1. Chapter 32 Gastroenterology

2. Topics General Pathophysiology, Assessment, and Treatment
Specific Illnesses

3. General Pathophysiology
General Risk Factors
Excessive Alcohol Consumption
Excessive Smoking
Increased Stress
Ingestion of Caustic Substances
Poor Bowel Habits
Emergencies
Acute emergencies usually arise from chronic underlying problems.

4. Abdominal Pain Types Causes Visceral Somatic Referred Inflammation
Distention
Ischemia

5. General Pathophysiology
Pain from hollow organs tends to be vague and nondescript, whereas pain from solid organs tends to be localized.

6. General Assessment Scene Size-up & Initial Assessment
Scene clues.
Identify and treat life-threatening conditions.
Focused History & Physical Exam
Focused History
Obtain SAMPLE History.
Obtain OPQRST History.
Associated symptoms
Pertinent negatives

7. General Assessment Physical Exam General assessment and vital signs
Abdominal assessment
Inspection, Auscultation, and Palpation
Cullen’s Sign
Grey-Turner’s Sign

8. General Treatment Maintain the airway. Support breathing.
High-flow oxygen or assisted ventilations.
Maintain circulation.
Monitor vital signs and cardiac rhythm.
Establish IV access.
Transport in position of comfort.

9. Specific Illnesses The Gastrointestinal System
Upper Gastrointestinal Tract
Lower Gastrointestinal Tract
Liver
Gallbladder
Pancreas
Appendix

10. Upper Gastrointestinal Bleeding
Causes
Peptic Ulcer Disease
Gastritis
Varix Rupture
Mallory-Weiss Tear
Esophagitis
Duodenitis

11. Upper Gastrointestinal Bleeding
Signs & Symptoms
General abdominal discomfort
Hematemesis and melena
Classic signs and symptoms of shock
Changes in orthostatic vital signs
Treatment
Follow general treatment guidelines.
Begin volume replacement using 2 large-bore IVs.
Differentiate life-threatening from chronic problem.

12. Esophageal Varices Cause Portal Hypertension
Chronic alcohol abuse and liver cirrhosis
Ingestion of caustic substances

13. Esophageal Varices Signs & Symptoms Treatment Hematemesis, Dysphagia
Painless Bleeding
Hemodynamic Instability
Classic Signs of Shock
Treatment
Follow General Treatment Guidelines.
Aggressive Airway Management
Aggressive Fluid Resuscitation

14. Esophageal Varices
Prehospital placement of nasogastric tubes should be avoided in cases of suspected esophageal varices.

15. Acute Gastroenteritis
Cause
Damage to Mucosal GI Surfaces
Pathologic inflammation causes hemorrhage and erosion of the mucosal and submucosal layers of the GI tract.
Risk Factors
Alcohol and tobacco use
Chemical ingestion (NSAIDs, chemotherapeutics)
Systemic infections

16. Acute Gastroenteritis
Signs & Symptoms
Rapid Onset of Severe Vomiting and Diarrhea
Hematemesis, Hematochezia, Melena
Diffuse Abdominal Pain
Classic Signs of Shock
Treatment
Follow General Treatment Guidelines.
Fluid Volume Replacement.
Consider Administration of Antiemetics.

17. Gastroenteritis Similar to Acute Gastroenteritis
Long-Term Mucosal Changes or Permanent Damage.
Primarily due to microbial infection.
More frequent in developing countries.
Follow General Treatment Guidelines.

18. Gastroenteritis
Most cases of gastroenteritis are viral. Patients with bacterial gastroenteritis tend to be considered more ill than those with viral gastroenteritis.

19. Peptic Ulcers Pathophysiology Erosions caused by gastric acid.
Terminology based on the portion of tract affected.
Causes:
NSAID Use
Alcohol/Tobacco Use
H. pylori

20. Peptic Ulcers Signs & Symptoms Treatment Abdominal Pain
Observe for signs of hemorrhagic rupture.
Acute pain, hematemesis, melena
Treatment
Follow general treatment guidelines.
Consider administration of histamine blockers and antacids.

21. Lower Gastrointestinal Bleeding
Pathophysiology
Bleeding distal to the ligament of Treitz
Causes
Diverticulosis
Colon lesions
Rectal lesions
Inflammatory bowel disorder

22. Lower Gastrointestinal Bleeding
Signs & Symptoms
Determine acute vs. chronic.
Quantity/color of blood in stool.
Abdominal pain
Signs of shock.
Treatment
Follow general treatment guidelines.
Establish IV access with large-bore catheter(s).

23. Ulcerative Colitis Pathophysiology Signs & Symptoms Treatment
Causes Unknown
Signs & Symptoms
Abdominal Cramping
Nausea, Vomiting, Diarrhea
Fever or Weight Loss
Treatment
Follow general treatment guidelines.

24. Crohn’s Disease Pathophysiology Causes unknown.
Can affect the entire GI tract.
Pathologic inflammation:
Damages mucosa.
Hypertrophy and fibrosis of underlying muscle.
Fissures and fistulas.

25. Crohn’s Disease Signs and Symptoms Treatment
Difficult to differentiate.
Clinical presentations vary drastically.
GI bleeding, nausea, vomiting, diarrhea.
Abdominal pain/cramping, fever, weight loss.
Treatment
Follow general treatment guidelines.

26. Diverticulitis Pathophysiology Signs & Symptoms Treatment
Inflammation of small outpockets in the mucosal lining of the intestinal tract.
Common in the elderly.
Diverticulosis.
Signs & Symptoms
Abdominal pain/tenderness.
Fever, nausea, vomiting.
Signs of lower GI bleeding.
Treatment
General treatment guidelines.

27. Hemorrhoids Pathophysiology Signs & Symptoms Treatment
Mass of swollen veins in anus or rectum.
Idiopathic.
Signs & Symptoms
Limited bright red bleeding and painful stools.
Consider lower GI bleeding.
Treatment
General treatment guidelines.

28. Bowel Obstruction Pathophysiology
Blockage of the hollow space of the small or large intestines
Hernias

29. Bowel Obstruction
Pathophysiology
Intussusception

30. Bowel Obstruction
Pathophysiology
Volvulus

31. Bowel Obstruction
Pathophysiology
Adhesions

32. Bowel Obstruction Pathophysiology Signs & Symptoms Treatment
Other Causes
Foreign bodies, gallstones, tumors, bowel infarction
Signs & Symptoms
Decreased Appetite, Fever, Malaise
Nausea and Vomiting
Diffuse Visceral Pain, Abdominal Distention
Signs & Symptoms of Shock
Treatment
Follow general treatment guidelines.

33. Accessory Organ Diseases
GI Accessory Organs
Liver
Gallbladder
Pancreas
Vermiform Appendix

34. Appendicitis Pathophysiology Inflammation of the vermiform appendix.
Frequently affects older children and young adults.
Lack of treatment can cause rupture and subsequent peritonitis.

35. Appendicitis Signs & Symptoms Treatment
Nausea, vomiting, and low-grade fever.
Pain localizes to RLQ (McBurney’s point).
Treatment
Follow general treatment guidelines.

36. Cholecystitis Pathophysiology Inflammation of the Gallbladder
Cholelithiasis
Chronic Cholecystitis
Bacterial infection
Acalculus Cholecystitis
Burns, sepsis, diabetes
Multiple organ failure

37. Cholecystitis Signs & Symptoms Treatment URQ Abdominal Pain
Murphy’s sign
Nausea, Vomiting
History of Cholecystitis
Treatment
Follow general treatment guidelines.

38. Pancreatitis Pathophysiology Inflammation of the Pancreas
Classified as metabolic, mechanical, vascular, or infectious based on cause.
Common causes include alcohol abuse, gallstones, elevated serum lipids, or drugs.

39. Pancreatitis Signs & Symptoms Treatment Mild Pancreatitis
Epigastric Pain, Abdominal Distention, Nausea/Vomiting
Elevated Amylase and Lipase Levels
Severe Pancreatitis
Refractory Hypotensive Shock and Blood Loss
Respiratory Failure
Treatment
Follow general treatment guidelines

40. Hepatitis Pathophysiology Injury to Liver Cells Types of Hepatitis
Typically due to inflammation or infection.
Types of Hepatitis
Viral hepatitis (A, B, C, D, and E)
Alcoholic hepatitis
Trauma and other causes
Risk Factors

41. Hepatitis Signs & Symptoms Treatment URQ abdominal tenderness
Loss of appetite, weight loss, malaise
Clay-colored stool, jaundice, scleral icterus
Photophobia, nausea/vomiting
Treatment
Follow general treatment guidelines.
Use PPE and follow BSI precautions

42. Summary General Pathophysiology, Assessment, and Management
Specific Illnesses
Upper Gastrointestinal Diseases
Lower Gastrointestinal Diseases
Accessory Organ Diseases