GI EMERGENCIES Flashcards
Esophagogastric Varices Bleeding
due to liver issues (alcohol/hepatitis C), causing back-up of blood vessels surrounding esophagus and stomach
Assess:
- ETOH habit or hep C
- GRADUAL development of sx of liver issues (fatigue, edematous ab, pruritus, n/v,…)
- possible rupture with dysphagia, hypotension, sx of shock, hematemesis, melena
Manage:
- patent airway, suction, advanced airway w/ decr LOC, volume resuscitation, BP management
Mallory-Weiss Syndrome
Boerhaave Syndrome
DUE TO HIGH PRESSURE FROM SEVERE VOMITING that leads to tear btwn esophagus and stomach
relatively shallow tear vs complete tear
Assess:
- ETOH habit
- hematemesis vs less bleeding (bleeding internally) + upper chest pain
Manage:
- patent airway, suction, advanced airway w/ decr LOC, volume resuscitation, BP management, rule out MI
Gastritis -> Peptic Ulcer Disease —> Peritonitis
erosion of inner protective layer of stomach and duodenum;
caused by H pylori, chronic NSAID, smoking/ETOH, extreme stress
Assess:
- n/v, belching, heart burn (DIMINISHES WITH FOOD INTAKE BUT RETURNS)
- blood loss? hypotension? orthostatic vitals?
Manage:
- patent airway, suction, advanced airway w/ decr LOC, volume resuscitation, BP management, antiemetic
Gastroesophageal Reflux Disease (GERD)
when LES allows stomach acid to move up possibly damaging esophageal wall;
smoking, obesity, pregnancy, fatty food, ETOH, citrus fruits
Assess:
- heartburn, POSITIONAL DISCOMFORT, difficulty swallowing
- hematemesis or melena
Manage:
- “heartburn vs MI???”
- antacids, PPI, H2 blockers
Hiatal Hernia
when upper portion of stomach is protruding thru diaphragm and contents are stuck between the diaphragm and LES
Assess:
- heartburn if food/acid gets trapped in the hernia
- hematemesis or melena
Manage:
- “heartburn vs MI???”
- antacids, PPI, H2 blockers
Hemorrhoids
inflammation of blood vessels around the rectum caused by increased pressure/irritation
Assess:
- hematochezia / itching / small mass on rectum
Manage:
- orthostatic vitals? hemodynamically stable?
- hydrate, high-fiber diet, Colace 200mg BID stool softener
Anal Fissures
linear tears to mucosal lining in and near anus
Assess:
- pain w/ defecation or stretch / blood smear after wipe
Manage:
- orthostatic vitals? hemodynamically stable?
- pad with sterile dressing (no packing) / wound care
Esophagitis
inflammation of esophagus due to infection or gastric reflux irritation; also related to eiosinophil
Assess:
- indigestion, lower chest and upper ab pain - worse when supine, bitter burp, dysphagia (w/ pain poss), food impaction
Manage:
- “heartburn vs MI???”
- indigestion? = GERD; dysphagia? = esophageal stricture
Tracheoesophageal Fistula
opening that connects trachea and esophagus
congenital or acquired (cancer, medical procedure like ET intubation, tumor, trauma)
Assess:
- fever, cough, aspiration, decreased LOC, sepsis, etc…
Manage:
- ensure adequate ventilation and manage for potential sepsis
- proper tube placement (verify with auscultating epigastric and adjust)
- surgical repair
Esophageal Stricture/Stenosis
ABNORMAL NARROWING of esophagus due to inflammation, tumor, infection, acid reflux, scar tissue
Assess:
- multiple hx episodes of choking
- dysphagia –> odynophagia
- can’t speak
Manage:
- airway patency (obstruction / aspiration / oral secretion / sit up)
- contact MD FOR USE OF GLUCAGON which can potentially dilate esophagus
- encourage trip to ER for endoscopy
Peritonitis
inflammation of peritoneum due organ rupture -> spillage OR bacterial migration from intestine (commonly result of ascites)
Assess:
- abdominal pain location depending on ruptured organ
- board-hard abdomen, fetal position, fever
- consider septic shock and hypovolemic shock
Manage:
- “rupture? infection? internal bleeding? hemodynamic?”
- restore volume (fluid and/or norepinephrine)
- manage pain and nausea
- transport
Cholecystitis and Biliary Tract Disorder
due to decreased flow of biliary materials causing pressure
Assess:
- severe right quadrant pain triggered by FATTY FOOD
- positive Murphy’s Sign (finger along right rib arch and pain when patient inhales)
- Charcot Triad: fever / RUQ pain / jaundice
Manage:
- usually non life-threatening
- manage pain (opiate prn) and nausea (fluid prn)
Appendicitis
due to accumulation of fecal matter in the region and build up of bacteria; can rupture leading to peritonitis, sepsis/septicemia, and death;
Assess:
- early - periumbilical pain, n/v, low-grade fever
- ripe - pain in RLQ (McBurney Point: 2/3 way down-right from belly button)
- rupture - sudden decrease in pressure and pain
Manage:
- “rupture? infection? internal bleeding? hemodynamic?”
- restore volume (fluid and/or norepinephrine)
- manage pain and nausea
Diverticulitis
weak area in colon that begins to form small pouches and gets inflamed; when feces is stuck in this pouch ~ appendicitis; chance of sepsis; body tries to fix this issue and can result in fistula (colon and bladder), adhesion, scarring
Assess:
- typically LLQ pain but really can happen anywhere, fever, malaise, chills, n/v
Manage:
- “rupture? infection? internal bleeding?”
- restore volume (fluid and/or norepinephrine)
- manage pain and nausea
Pancreatitis
autodigestion leading to inflammation of pancreas due to blocked tube; associated with alcohol abuse
Assess:
- sharp severe pain localized @ epigastric area radiating to back
- n/v fever, hypotension, fever, muscle spasm from hypocalcemia
- internal bleeding: Cullen Sign and Grey-Turner Sign
Manage:
- “rupture? infection? internal bleeding? hemodynamic?”
- restore volume (fluid and/or norepinephrine)
- manage pain (meperidine, NO morphine) and nausea
Ulcerative Colitis
chronic generalized inflammation of the colon, starting from weakening/thinning of rectum and progresses along the colon
Assess:
- gradual onset of bloody diarrhea/hematochezia
- mild to severe abdominal pain
- joint pain/skin lesions (autoimmune?)
Manage:
- “infection? internal bleeding? hemodynamic?”
- restore volume (fluid and/or norepinephrine)
- manage pain and nausea
Crohn Disease
chronic inflammation of entire GI tract, MAINLY THE ILEUM & (small to large connection) PATCHY INFLAMMATION THRUOUT; attacks from immune system causing scarring, narrowing, stiffness, weakening
Assess:
- abdominal pain usually @ LRQ
- rectal bleeding, weight loss, skin disorders
Manage:
- “infection? internal bleeding? hemodynamic?”
- restore volume (fluid and/or norepinephrine)
- manage pain and nausea
Irritable Bowel Syndrome
Ab pain and change in bowel habit with unclear cause
- HYPERSENSITIVITYof bowel pain receptor or sm muscles
- psychiatric disorder connection
Assess:
- pain and discomfort thruout abdomen
- RELIEF AFTER POOPING
Manage:
- non life-threatening
- symptomatic treatment (pain)
- consider psychiatric issues in mind
Acute Gastroenteritis
Inflammation of GI system due to infection from viral, bacterial, parasitic causes; norovirus, C Diff
Assess:
- n/v/d, fever, abdominal pain, diarrhea, dehydration
Manage:
- orthostatic vital signs for fluid resuscitation
- symptomatic treatment
Rectal Abscess
Lubrication duct blockage in rectum
Assess:
- pain, fever, itching, poss constipation
Manage:
- position of comfort (lateral), symptomatic treatment, transport for surgery
Cirrhosis
Early stages of liver failure caused by hepatitis and other issues
Assess:
- EARLY: weakness, joint aches, fatigue, n/v, urticaria
- LATE: RUQ ab pain, acholic stool (yellow due to lack of bilirubin excretion), dark urine, jaundice (skin/eyes)
Manage:
- use lower dosage for any drugs as it will last longer and monitor therapeutic/adverse effect
- bleeding control impaired
- symptomatic treatment; consider hypotension
Hepatic Encephalopathy
Brain dysfunction caused by continuous liver failure
Ammonia produced due to liver failure messes with neuron and blood-brain barrier
Assess:
- AMS (memory loss <—> coma)
Manage:
- symptomatic treatment
- “other reversible causes of AMS???”
Esophageal Obstruction
Children - usually at UES; Adult - usually at LES
Assess:
- inability to swallow, drooling, choking, gagging
- 1/3 of children are asymptomatic
Manage:
- airway patent, positioning, suction ready, keep patient calm
- MD call for Glucagon usage
Mesenteric Ischemia
Blood flow interruption to mesentery caused by arterial/venous embolism, thrombosis, vasospasm
Assess:
- gradual or sudden onset
Manage:
- “sepsis?” Symptomatic treatment
- transport
Small-Bowel Obstruction
Most common cause is postoperative adhesion
Assess:
- fever, tachycardia, hyper/hypotension,
- abdominal pain, n/v of poop material/smell, hyperactive or hypoactive bowel sound, constipation
Manage:
- symptomatic treatment (pain, nausea)
- consider “sepsis?”, “NG tube?”
Large-Bowel Obstruction
Mechanical obstruction decreasing lumen in colon
Think colon cancer/diverticulitis
Intussusception in children (telescoping)
Assess:
- abdominal pain, n/v, constipation
- percussion will show hyperresonance
- think rupture
Manage:
- symptomatic treatment (pain, nausea), hypotension
- may be obstructed for longer time compared to small-bowel obstruction
Abdominal Wall Hernia
Protrusion of organ/structure into adjacent cavity
Assess:
- location - epigastric, umbilical, inguinal, femoral
- reducible, incarcerated (trapped), strangulated, incisional (post-surgery)
Manage:
- symptomatic treatment
