Ch 18 Gastrointestinal and Urologic Emergencies

Question 1

Solid organs

Answer 1

Liver, Spleen, Pancreas, Kidneys, Ovaries

Trauma can cause shock and bleeding because these organs are very vascular

Question 2

Hollow organs

Answer 2

Stomach, Gallbladder, Ureter, Small intestine, Large intestine, Fallopian tubes, Urinary bladder, Uterus

Trauma may cause contents of the organ to leak and contaminate the abdominal cavity

Question 3

Retroperitoneal organs

Answer 3

Kidneys, ovaries, pancreas

Question 4

Retroperitoneal

Answer 4

Behind the peritoneum

Question 5

Role of the liver

Answer 5

Assists digestion by secreting bile, which aides the digestion of fats; Filters toxic substances produced by digestion, creates glucose stores and produces substances necessary for blood clotting

Question 6

Role of the gallbladder

Answer 6

Reservoir for bile

Question 7

Role of the small intestine

Answer 7

Duodenum - Digestive juices from pancreas and liver mix together
Jejunum - Absorption of digestive products (most surface area and work)
Ileum - Absorbes nutrients not absorbed earlier, bile to be returned to the liver, and vitamin B12

Question 8

Role of the pancreas

Answer 8

Secretes juices containing enzymes that help break down starches (such as amylase), fats and proteins; produces bicarbonate and insulin

Question 9

Bicarbonate neutralizes ____

Answer 9

The acids in the duodenum

Question 10

Role of the colon/large intestine

Answer 10

Food that wasn’t broken down moves to the colon; Movement called peristalsis moves waste matter, water is absorbed and stool is formed, and defecated through the rectum and anus

Question 11

Role of the spleen

Answer 11

Part of the lymphatic system and assists filtration of blood, aids development of red blood cells, serves as a reservoir for blood; Produces antibodies to help fight disease and infection

Question 12

The urinary system

Answer 12

Controls the discharge of certain waste materials filtered from the blood by the kidneys; Often considered hand in hand with the reproductive system since may organs are shared/can directly affect the each other

Question 13

Role of the kidneys

Answer 13

Help with the regulation of acid balance/pH and blood pressure; Rid the body of toxic wastes (through blood and urine), control the body’s balance of fluids and electrolytes; Removal of sodium chloride tied to BP

~20% of output of blood passes through kidneys each minute and large vessels attach them directly to the aorta; Kidney disease is a common cause of hypertension

Question 14

Role of the ureters

Answer 14

Small tubes pass from the renal pelvis of each kidney to drain into urinary bladder with peristalsis

Question 15

Peristalsis

Answer 15

Wavelike contraction of smooth muscle

Question 16

Peptic Ulcer Disease

Answer 16

PUD; When the protective layers of mucus in the stomach and duodenum erode, allowing acids to eat at the organ itself; affects M and W, and occurs in older population

Most are a result of infection with H. Pylori, or chronic NSAID use (Common in geriatric pop.)

Question 17

S/S of PUD

Answer 17

Burning or gnawing pain in stomach that subsides or diminishes after eating then remerges 2-3h later
Pain presents in upper abdomen, sometimes, below the sternum
Nausea, vomiting, belching, heartburn, hematemesis, melena

Question 18

Gallstones

Answer 18

When a stone forms and blocs the outlet from the gallbladder causing pain. If the blockage does not pass on its own, it can lead to severe inflammation called cholecystitis

Question 19

Cholecystitis

Answer 19

When the walls of the gallbladder become inflamed; may lead to rupture, causing inflammation to spread and irritate surrounding structures

Question 20

S/S of Gallstones

Answer 20

Constant, severe pain in RUQ or midabdominal region and may refer to upper back, shoulder or flank; may constantly increase or come and go
Cholecystitis produces symptoms about 30 min after fatty meals and at night
Nausea, vomiting, indigestion, bloating, gas, belching

Question 21

Pancreatitis

Answer 21

Inflammation caused by gallstones, alcohol abuse, other diseases

Question 22

S/S of Pancreatitis

Answer 22

Severe pain in LUQ or RUQ, may often radiate to back; patients report worse after eating
Nausea, vomiting, abdominal distention, tenderness, tachycardia (if complicated by sepsis or hemorrhage)

Question 23

Appendicitis

Answer 23

Inflammation of a small recess in the large intestine; Can eventually cause tissue to die or rupture, causing abscess, peritonitis or death

Question 24

S/S of Appendicitis

Answer 24

Initial pain may be generalized, full and diffuse; Later localizes to RLQ and can cause referred pain
Nausea, vomiting, lack of appetite for food, fever, chills, rebound tenderness

Question 25

Gastrointestinal hemorrhage

Answer 25

Bleeding within the GI tract, a symptom of another issue
Acute - short term and severe, Chronic - long term and less severe
Upper GI bleeding - between the esophagus and upper small intestine, Lower GI bleeding - between small intestine and anus/rectum

Question 26

S/S of Gastrointestinal hemorrhage

Answer 26

Upper GI - hematemesis bright red or coffee grounds

Lower GI - Melena

Question 27

Esophagitis

Answer 27

The lining of the esophagus becomes inflamed by infection of from the acids of the stomach - GERD

Question 28

S/S of Esophagitis

Answer 28

Pain on swallowing, feeling like an object is stuck in their throat
heartburn, nausea, vomiting , sores in the mouth
Worst case - bleeding from small capillaries within the esophageal lining or main blood vessels

Question 29

Esophageal Varices

Answer 29

The amount of pressure within the blood vessels surrounding the esophagus increases - frequently as a result of liver failure; blood vessels eventually drain into the liver; if damaged liver, blood cannot flow through it easily and backs up causing capillary network of the esophagus to leak; building pressure causes vessels to fail causing massive upper GI bleding

Question 30

S/S of Esophageal Varices

Answer 30

Initial - signs of liver disease (fatigue, weight loss, jaundice, edema of abd., nausea, vomiting), a very gradual process
Rupture - Sudden onset discomfort in epigastric region, severe difficulty swallowing, vomiting bright red, hypotension, signs of shock
Less dramatic - bleeding, hematemesis, melena

Question 31

Mallory-Weiss Tear

Answer 31

Tear in the junction between the esophagus and the stomach, causing severe bleeding
Primary risk factors include alcoholism and eating disorders, more prevalent in older adults, older children; pregnant women at higher risk due to pregnancy-related vomiting

Question 32

S/S of Mallory-Weiss Tear

Answer 32

Vomiting, bleeding ranges from minor to severe; Pts may experience S/S of shock, upper abdominal pain, hematemesis, melena

Question 33

GERD

Answer 33

Gastrointestinal reflux disease; The sphincter between the esophagus and the stomach opens allowing stomach acid to move into the esophagus – acid reflux disease

Question 34

Gastroenteritis

Answer 34

Comprises a family of conditions of infection combined with diarrhea, nausea and vomiting; can be caused by viral organisms, noninfectious conditions (reactions to meds, exposure to toxins, chemo)

Question 35

S/S of Gastroenteritis

Answer 35

Diarrhea, frequent or liquidy, may contain blood or pus, be foul smelling
Abdominal cramping, nausea, vomiting, fever, anorexia, dehydration

Question 36

Diverticulitis

Answer 36

Decreased fiber intake = hard stool
Small outcroppings in the colonic wall bulge and turn into pouches where bacteria can grow and cause inflammation and infections

Question 37

S/S of Diverticulitis

Answer 37

Abdominal pain (usually left-sided), fever, malaise, body aches, chills, nausea, vomiting

Question 38

Hemorrhoids

Answer 38

Swelling and inflammation of the blood vessels surrounding the rectum; can be internal or external

Question 39

S/S of Hemorrhoids

Answer 39

Bright red blood during defecation

Question 40

Cystitis

Answer 40

Bladder inflammation generally caused by a bacterial infection, can be referred to as a Urinary Tract Infection (UTI), serious if infection spreads to kidneys

Question 41

Kidneys

Answer 41

When kidneys fail, the ability to secrete waste from the body decreases leading to uremia - when waste, urea, normally excreted in urine remains in the blood

Question 42

Hernia

Answer 42

Protrusion of an organ or tissue through a hole or opening in a body cavity
Risk of strangulation - compression by surrounding tissues eventually compromising blood supply