Chapter 32 Gastroenterology. Topics General Pathophysiology, Assessment, and Treatment Specific Illnesses General Pathophysiology, Assessment, and.

Chapter 32Chapter 32GastroenterologyGastroenterology

TopicsTopics

General Pathophysiology, Assessment, and Treatment

Specific Illnesses

General Pathophysiology, Assessment, and Treatment

Specific Illnesses

General General PathophysiologyPathophysiology 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.

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.

AbdominAbdominal Painal Pain Types

Visceral Somatic Referred

Causes Inflammation Distention Ischemia

Types Visceral Somatic Referred

Causes Inflammation Distention Ischemia

General General PathophysiologyPathophysiology

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

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

General General AssessmentAssessment 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

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

General General AssessmentAssessment Physical Exam

General assessment and vital signs

Abdominal assessment

• Inspection, Auscultation, and Palpation

• Cullen’s Sign

• Grey-Turner’s Sign

Physical ExamGeneral assessment and vital

signsAbdominal assessment

• Inspection, Auscultation, and Palpation

• Cullen’s Sign

• Grey-Turner’s Sign

General TreatmentGeneral 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.

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.

Specific IllnessesSpecific Illnesses The

Gastrointestinal System Upper

Gastrointestinal Tract

Lower Gastrointestinal Tract

Liver Gallbladder Pancreas Appendix

The Gastrointestinal System Upper

Gastrointestinal Tract

Lower Gastrointestinal Tract

Liver Gallbladder Pancreas Appendix

Causes Peptic Ulcer Disease Gastritis Varix Rupture Mallory-Weiss Tear Esophagitis Duodenitis

Causes Peptic Ulcer Disease Gastritis Varix Rupture Mallory-Weiss Tear Esophagitis Duodenitis

Upper Upper Gastrointestinal Gastrointestinal

BleedingBleeding

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.

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.

Upper Upper Gastrointestinal Gastrointestinal

BleedingBleeding

Esophageal VaricesEsophageal Varices Cause

Portal Hypertension Chronic

alcohol abuse and liver cirrhosis

Ingestion of caustic substances

Cause Portal

Hypertension Chronic

alcohol abuse and liver cirrhosis

Ingestion of caustic substances

Esophageal VaricesEsophageal Varices Signs & Symptoms

Hematemesis, Dysphagia Painless Bleeding Hemodynamic Instability Classic Signs of Shock

Treatment Follow General Treatment Guidelines.

Aggressive Airway Management Aggressive Fluid Resuscitation

Signs & Symptoms Hematemesis, Dysphagia Painless Bleeding Hemodynamic Instability Classic Signs of Shock

Treatment Follow General Treatment Guidelines.

Aggressive Airway Management Aggressive Fluid Resuscitation

Esophageal VaricesEsophageal Varices

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

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

Acute Acute GastroenteritisGastroenteritis 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

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

Acute Acute GastroenteritisGastroenteritis 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.

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.

GastroenteritisGastroenteritis

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.

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.

GastroenteritisGastroenteritis

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

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

Peptic UlcersPeptic Ulcers Pathophysiology

Erosions caused by gastric acid.

Terminology based on the portion of tract affected.

Causes: NSAID Use Alcohol/Tobacco Use H. pylori

Pathophysiology Erosions caused by

gastric acid. Terminology based

on the portion of tract affected.

Causes: NSAID Use Alcohol/Tobacco Use H. pylori

Peptic UlcersPeptic Ulcers

Signs & Symptoms Abdominal Pain Observe for signs of hemorrhagic rupture.

Acute pain, hematemesis, melena

Treatment Follow general treatment guidelines. Consider administration of histamine

blockers and antacids.

Signs & Symptoms Abdominal Pain Observe for signs of hemorrhagic rupture.

Acute pain, hematemesis, melena

Treatment Follow general treatment guidelines. Consider administration of histamine

blockers and antacids.

Pathophysiology Bleeding distal to the ligament of Treitz Causes

Diverticulosis Colon lesions Rectal lesions Inflammatory bowel disorder

Pathophysiology Bleeding distal to the ligament of Treitz Causes

Diverticulosis Colon lesions Rectal lesions Inflammatory bowel disorder

Lower Lower Gastrointestinal Gastrointestinal

BleedingBleeding

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).

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).

Lower Lower Gastrointestinal Gastrointestinal

BleedingBleeding

Ulcerative ColitisUlcerative Colitis Pathophysiology

Causes Unknown

Signs & Symptoms Abdominal Cramping Nausea, Vomiting,

Diarrhea Fever or Weight Loss

Treatment Follow general

treatment guidelines.

Pathophysiology Causes Unknown

Signs & Symptoms Abdominal Cramping Nausea, Vomiting,

Diarrhea Fever or Weight Loss

Treatment Follow general

treatment guidelines.

Crohn’s DiseaseCrohn’s Disease Pathophysiology

Causes unknown. Can affect the entire

GI tract. Pathologic

inflammation: Damages mucosa. Hypertrophy and

fibrosis of underlying muscle.

Fissures and fistulas.

Pathophysiology Causes unknown. Can affect the entire

GI tract. Pathologic

inflammation: Damages mucosa. Hypertrophy and

fibrosis of underlying muscle.

Fissures and fistulas.

Crohn’s DiseaseCrohn’s Disease

Signs and Symptoms Difficult to differentiate.

Clinical presentations vary drastically.

GI bleeding, nausea, vomiting, diarrhea. Abdominal pain/cramping, fever, weight loss.

Treatment Follow general treatment guidelines.

Signs and Symptoms Difficult to differentiate.

Clinical presentations vary drastically.

GI bleeding, nausea, vomiting, diarrhea. Abdominal pain/cramping, fever, weight loss.

Treatment Follow general treatment guidelines.

DiverticulitisDiverticulitis Pathophysiology

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.

Pathophysiology 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.

HemorrhoidsHemorrhoids Pathophysiology

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.

Pathophysiology 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.

Bowel ObstructionBowel Obstruction Pathophysiology

Blockage of the hollow space of the small or large intestines

Hernias

Pathophysiology Blockage of the

hollow space of the small or large intestines

Hernias

Bowel ObstructionBowel Obstruction Pathophysiology

Intussusception

Pathophysiology Intussusception

Bowel ObstructionBowel Obstruction Pathophysiology

Volvulus

Pathophysiology Volvulus

Pathophysiology Adhesions

Pathophysiology Adhesions

Bowel ObstructionBowel Obstruction

Bowel ObstructionBowel Obstruction Pathophysiology

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.

Pathophysiology 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.

Accessory Organ Accessory Organ DiseasesDiseases GI Accessory Organs

Liver Gallbladder Pancreas Vermiform Appendix

GI Accessory Organs Liver Gallbladder Pancreas Vermiform Appendix

AppendicitisAppendicitis

Pathophysiology Inflammation of the vermiform appendix. Frequently affects older children and young

adults. Lack of treatment can cause rupture and

subsequent peritonitis.

Pathophysiology Inflammation of the vermiform appendix. Frequently affects older children and young

adults. Lack of treatment can cause rupture and

subsequent peritonitis.

AppendicitisAppendicitis Signs & Symptoms

Nausea, vomiting, and low-grade fever. Pain localizes to RLQ

(McBurney’s point).

Treatment Follow

general treatment guidelines.

Signs & Symptoms Nausea, vomiting, and low-grade fever. Pain localizes to RLQ

(McBurney’s point).

Treatment Follow

general treatment guidelines.

CholecystitisCholecystitis Pathophysiology

Inflammation of the Gallbladder

Cholelithiasis Chronic

Cholecystitis Bacterial infection

Acalculus Cholecystitis Burns, sepsis,

diabetes Multiple organ failure

Pathophysiology Inflammation of the

Gallbladder Cholelithiasis Chronic

Cholecystitis Bacterial infection

Acalculus Cholecystitis Burns, sepsis,

diabetes Multiple organ failure

CholecystitisCholecystitis

Signs & Symptoms URQ Abdominal Pain

Murphy’s sign

Nausea, Vomiting History of Cholecystitis

Treatment Follow general treatment guidelines.

Signs & Symptoms URQ Abdominal Pain

Murphy’s sign

Nausea, Vomiting History of Cholecystitis

Treatment Follow general treatment guidelines.

PancreatitisPancreatitis

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.

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.

PancreatitisPancreatitis Signs & Symptoms

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

Signs & Symptoms 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

HepatitisHepatitis

Pathophysiology Injury to Liver Cells

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

Pathophysiology Injury to Liver Cells

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

HepatitisHepatitis Signs & Symptoms

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

Signs & Symptoms 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

SummarySummary

General Pathophysiology, Assessment, and Management

Specific Illnesses Upper Gastrointestinal Diseases Lower Gastrointestinal Diseases Accessory Organ Diseases

General Pathophysiology, Assessment, and Management

Specific Illnesses Upper Gastrointestinal Diseases Lower Gastrointestinal Diseases Accessory Organ Diseases