Chapter 32
Gastroenterology
Topics
 General Pathophysiology,
Assessment, and Treatment
 Specific Illnesses
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.
Abdominal
Pain
 Types
 Visceral
 Somatic
 Referred
 Causes
 Inflammation
 Distention
 Ischemia
General Pathophysiology
 Pain from hollow organs tends to
be vague and nondescript,
whereas pain from solid organs
tends to be localized.
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
General Assessment
Physical Exam
 General assessment and vital
signs
 Abdominal assessment
• Inspection, Auscultation, and
Palpation
• Cullen’s Sign
• Grey-Turner’s Sign
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.
Specific Illnesses
 The
Gastrointestinal
System
 Upper
Gastrointestinal
Tract
 Lower
Gastrointestinal
Tract
 Liver
 Gallbladder
 Pancreas
 Appendix
Upper Gastrointestinal
Bleeding
 Causes
Peptic Ulcer Disease
Gastritis
Varix Rupture
Mallory-Weiss Tear
Esophagitis
Duodenitis
Upper Gastrointestinal
Bleeding
 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.
Esophageal Varices
 Cause
 Portal
Hypertension
 Chronic
alcohol abuse
and liver
cirrhosis
 Ingestion of
caustic
substances
Esophageal Varices
 Signs & Symptoms
 Hematemesis, Dysphagia
 Painless Bleeding
 Hemodynamic Instability
 Classic Signs of Shock
 Treatment
 Follow General Treatment Guidelines.
 Aggressive Airway Management
 Aggressive Fluid Resuscitation
Esophageal Varices
 Prehospital placement of
nasogastric tubes should be
avoided in cases of suspected
esophageal varices.
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 (NSAIDs, chemotherapeutics)
 Systemic infections
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.
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.
Gastroenteritis
 Most cases of gastroenteritis are
viral. Patients with bacterial
gastroenteritis tend to be
considered more ill than those
with viral gastroenteritis.
Peptic Ulcers
 Pathophysiology
 Erosions caused by
gastric acid.
 Terminology based
on the portion of
tract affected.
 Causes:
 NSAID Use
 Alcohol/Tobacco Use
 H. pylori
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.
Lower Gastrointestinal
Bleeding
 Pathophysiology
Bleeding distal to the ligament of Treitz
Causes




Diverticulosis
Colon lesions
Rectal lesions
Inflammatory bowel disorder
Lower Gastrointestinal
Bleeding
 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).
Ulcerative Colitis
 Pathophysiology
 Causes Unknown
 Signs &
Symptoms
 Abdominal Cramping
 Nausea, Vomiting,
Diarrhea
 Fever or Weight Loss
 Treatment
 Follow general
treatment guidelines.
Crohn’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 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.
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.
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.
Bowel Obstruction
 Pathophysiology
 Blockage of the
hollow space of the
small or large
intestines
 Hernias
Bowel Obstruction
 Pathophysiology
 Intussusception
Bowel Obstruction
 Pathophysiology
 Volvulus
Bowel Obstruction
 Pathophysiology
 Adhesions
Bowel 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 Diseases
 GI Accessory Organs
Liver
Gallbladder
Pancreas
Vermiform Appendix
Appendicitis
 Pathophysiology
Inflammation of the vermiform appendix.
Frequently affects older children and young
adults.
Lack of treatment can cause rupture and
subsequent peritonitis.
Appendicitis
 Signs & Symptoms
 Nausea, vomiting, and low-grade fever.
 Pain localizes to RLQ
(McBurney’s point).
 Treatment
 Follow
general
treatment
guidelines.
Cholecystitis
 Pathophysiology
 Inflammation of the
Gallbladder
 Cholelithiasis
 Chronic
Cholecystitis
 Bacterial infection
 Acalculus
Cholecystitis
 Burns, sepsis,
diabetes
 Multiple organ failure
Cholecystitis
 Signs & Symptoms
URQ Abdominal Pain
 Murphy’s sign
Nausea, Vomiting
History of Cholecystitis
 Treatment
Follow general treatment guidelines.
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.
Pancreatitis
 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
Hepatitis
 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
Hepatitis
 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
Summary
 General Pathophysiology,
Assessment, and Management
 Specific Illnesses
Upper Gastrointestinal Diseases
Lower Gastrointestinal Diseases
Accessory Organ Diseases