Ch 21- GI Emergencies Flashcards
What are the undesirable symptoms of GI illness?
Nausea
Vomiting
Diarrhea
What is septicemia?
Generalized infection that could be caused by GI disorder
What are the known behavorial risks factors associated with GI disorders?
Smoking
Alcohol Consumption
What other factors place a pt at risk for GI disorders?
Sleep patterns- GERD IBS functional dyspepsia
Dietary Behavior- IBS Cholecystitis GERD
Work Behaviors- IBS peptic ulcer disease
Exercise behavior- IBS Peptic ulcer disease
Stress- disease throughout GI tract
What does the mouth do?
Breaks down food, begins chemical breakdown of food with saliva
What does the esophagus do?
Moves food from mouth to stomach
What does the stomach do?
Perform mechanical and chemical breakdown of food (food in, chyme out)
What is chyme?
Pulpy acid fluid that passes from stomach to small intestines; consists of gastric juices and partly digested food
What does the liver do?
Produce bile
Assist with carb, protein and fat metabolism
Vitamin storage and manufacture
Blood detoxification
Waste elimination
What does the pancrease do?
Endocrine: produce insulin, somatostatin and glucagon
Exocrine: produce enzymes for protein, carb and fat breakdown in the duodenum
What does the gallbladder do?
Stores bile
What does the spleen do?
Filter blood; recycle dead red blood cells
What does the aorta do?
Main artery supplying blood to lower body
What does the bladder do?
Stores urine
Where is the uterus located? What does it do?
Suprapubis area
Reproduction
Where is the iliac arteries? What do they do?
Central abdomen; lower right and left quadrants
Supply blood to the legs and pelvis
What parts is the small intestine broken into?
Duodenum
Jejunum
Ileum
Where is the duodeum? What does it do?
Central; upper umbilical
Major site for chemical breakdown of food; major site of water, fat, protein, cab and vitamin absorption
Where is the Jejunum? What does it do?
Central; upper umbilical
Moves chyme forward; absorbs nutrients
Where is the ileum? What does it do?
Central, hypogastric to lower right abdomen
Moves chyme forward; absorbs nutrients
What are the parts of the large intestine?
Ascending colon
Transverse Colon
Descending Colon
Sigmoid Colon
Rectum
Anus
Where is the ascending colon? What does it do?
Right lower quadrant; hypogastric into epigastric
Water reabsorption, formation of feces, bacterial digestion of food
Where is the transverse colon? What does it do?
Right to left upper quadrant; epigastric
Water reabsorption; formation of feces, bacterial digestion of food
What does the descending colon do? Where is it located?
Left upper/lower quadrant; epigastric to umbilical
Water reabsorption; formation of feces, bacterial digestion of food
Where is the sigmoid colon? What does it do?
Left lower quadrant; hypogastric
Water reabsorption, formation of feces, bacterial digestion of food
Where is the rectum? What does it do?
Suprapubic, hypogastric
Stores feces for later release
Where is the anus? What does it do?
Most inferior portion of large intestine
Sphincter to control release of feces
What are the parts of the peritoneum?
Parietal peritoneum
Visceral peritoneum
Peritoneal cavity
Mesentary
Where is the parietal peritoneum? What does it do?
Lining or bag that contains abd organs
Protects supports the organs within the abd
Where is the visceral peritoneum?
Lining that covers organs
Where is the peritoneal cavity?
Space between parietal and visceral peritoneum
Where is the mesentary? What does it do?
Double layered fold of peritoneal tissue that attaches structures to abd wall; anchors them in place
Attaches some organs to posterior wall of abd; provides passageway for blood and lymph vessels ad nerves
What is the primary function of the GI system?
Absorb the products of digestion to fuel the cells within the body
What does pancreas juice do?
Neutralize gastric acid
What does bile do?
Stored in the gallbladder; released into the duodenum; help dissolve fats
Where is bile produced?
The liver
What else does the liver do?
Promote carb metabolism; store glycogen; converts glycogen into glucose to raise blood sugar; detoxifies drugs; completes breakdown of dead red and white blood cells; creates clotting factor; store vitamins and minerals
What vein delivers blood from the liver back tot he heart?
Portal vein
How does stool become solidified?
Thought he osmotic function of the colon; water reabsorption
What does the appendix contain?
T and B lymphocytes, secretes immunoglobulin A, serves as storage site for nonpathogenic intestinal bacteria
How do you assess a pt w/ GI complaints?
Scene size up
ABCs
Manage life threats
Administer O2
Prevent aspiration; sometimes w/ NG OG tube
Auscultate lung sounds
What to ask during assessment/ history taking of pt w/ GI complaints?
Last oral intake- foods ingested over past 24hrs
Meal tolerance- any change sin appetite? Recent weight gain/loss? Vomiting after eating? Burping? Flatulence?
Childbearing age? Pregnant?
Difficulty swallowing? Pain w/ swallowing?
Recent bowel movement? Color? Consistency?
Recent travel? Exposed to infection?
Additions/changes to medications including OTC meds?
What to look for in secondary assessment?
Striae- stretch marks, indicate sudden weight gain or loss
Scaphoid- decreased abd volume, will be concave
Distended- will be overly full
Borborygmi- indicates strong contractions of intestines; stomach growling; found when listening to abd sounds
Hyperperistalsis- increased activity of the bowel
Hypoperistalsis- decreased activity of the bowel
Percussion of the abd should produce tympanic (empty) sound
Pain is common finding in GI disorders
What is rebound tenderness? What does it indicate?
Tenderness in the abd after removing pressure
Indicate: peritoneum is irritiert
What should you note during palpation?
Masses- can indicate engorged liver, bowel DISTENTION, aortic aneurysm, cyst, tumor
What is the goal when providing pain management for pt’s w/ GI disorders?
To make them more comfortable
What common meds do we use for pain management of GI disorders?
Morphine- opioid, can cause hypotension and resp depressoin
Demerol- opioid, used for moderate to severe pain
Toradol- no opioid, moderate to severe pain, contraindicated in pt’s w/ renal disease, previous/recurrent GI bleeding, pregnant
Fentanyl- opioid w/ short half life, can cause hypotension and resp depression
What fluids do we provide to pt’s that are dehydrated from GI disorder?
Stable condition: hypotonic, moves fluid from vascular space to interstitial space eventually into intracellular space, 125ml/hr generally sufficient
Profoundly dehydrated: use isotonic solution, will respond vascular space first
Be mindful to not cause hemodilution. Blood must have have oxygen carrying capacity
Titrate fluids to bp 90-100 mmhg
What is cholecystitis?
Inflammation of gall bladder
Treatments is supportive with pain management and fluid resuscitation as needed. Pt will likely need surgery. Transport to facility with GI speciality or general surgery
What causes hypovolemia in GI disorders?
Dehydration and/or hemorrhage
What is melena?
Dark, tarry stool
Upper GI bleeding
What is hematochezie?
Bright red blood in stool
Lower GI bleeding
What is the treatment for pt’s with GI bleeding?
ABCS
Manage life threats
Fluid resuscitation- 1L isotonic w/ 10th set
What is esophageal varies?
Pressure increase in blood vessels that surround the esophagus an stomach
Blood drains into portal system
Causes portal hypertension
Hep C primary cause
What are the s/s of esophageal varies?
Presents initially as liver failure: fatigue, weight loss, jaundice, anorexia, edematous abdomen, pruiritus, abd pain, n/v
Rupture of varies is sudden. Presents with dysphagia, vomiting of bright red blood, hypotension, shock
Can be life threatening
How do you manage pt w/ esophageal varices?
Assessment
Manage life threats
Establish 2 large bore IV w/ liter bags isotonic solution
Secure airway if LOC decreases
What is Mallory Weiss Syndrome?
Unique type of esophageal condition which causes severe hemorrhage
Junction between esophagus and stomach tears
Does not completely tear though walls of esophagus
What is boerhaave syndrome?
Occurs during vomiting
Tears longitudinally and travels entirely through wall of esophagus
Passage for blood, air, and food out of esophagus into mediastinum
How do Mallory weiss present?
Vomiting- women typically associated with morning sickness, men typically associated with alcohol consumption
Bleeding- can be severe leading to hypovolemia, or small amount of blood loss
May have signs of shock in extreme cases- epigastric and abd pain, hematemesis, Melina
What are the signs of boerhaave syndrome?
Vomiting accompanied w/ upper chest pain
Swallowing exacerbates pain
Little bleeding because blood travels through newly created hole: fills mediastinum with blood
Can also have non sterile particles in mediastinum- leads to septicemia, pneumediastinum, mediastinitis, emphysema, subcu emphysema
Pt’s may have fever, sepsis
How do you manage Mallory weiss syndrome?
Determined by amount of blood loss
Manage life threats
Manage ABCs
Fluid resuscitation for decreased blood volume as needed
How do you manage Boerhaave syndrome?
Related to potential sepsis
Manage symptoms
Provide fluid resuscitation as needed
Do not overlook MI until proven otherwise
ASA therapy is not desired
What is peptic ulcer disease?
Protective layer of stomach and duodenum have eroded
Precede by gastritis
Can be caused by h.pylori, NASID use
Zollinger Ellison syndrome- tumors in pancreas cause increased acid production leading to PUD
What s/s appears in PUD?
Epigastric pain described as gnawing or burning that is relieved after eating, reappears in 2-3hrs
Perforation occurs when erosion has eaten through wall of stomach and duodenum. Can cause peritonitis
How do you manage PUD?
Assessment to find and manage hypotension that could be present from blood loss
Orthostatic vitals critical in determining fluid needs
Initiate IV access and provide fluids as needed
Be on lookout for sepsis
What is GERD?
Gastro Esophageal Reflux Disease
How is GERD characterized?
Sphincter between esophagus and stomach is weak, acid moves from stomach into esophagus
Factors that increase incident: smokin, obesity, pregnancy
Long term GERD can cause esophageal wall damage
What is a hiatal hernia?
Protrusion of stomach through diaphragm
What can happen w/ hiatal hernia?
Food and acid can get trapped inside hernia
Produces GERD like symptoms
Caused by increased intra abdominal pressure
More prevalent in older women
Do not become symptomatic until food/acid is trapped in hernia
What is the predominant finding in GERD?
heartburn
How do you manage GERD?
Supportive care
H2 receptor blockers can be used to treat if needed
Surgical repair may be needed
What is lower GI Bleed?
Most common cause hemorrhoids; caused by swelling and inflammation of vascular cushion surrounding rectum; known as sinusoids
What are the types of hemorrhoids?
Internal and external
How to assess hemorrhoids?
Red blood during defecation
Itching
Small mass near or in rectum
How to manage hemorrhoids?
Supportive
Ensure hemodynamic stability
What is anal fissures?
Linear tears in mucosal lining, near any that cause lower Gi bleeding
Can be Caused by Chrons disease, HIV, trauma, anorectal cancer
What do you find during assessment of a pt w/ anal fissure?
Painful defecation
Small amount of bight red blood
Stretching causes pain
How do you manage pt w/ anal fissure?
Supportive care
Can place 5x9 dressing over anus to help pad area
Generally heal without surgical intervention
What is esophagitis?
Inflammation of esophagus
Can be caused by infection or reflux
Causes irritation and swelling
Generally present with heartburn
How do you manage esophagitist?
Supportive care
If they have CP, rule out MI
Treat symptoms
What is tracheoesophageal fistula?
An opening between the two parts of the trachea and esophagus that touch
Can be born with this
Commonly acquire through cancer, trauma, iatrogenic means (intubation)
Food can move thought esophagus into trachea and into lungs
Have high mortality rate d/t increased risk of developing sepsis, pneumonia, ARDS
Can present w/ cough, fever, aspiration, decreased LOC, have G tube,
Main presentation will be tachycardia, fever, sepsis
How do you manage TEF?
Manage ABCS
Care focuses on ventilation
Intubation may ne necessary
