Chapter 16A - Gastrointestinal Emergencies Flashcards
Hemoptysis
Coughing up or spitting up of bright red blood usually from blood that entered the respiratory system
usually from a tear in an artery in the posterior pharynx or somewhere in the respiratory system
because it promotes coughing, it can spray dramatically - take BSI
Hematemesis
Vomiting of partially digested blood that has entered the stomach
it has a brownish coffee grounds appearance
could be from a nosebleed, or esophageal varices, or perforated bleeding ulcer
if large amount of blood, may appear like one wine.
Melena
Passing black, tarry stools indicates intestinal bleeding, but the blood has been completely digested therefore it is not rectal bleeding
Hematochezia
Indicates bleeding in the last few inches of the intestine, usually the rectum, and usually indicates hemorrhoids
Hematuria
Passing blood in the urine usually appears as a rust colored urine if the problem is in the kidneys, and bits of bright red blood if the problem is in the bladder or urethra
Ascites
Distention of the abdomen due to Free Water in the peritoneal cavity
having leaked or backed up into the cavity due to liver failure
account for the huge abdomen seen in alcoholics
Gastric ulcer – pathophysiology
Erosion or ulceration of the stomach wall
Are stomach infections caused by bacteria (helicobacter pylori)
Can be cured with antibiotics not antacids or Tagamet, Axid, or Pepcid
Gastric ulcer – signs and symptoms
– Persistent pain in the upper abdomen, often described as burning
– pain is somewhat or completely relieved by eating bland foods (sponge-up the acids)
- often have hematemesis, or melena
Gastric ulcer – treatment
– Supportive
– transport in shock position (the raised legs take pressure off the abdominal wall, which lessens the pain)
Abdominal aortic aneurysm – pathophysiology
A ballooning of the wall of the artery as a result of defects, leading to dissecting (separating the layers) which thins the number of layers containing the blood pressure and as some of the ballooning pushes inward, can decrease aortic blood flow
Abdominal aortic aneurysm – signs/symptoms
O – lifting heavy weights, straining
Q – tearing, hot, knifelike
R – pain from anterior abdomen, boring through the back
S – very severe and hits maximum at time of onset (doesn’t build up)
T – sudden onset
Abdominal aortic aneurysm – associated signs/symptoms
All due to internal ballooning decreasing the inside diameter of the aorta and decreasing one opening more than the other (right versus left femoral)
– Unequal femoral pulses
– may have severe signs of shock if leaking
Abdominal aortic aneurysm – treatment
– Supportive
– transport in shock position
– transport RLS code 3
Appendicitis – pathophysiology
Inflammation/infection of the appendix which can rupture or become infected
Appendicitis – signs/symptoms
– Fever
– anorexia
- nausea/vomiting
– sharp right lower quadrant pain, guarding, rebound tenderness (increases over several hours)
Appendicitis – treatment
– Supportive
– transport in Shock position (raised legs lessens pain)
Esophageal varices – pathophysiology
Varicose veins in the esophagus (enlarged veins) usually from chronic, excessive alcohol abuse, which also tends to damage that esophageal lining. Chronic alcoholism causes cirrhosis of the liver which damages it’s filtering mechanism and results in a back up of blood into veins that flow into the liver (from the intestines and esophagus) those varicose veins can rupture – if they do, severe, catastrophic bleeding occurs
Esophageal varices – signs/symptoms
– Massive hematemesis
– dramatic hemoptysis
– life threatening hypovolemia
Esophageal varices – treatment
– Supportive
– airway maintenance = a major problem
– treat for shock
– transport code 3
Gallbladder inflammation/cholecystitis – pathophysiology
Gallstone production and blockage of the bile ducts, with inflammation and digestive upset from lack of bile
Gallbladder inflammation/cholecystitis – signs/symptoms
– History of recent ingestion of a meal with a lot of fat
– gradual onset of sharp pain in the right upper quadrant, possibly the right shoulder area, especially after a fatty meal
– possible Jaundice
– nausea/vomiting
Gallbladder inflammation/cholecystitis – treatment
– Supportive
– transport in shock position (raised legs lessens the pain)
– no code 3
Kidney stones – pathophysiology
Stone production and blockage of the ureters
Kidney stones – signs/symptoms
- tremendous pain in the lower quadrants, radiating in pulse like waves from the rear flank downward towards the pubic synthesis (bladder) worsens as the stone is pushed along
– anxieties, restlessness
– Nausea/vomiting
– hematuria
Kidney stones – treatment
– Supportive
– transport instruct position (patient may assume a fetal position = on his side)
– no code 3
Bowel obstruction – pathophysiology
Typically occurs in the elderly (or younger people dieting). Constipation and then obstruction. Sometimes there is a history of recent abdominal surgery. The obstruction may be feces, a tumor or scar tissue.
Bowel obstruction – signs/symptoms
– Crampy pain in the abdomen (in spasms, usually diffuse) – often has abdominal distention – anorexia – nausea/vomiting – fever
Bowel obstruction – treatment
– Supportive
– transport in shock position
– no code 3
Chronic liver disease – pathophysiology
(Hepatitis but not necessarily infections) destruction of liver cells with formation of scar tissue which prevent normal functioning and obstructs blood flow into the liver
- there by backing up fluid into the hepatic-portal system, causing acsites
– may be the result of chronic alcohol abuse, tumors, Tylenol overdose or viral hepatitis
Chronic liver disease – signs/symptoms
– Jaundice – ascites - pedal edema – muscle atrophy – decreased clotting (therefore bruising) – petechiae – varicose vein or spider veins
Chronic liver disease – treatment
– Supportive
– transport in shock position or transport in semi Fowler’s if that is more comfortable
Pancreatitis – pathophysiology
Inflammation of the pancreas with enzyme leakage, causing tissue destruction that - often in chronic alcoholics (may be mistaken for an MI)
Pancreatitis – signs/symptoms
– Sudden, severe left upper quadrant epigastric pain
– steady, boring to the back of may radiate to the left shoulder or back
– usually with a history of chronic alcohol abuse
– may have abdominal distention and or tenderness
– nausea/vomiting
– may develop shock
Pancreatitis – treatment
– Supportive
– transport in shock position
Irritable bowel syndrome - signs/symptoms
Abdominal pain, abdominal cramping, gas, bloating, diarrhea or constipation. The pain is described as worse than childbirth – a sudden knife like pain that doubles you over – can bring you to your knees
Diverticulitis – pathophysiology
Inflammation of small pouches formed on the intestinal wall (diverticulosis)
Diverticulitis – signs/symptoms
– Abdominal pain (LLQ)
– fever
– vomiting
– constipation
Gastroesophageal reflux disease
Presents as heartburn
