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Esophageal VaricesEsophageal Varices Cause
Portal Hypertension Chronic
alcohol abuse and liver cirrhosis
Ingestion of caustic substances
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Esophageal VaricesEsophageal Varices Signs & Symptoms
Hematemesis, Dysphagia Painless Bleeding Hemodynamic Instability Classic Signs of Shock
Treatment Follow General Treatment Guidelines.
Aggressive Airway Management Aggressive Fluid Resuscitation
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Acute Acute GastroenteritisGastroenteritis 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
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Acute Acute GastroenteritisGastroenteritis 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.
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GastroenteritisGastroenteritis 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.
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Peptic UlcersPeptic Ulcers Pathophysiology
Erosions caused by gastric acid.
Terminology based on the portion of tract affected.
Causes: NSAID Use Alcohol/Tobacco Use H. pylori
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Peptic UlcersPeptic 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.
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Pathophysiology Bleeding distal to the ligament of Treitz Causes
Diverticulosis Colon lesions Rectal lesions Inflammatory bowel disorder
Lower Lower Gastrointestinal Gastrointestinal
BleedingBleeding
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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).
Lower Lower Gastrointestinal Gastrointestinal
BleedingBleeding
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Ulcerative ColitisUlcerative Colitis Pathophysiology
Causes Unknown Signs &
Symptoms Abdominal Cramping Nausea, Vomiting,
Diarrhea Fever or Weight Loss
Treatment Follow general
treatment guidelines.
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Crohn’s DiseaseCrohn’s Disease Pathophysiology
Causes unknown. Can affect the entire
GI tract. Pathologic
inflammation: Damages mucosa. Hypertrophy and
fibrosis of underlying muscle.
Fissures and fistulas.
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Crohn’s DiseaseCrohn’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.
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DiverticulitisDiverticulitis 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.
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HemorrhoidsHemorrhoids 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.
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Bowel ObstructionBowel Obstruction Pathophysiology
Blockage of the hollow space of the small or large intestines
Hernias
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Bowel ObstructionBowel Obstruction Pathophysiology
Intussusception
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Bowel ObstructionBowel Obstruction Pathophysiology
Volvulus
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Pathophysiology Adhesions
Bowel ObstructionBowel Obstruction
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Bowel ObstructionBowel 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.
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Accessory Organ Accessory Organ DiseasesDiseases GI Accessory Organs
Liver Gallbladder Pancreas Vermiform Appendix
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AppendicitisAppendicitis Pathophysiology
Inflammation of the vermiform appendix. Frequently affects older children and young
adults. Lack of treatment can cause rupture and
subsequent peritonitis.
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AppendicitisAppendicitis Signs & Symptoms
Nausea, vomiting, and low-grade fever. Pain localizes to RLQ
(McBurney’s point).
Treatment Follow
general treatment guidelines.
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CholecystitisCholecystitis Pathophysiology
Inflammation of the Gallbladder
Cholelithiasis Chronic
Cholecystitis Bacterial infection
Acalculus Cholecystitis Burns, sepsis,
diabetes Multiple organ failure
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CholecystitisCholecystitis Signs & Symptoms
URQ Abdominal Pain Murphy’s sign
Nausea, Vomiting History of Cholecystitis
Treatment Follow general treatment guidelines.
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PancreatitisPancreatitis 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.
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PancreatitisPancreatitis 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
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HepatitisHepatitis 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
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HepatitisHepatitis 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
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GastroenterologyGastroenterology General Pathophysiology,
Assessment, and Management Specific Illnesses
Upper Gastrointestinal Diseases Lower Gastrointestinal Diseases Accessory Organ Diseases