GI Emergencies

7/29/2019 GI Emergencies

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Brad Collins, CCEMT-P

Emergencies


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General Pathophysiology, Assessment,

and Management

Specific Illnesses


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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.


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Types Visceral

Somatic

Referred

Causes Inflammation

Distention Ischemia


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Scene Size-up and Initial Assessment Scene clues.

Identify and treat life-threatening conditions.

Focused History Obtain SAMPLE history.

Obtain OPQRST history.

Associated symptoms Pertinent negatives


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Physical Exam General Assessment and Vital Signs

Abdominal Assessment

Inspection, auscultation, and palpation

Cullens sign

Grey-Turners sign


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Maintain the airway.

Support breathing. High-flow, high-concentration oxygen or assisted

ventilations.

Maintain circulation.

Monitor vital signs and cardiac rhythm.

Establish IV access. Pain Medication as needed

Transport in position of comfort.


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The GastrointestinalSystem Upper

Gastrointestinal Tract

LowerGastrointestinal Tract

Liver

Gallbladder

Pancreas Appendix


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Causes Peptic Ulcer Disease

Gastritis

Esophageal Varix Rupture

Mallory-Weiss Tear

Esophagitis

Duodenitis


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Signs and 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.


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Cause

Portal

Hypertension

Chronic alcoholabuse and liver

cirrhosis

Ingestion of caustic

substances


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Signs and Symptoms Hematemesis, dysphagia

Painless bleeding

Hemodynamic instability Classic signs of shock

Treatment Follow general treatment guidelines.

Aggressive airway managementAggressive fluid resuscitation


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Cause Damage to Mucosal GI Surfaces

Pathologic inflammation causes hemorrhage and

erosion of the mucosal and submucosal layers of the GItract.

Risk Factors

Alcohol and tobacco use

Chemical ingestion (NSAIDs, chemotherapeutics) Systemic infections


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Signs and Symptoms

Rapid onset of severe vomiting and diarrhea

Hematemesis, hematochezia, melena

Diffuse abdominal pain Classic signs of shock

Treatment


Fluid volume replacement. Consider administration of antiemetics.


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Similar to Acute Gastroenteritis Long-term mucosal changes or permanent

damage

Primarily due to microbial infection More frequent in developing countries



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Pathophysiology Erosions caused by

gastric acid

Terminology basedon the portion oftract affected

Causes: NSAID use

Alcohol/tobacco use H. pylori


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Signs and Symptoms Abdominal pain.

Observe for signs of

hemorrhagic rupture.Acute pain, hematemesis,

melena

Treatment

Follow general treatmentguidelines.

Consider administration of

histamine blockers and

antacids.


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Pathophysiology Bleeding distal to the ligament

of Treitz

Causes Diverticulosis

Colon lesions

Rectal lesions

Inflammatory bowel disorder


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Signs and Symptoms Determine acute vs.

chronic.

Quantity/color of blood instool.

Abdominal pain.

Signs of shock.

Treatment Follow general treatment

guidelines. Establish IV access with

large-bore catheter(s).


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Pathophysiology Causes Unknown

Signs and Symptoms Abdominal Cramping

Nausea, Vomiting, Diarrhea Fever or Weight Loss


guidelines.


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Pathophysiology Causes unknown

Can affect the entire GI

tract

Pathologic

inflammation: Damages mucosa

Hypertrophy and fibrosis of

underlying muscle

Fissures and fistulas


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Signs and Symptoms Difficult to differentiate Clinical presentations vary

drastically.

GI bleeding, nausea,vomiting, diarrhea

Abdominal pain/cramping,fever, weight loss


guidelines.


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Pathophysiology Inflammation of small out-pockets

in the mucosal lining of theintestinal tract

Common in the elderly

Diverticulitis Signs and Symptoms

Abdominal pain/tenderness

Fever, nausea, vomiting

Signs of lower GI bleeding

Treatment General treatment guidelines


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Pathophysiology Mass of swollen veins in anus or

rectum

Idiopathic

Signs and Symptoms

Limited bright red bleeding and

painful stools

Consider lower GI bleeding

Treatment

General treatment guidelines


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Pathophysiology Blockage of the

hollow space of the

small or large

intestines Hernias


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o Intestinal gas looks

black on an x-ray and

is useful at providing a

natural contrast for

detecting abdominaldisease.

o The best way to

evaluate an x-rayshowing abdominal

gas is to determine

the bowel gas pattern.


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Pathophysiology Intussusception


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Pathophysiology Volvulus


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Pathophysiology

Adhesions

Bowel Obstruction (4 of 5)


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Pathophysiology Other Causes Foreign bodies, gallstones, tumors,

bowel infarction

Signs and Symptoms Decreased appetite, fever,

malaise

Nausea and vomiting

Diffuse visceral pain, abdominal

distention Signs and symptoms of shock


guidelines.


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GI Accessory Organs Liver

Gallbladder

Pancreas Vermiform Appendix


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Pathophysiology Inflammation of the vermiform appendix.

Frequently affects older children and young adults.

Lack of treatment can cause rupture andsubsequent peritonitis.


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Signs and Symptoms Nausea, vomiting, and low-grade fever.

Pain localizes to RLQ (McBurneys point).

Treatment



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Pathophysiology Inflammation of the

Gallbladder

Cholelithiasis

Chronic Cholecystitis Bacterial infection

Acalculus Cholecystitis Burns, sepsis, diabetes

Multiple organ failure


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Signs and Symptoms URQ abdominal pain

Murphys sign

Nausea, vomiting History of cholecystitis



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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.


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Signs and Symptoms Mild Pancreatitis Epigastric pain, abdominal distention, nausea/vomiting

Elevated amylase and lipase levels

Severe Pancreatitis Refractory hypotensive shock and blood loss

Respiratory failure



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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


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Signs and Symptoms URQ abdominal tenderness

Loss of appetite, weight loss, malaise

Clay-colored stool, jaundice, scleral icterus Photophobia, nausea/vomiting


Use PPE and follow BSI precautions.


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General Pathophysiology, Assessment,

and Management

Specific Illnesses

Upper Gastrointestinal Diseases Lower Gastrointestinal Diseases

Accessory Organ Diseases


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GI Emergencies

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