Ch 18 Gastrointestinal and Urologic Emergencies Flashcards
Solid organs
Liver, Spleen, Pancreas, Kidneys, Ovaries
Trauma can cause shock and bleeding because these organs are very vascular
Hollow organs
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
Retroperitoneal organs
Kidneys, ovaries, pancreas
Retroperitoneal
Behind the peritoneum
Role of the liver
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
Role of the gallbladder
Reservoir for bile
Role of the small intestine
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
Role of the pancreas
Secretes juices containing enzymes that help break down starches (such as amylase), fats and proteins; produces bicarbonate and insulin
Bicarbonate neutralizes ____
The acids in the duodenum
Role of the colon/large intestine
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
Role of the spleen
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
The urinary system
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
Role of the kidneys
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
Role of the ureters
Small tubes pass from the renal pelvis of each kidney to drain into urinary bladder with peristalsis
Peristalsis
Wavelike contraction of smooth muscle
Peptic Ulcer Disease
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.)
S/S of PUD
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
Gallstones
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
Cholecystitis
When the walls of the gallbladder become inflamed; may lead to rupture, causing inflammation to spread and irritate surrounding structures
S/S of Gallstones
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
Pancreatitis
Inflammation caused by gallstones, alcohol abuse, other diseases
S/S of Pancreatitis
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)
Appendicitis
Inflammation of a small recess in the large intestine; Can eventually cause tissue to die or rupture, causing abscess, peritonitis or death
S/S of Appendicitis
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
Gastrointestinal hemorrhage
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
S/S of Gastrointestinal hemorrhage
Upper GI - hematemesis bright red or coffee grounds
Lower GI - Melena
Esophagitis
The lining of the esophagus becomes inflamed by infection of from the acids of the stomach - GERD
S/S of Esophagitis
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
Esophageal Varices
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
S/S of Esophageal Varices
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
Mallory-Weiss Tear
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
S/S of Mallory-Weiss Tear
Vomiting, bleeding ranges from minor to severe; Pts may experience S/S of shock, upper abdominal pain, hematemesis, melena
GERD
Gastrointestinal reflux disease; The sphincter between the esophagus and the stomach opens allowing stomach acid to move into the esophagus – acid reflux disease
Gastroenteritis
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)
S/S of Gastroenteritis
Diarrhea, frequent or liquidy, may contain blood or pus, be foul smelling
Abdominal cramping, nausea, vomiting, fever, anorexia, dehydration
Diverticulitis
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
S/S of Diverticulitis
Abdominal pain (usually left-sided), fever, malaise, body aches, chills, nausea, vomiting
Hemorrhoids
Swelling and inflammation of the blood vessels surrounding the rectum; can be internal or external
S/S of Hemorrhoids
Bright red blood during defecation
Cystitis
Bladder inflammation generally caused by a bacterial infection, can be referred to as a Urinary Tract Infection (UTI), serious if infection spreads to kidneys
Kidneys
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
Hernia
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
