GastroenterologyGastroenterology

SectionsSections 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.

AbdominAbdominal Painal Pain Types

Visceral Somatic Referred

Causes Inflammation Distention Ischemia

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

General General AssessmentAssessment Physical Exam

General assessment and vital signs Abdominal 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.

Specific IllnessesSpecific Illnesses 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

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.

Upper Upper Gastrointestinal Gastrointestinal

BleedingBleeding

Esophageal VaricesEsophageal Varices 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

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

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.

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.

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

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.

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).

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.

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.

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.

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.

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.

Bowel ObstructionBowel Obstruction Pathophysiology

Blockage of the hollow space of the small or large intestines

Hernias

Bowel ObstructionBowel Obstruction Pathophysiology

Intussusception

Bowel ObstructionBowel Obstruction Pathophysiology

Volvulus

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.

Accessory Organ Accessory Organ DiseasesDiseases 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.

AppendicitisAppendicitis 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

CholecystitisCholecystitis 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.

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

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

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

GastroenterologyGastroenterology General Pathophysiology,

Assessment, and Management Specific Illnesses

Upper Gastrointestinal Diseases Lower Gastrointestinal Diseases Accessory Organ Diseases