Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 6 Gastroenterology

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics General Pathophysiology, Assessment, and Management Specific Illnesses

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Abdominal Pain Types –Visceral –Somatic –Referred Causes –Inflammation –Distention –Ischemia

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment (1 of 2) 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

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment (2 of 2) Physical Exam –General Assessment and Vital Signs –Abdominal Assessment Inspection, auscultation, and palpation Cullen’s sign Grey-Turner’s sign

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Treatment Maintain the airway. Support breathing. –High-flow, high-concentration oxygen or assisted ventilations. Maintain circulation. Monitor vital signs and cardiac rhythm. Establish IV access. Transport in position of comfort.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Specific Illnesses The Gastrointestinal System –Upper Gastrointestinal Tract –Lower Gastrointestinal Tract –Liver –Gallbladder –Pancreas –Appendix

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Upper Gastrointestinal Bleeding (1 of 2) Causes –Peptic Ulcer Disease –Gastritis –Varix Rupture –Mallory-Weiss Tear –Esophagitis –Duodenitis

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Upper Gastrointestinal Bleeding (2 of 2) 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Esophageal Varices (1 of 2) Cause –Portal Hypertension Chronic alcohol abuse and liver cirrhosis Ingestion of caustic substances

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Esophageal Varices (2 of 2) Signs and Symptoms –Hematemesis, dysphagia –Painless bleeding –Hemodynamic instability –Classic signs of shock Treatment –Follow general treatment guidelines. Aggressive airway management Aggressive fluid resuscitation

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Acute Gastroenteritis (1 of 2) 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

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Acute Gastroenteritis (2 of 2) Signs and 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Peptic Ulcers (1 of 2) Pathophysiology –Erosions caused by gastric acid –Terminology based on the portion of tract affected –Causes: NSAID use Alcohol/tobacco use H. pylori

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Peptic Ulcers (2 of 2) Signs and 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Lower Gastrointestinal Bleeding (1 of 2) Pathophysiology –Bleeding distal to the ligament of Treitz –Causes Diverticulosis Colon lesions Rectal lesions Inflammatory bowel disorder

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Lower Gastrointestinal Bleeding (2 of 2) Signs and 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).

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Ulcerative Colitis Pathophysiology –Causes Unknown Signs and Symptoms –Abdominal Cramping –Nausea, Vomiting, Diarrhea –Fever or Weight Loss Treatment –Follow general treatment guidelines.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Crohn’s Disease (1 of 2) Pathophysiology –Causes unknown –Can affect the entire GI tract –Pathologic inflammation: Damages mucosa Hypertrophy and fibrosis of underlying muscle Fissures and fistulas

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Crohn’s Disease (2 of 2) 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diverticulitis Pathophysiology –Inflammation of small outpockets in the mucosal lining of the intestinal tract –Common in the elderly –Diverticulosis Signs and Symptoms –Abdominal pain/tenderness –Fever, nausea, vomiting –Signs of lower GI bleeding Treatment –General treatment guidelines

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hemorrhoids 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

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Bowel Obstruction (1 of 5) Pathophysiology –Blockage of the hollow space of the small or large intestines –Hernias

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Bowel Obstruction (2 of 5) Pathophysiology –Intussusception

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Bowel Obstruction (3 of 5) Pathophysiology –Volvulus

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology –Adhesions Bowel Obstruction (4 of 5)

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Bowel Obstruction (5 of 5) 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 Treatment –Follow general treatment guidelines.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Accessory Organ Diseases GI Accessory Organs –Liver –Gallbladder –Pancreas –Vermiform Appendix

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Appendicitis (1 of 2) Pathophysiology –Inflammation of the vermiform appendix. –Frequently affects older children and young adults. –Lack of treatment can cause rupture and subsequent peritonitis.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Appendicitis (2 of 2) Signs and Symptoms –Nausea, vomiting, and low-grade fever. –Pain localizes to RLQ (McBurney’s point). Treatment –Follow general treatment guidelines.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cholecystitis (1 of 2) Pathophysiology –Inflammation of the Gallbladder –Cholelithiasis –Chronic Cholecystitis Bacterial infection –Acalculus Cholecystitis Burns, sepsis, diabetes Multiple organ failure

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Cholecystitis (2 of 2) Signs and Symptoms –URQ abdominal pain Murphy’s sign –Nausea, vomiting –History of cholecystitis Treatment –Follow general treatment guidelines.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pancreatitis (1 of 2) 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pancreatitis (2 of 2) 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 Treatment –Follow general treatment guidelines.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hepatitis (1 of 2) 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

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hepatitis (2 of 2) Signs and 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.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary General Pathophysiology, Assessment, and Management Specific Illnesses –Upper Gastrointestinal Diseases –Lower Gastrointestinal Diseases –Accessory Organ Diseases