Chapter 16A - Gastrointestinal Emergencies

Question 0

Hemoptysis

Answer 0

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

Question 1

Hematemesis

Answer 1

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.

Question 2

Melena

Answer 2

Passing black, tarry stools indicates intestinal bleeding, but the blood has been completely digested therefore it is not rectal bleeding

Question 3

Hematochezia

Answer 3

Indicates bleeding in the last few inches of the intestine, usually the rectum, and usually indicates hemorrhoids

Question 4

Hematuria

Answer 4

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

Question 5

Ascites

Answer 5

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

Question 6

Gastric ulcer – pathophysiology

Answer 6

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

Question 7

Gastric ulcer – signs and symptoms

Answer 7

– 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

Question 8

Gastric ulcer – treatment

Answer 8

– Supportive

– transport in shock position (the raised legs take pressure off the abdominal wall, which lessens the pain)

Question 9

Abdominal aortic aneurysm – pathophysiology

Answer 9

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

Question 10

Abdominal aortic aneurysm – signs/symptoms

Answer 10

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

Question 11

Abdominal aortic aneurysm – associated signs/symptoms

Answer 11

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

Question 12

Abdominal aortic aneurysm – treatment

Answer 12

– Supportive
– transport in shock position
– transport RLS code 3

Question 13

Appendicitis – pathophysiology

Answer 13

Inflammation/infection of the appendix which can rupture or become infected

Question 14

Appendicitis – signs/symptoms

Answer 14

– Fever
– anorexia
- nausea/vomiting
– sharp right lower quadrant pain, guarding, rebound tenderness (increases over several hours)

Question 15

Appendicitis – treatment

Answer 15

– Supportive

– transport in Shock position (raised legs lessens pain)

Question 16

Esophageal varices – pathophysiology

Answer 16

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

Question 17

Esophageal varices – signs/symptoms

Answer 17

– Massive hematemesis
– dramatic hemoptysis
– life threatening hypovolemia

Question 18

Esophageal varices – treatment

Answer 18

– Supportive
– airway maintenance = a major problem
– treat for shock
– transport code 3

Question 19

Gallbladder inflammation/cholecystitis – pathophysiology

Answer 19

Gallstone production and blockage of the bile ducts, with inflammation and digestive upset from lack of bile

Question 20

Gallbladder inflammation/cholecystitis – signs/symptoms

Answer 20

– 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

Question 21

Gallbladder inflammation/cholecystitis – treatment

Answer 21

– Supportive
– transport in shock position (raised legs lessens the pain)
– no code 3

Question 22

Kidney stones – pathophysiology

Answer 22

Stone production and blockage of the ureters

Question 23

Kidney stones – signs/symptoms

Answer 23

• 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

Question 24

Kidney stones – treatment

Answer 24

– Supportive
– transport instruct position (patient may assume a fetal position = on his side)
– no code 3

Question 25

Bowel obstruction – pathophysiology

Answer 25

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.

Question 26

Bowel obstruction – signs/symptoms

Answer 26

– Crampy pain in the abdomen (in spasms, usually diffuse) 
– often has abdominal distention 
– anorexia 
– nausea/vomiting 
– fever

Question 27

Bowel obstruction – treatment

Answer 27

– Supportive
– transport in shock position
– no code 3

Question 28

Chronic liver disease – pathophysiology

Answer 28

(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

Question 29

Chronic liver disease – signs/symptoms

Answer 29

– Jaundice 
– ascites
- pedal edema 
– muscle atrophy 
– decreased clotting (therefore bruising) 
– petechiae 
– varicose vein or spider veins

Question 30

Chronic liver disease – treatment

Answer 30

– Supportive

– transport in shock position or transport in semi Fowler’s if that is more comfortable

Question 31

Pancreatitis – pathophysiology

Answer 31

Inflammation of the pancreas with enzyme leakage, causing tissue destruction that - often in chronic alcoholics (may be mistaken for an MI)

Question 32

Pancreatitis – signs/symptoms

Answer 32

– 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

Question 33

Pancreatitis – treatment

Answer 33

– Supportive

– transport in shock position

Question 34

Irritable bowel syndrome - signs/symptoms

Answer 34

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

Question 35

Diverticulitis – pathophysiology

Answer 35

Inflammation of small pouches formed on the intestinal wall (diverticulosis)

Question 36

Diverticulitis – signs/symptoms

Answer 36

– Abdominal pain (LLQ)
– fever
– vomiting
– constipation

Question 37

Gastroesophageal reflux disease

Answer 37

Presents as heartburn