2. Incidence of GI/GU Disorders
Every year about 62 million people are
diagnosed with a gastrointestinal
disorder.
The incidence and prevalence of most
digestive diseases increase with age,
although there are exceptions.
3. Morbidity & Mortality of GI/GU
Disorders
In 1992, GI disorders cost nearly $107 billion
in direct health care expenditures.
Currently, GI disorders result in nearly 200
million sick days,
50 million visits to a physician,
16.9 million days lost from school,
10 million hospitalizations,
And nearly 200,000 deaths per year.
4. 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.
5. Etiology of Pain
Inflammation
Foreign chemical
Bacterial contamination
Stimulation of nerve endings.
Irritation
Stretching, distention, bleeding
6. Visceral vs. Somatic
Visceral pain
Caused by stimulation of autonomic nerve
fibers that surround a hollow viscus
Cramping or gas type
Generally diffuse drill
Somatic pain
Produced by Bacterial or chemical irritation
of autonomic nerve
Guarding
Don’t want to move
Superficial
7. Solid Organs
Dull and steady in nature.
More localized.
Bleeding
Within capsule,
Rupture;
8. Hollow Organs
Colicky, crampy, dull, or gassy,
Typically intermittent.
Diffuse and poorly localized.
Path of a tube.
The place where the patient is
feeling the most pain may not be
the most tender on palpation.
9. Hollow Organs
Usually associated with
nausea,
vomiting,
tachycardia,
diaphoresis;
Bleeding
within the organ itself;
10. Referred Pain
Definition
Pain in area removed from tissue that caused
the pain
Caused by visceral fibers that synapse in the
spinal cord
Cause
same spinal segment,
skin has more receptors,
unable to distinguish,
12. 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
13. General Assessment
Physical Exam
General assessment and vital
signs
Abdominal assessment
Inspection, Auscultation, and
Palpation, Percussion
Cullen’s Sign: Discoloration
around the umbical area
Grey-Turner’s Sign:
Discoloration in the flank area
15. 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.
22. 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
Systemic infections
23. 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.
24. Peptic Ulcers
Pathophysiology
Erosions caused
by gastric acid.
Terminology based
on the portion of
tract affected.
Causes:
Alcohol/Tobacco Use
H. pylori
25. Peptic 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.
26. Pathophysiology
Bleeding distal to the ligament of
Treitz
Causes
Diverticulosis
Colon lesions
Rectal lesions
Inflammatory bowel disorder
Lower Gastrointestinal Bleeding
27. 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 Gastrointestinal Bleeding
28. Crohn’s Disease
Pathophysiology
Inflammatory bowel
disease, ? Autoimmune
etiology
Can affect the entire GI
tract.
Pathologic inflammation:
Damages mucosa.
Hypertrophy and fibrosis of
underlying muscle.
Fissures and fistulas.
29. Crohn’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.
30. Diverticulitis
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.
31. Hemorrhoids
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.
38. Appendicitis
Pathophysiology
Inflammation of the vermiform
appendix.
Frequently affects older children
and young adults.
Lack of treatment can cause
rupture and subsequent
peritonitis.
39. Cholecystitis
Pathophysiology
Inflammation of the
Gallbladder
Cholelithiasis
Chronic
Cholecystitis
Bacterial infection
Acalculus
Cholecystitis
Burns, sepsis, diabetes
Multiple organ failure
40. 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.Viral Hepatitis
A viral inflammatory disease:
1. Hepatitis A Virus (HAV),
2. Hepatitis B Virus (HBV),
3. Hepatitis C Virus (HCV) aka non-A, non-B hepatitis,
4. Hepatitis D Virus (HDV) only occurs in individuals
with HBV,
5. Hepatitis E Virus (HEV).
44. Inflammatory or Immune-
Mediated Disease
Infectious Disease
Physical Obstruction
Hemorrhage
General Mechanisms of
Nontraumatic Tissue Problems
45. Differentiating GI and Urologic
Complaints
Pathophysiologic Basis of Pain
Causes of Pain
Types of Pain
Visceral pain
Referred pain
General Pathophysiology,
Assessment and Management
46. Risk Factors
Older Patients
History of Diabetes
History of Hypertension
Multiple Risk Factors
Renal and Urologic Emergencies
Acute Renal Failure
Chronic Renal Failure
Renal Calculi
Urinary Tract Infection
Renal and Urologic Emergencies
47. Acute Renal Failure
Pathophysiology
Prerenal Acute Renal Failure
Dysfunction before the level of kidneys
Most common and most easily reversible
Renal Acute Renal Failure
Dysfunction within the kidneys
themselves
Postrenal Acute Renal Failure
Dysfunction distal to the kidneys
48. Acute Renal Failure
Assessment
Focused History
Change in urine output
Swelling in face, hands, feet, or
torso
Presence of heart palpitations or
irregularity
Changes in mental function
50. Acute Renal Failure
Physical
Assessment
Edema of face,
hands, or feet
Abdominal
findings
dependent on
the cause of
ARF
51. Renal Calculi
Pathophysiology
Results when “too
much insoluble
stuff”
accumulates in
the kidneys.
Stone types
Calcium salts
Struvite stones
Uric acid
Cystine
52. Renal Calculi
Assessment
Focused History
Severe pain in one flank that increases in
intensity and migrates from the flank to the
groin
Painful, frequent urination with visible
hematuria
Prior history of calculi
Physical Exam
Difficult due to patient discomfort
Tachycardia with pale, cool, and moist skin
53. Urinary Tract Infection
Pathophysiology
Risk Factors
Increased risk in female or catheterized
patients
Sexual activity
Lower and Upper UTIs
Urethritis
Cystitis
Prostatitis
Pyelonephritis
Community-acquired vs. nosocomial infections
54. Urinary Tract Infection
Assessment
Focused History
Abdominal pain
Frequent, painful urination
A “burning sensation” associated with
urination
Difficulty beginning and continuing to
void
Strong or foul-smelling urine
Similar past episodes