Summary of "Chapter 19 Gastrointestinal and Urologic Emergencies"

Summary of Chapter 19: Gastrointestinal and Urologic Emergencies

This chapter covers the anatomy, common presentations, and emergency management of gastrointestinal (GI) and urologic emergencies, focusing on abdominal pain and related life-threatening conditions. The content emphasizes patient assessment, recognition of critical signs, and appropriate prehospital care.

Main Ideas and Concepts

1. Anatomy Overview

The abdominal cavity contains:
- Gastrointestinal system: solid and hollow organs
  - Solid organs: liver, kidneys, spleen, pancreas
  - Hollow organs: stomach, small and large intestines, fallopian tubes, urinary bladder, ureters
- Genital system:
  - Male: testicles, epididymis, vas deferens, seminal vesicles, prostate, penis
  - Female: ovaries, fallopian tubes, uterus, cervix, vagina
- Urinary system: kidneys (solid organs), ureters, bladder, urethra
The peritoneum lines the abdominal cavity; inflammation (peritonitis) causes severe pain.
The pancreas lies in the retroperitoneal space (behind the peritoneum).

2. Pathophysiology and Common Conditions

Shock and bleeding: Injury to solid organs often causes bleeding and shock; hollow organ injury may cause leakage of contents, leading to peritonitis.
Peritonitis: Inflammation of the peritoneum caused by blood, pus, bile, or infection.
Acute abdomen: Sudden, severe abdominal pain indicating a potentially serious condition.
Ileus: Paralysis of intestinal muscles causing gas/feces retention and distension.
Diverticulitis: Inflammation of pockets in colon walls, causing severe pain.
Cholecystitis: Gallbladder inflammation often due to gallstones.
Appendicitis: Infection/inflammation of the appendix; characterized by nausea, vomiting, fever, and rebound tenderness.
Ulcers: Mucous layer erosion causing bleeding and possible peritonitis.
Pancreatitis: Inflammation of the pancreas caused by gallstones, alcohol abuse, etc., with upper quadrant pain and possible sepsis.
Gastrointestinal hemorrhage: Acute or chronic bleeding in the GI tract; causes include esophagitis, esophageal varices, Mallory-Weiss syndrome.
Urinary tract infections (cystitis): Common in elderly females; can cause altered mental status.
Kidney stones: Cause severe pain and urinary obstruction.
Kidney failure: Acute (reversible) or chronic (progressive); chronic requires dialysis or transplant.
Gynecologic causes: Lower quadrant pain may relate to ovaries, fallopian tubes, uterus; pelvic inflammatory disease (PID) causes severe pain and characteristic “PID shuffle.”
Abdominal aortic aneurysm (AAA): Tearing abdominal pain with hypotension and shock; palpation can cause rupture.
Hernias: Protrusions of tissue; strangulated hernias are surgical emergencies.

3. Assessment and Management

Scene size-up: Standard precautions (BSI), ABCs, safe environment.
Vital signs: Respirations, pulse, blood pressure (avoid BP on arm with dialysis shunt).
Patient history: Ask about bowel habits, urination, pain characteristics, bleeding (color and quantity).
Physical exam:
- Gentle palpation of abdomen in all four quadrants
- Always palpate the painful quadrant last to avoid generalized tenderness
- Assess for pulsatile masses (AAA)
Signs of shock: Tachycardia, hypotension, altered mental status.
Positioning: Patients often prefer fetal position or sitting with knees flexed to reduce abdominal strain.
Treatment:
- Oxygen administration
- Manage shock with ABCs, oxygen, position of comfort, and blankets
- Control bleeding with direct pressure
- Rapid transport for life-threatening conditions (e.g., AAA, ruptured varices)
- Do NOT palpate suspected AAA
- For dialysis patients, monitor for missed treatments and complications like fluid overload and infection
Dialysis considerations:
- Dialysis filters blood and removes toxins
- Missed dialysis can lead to fluid buildup and respiratory distress
- Complications include hypotension, dysrhythmias, muscle cramps, bleeding at access site
- Avoid blood pressure on arm with dialysis shunt

4. Medical Terminology and Key Definitions

Anorexia: Loss of appetite
Emesis: Vomiting
Colic: Crampy abdominal pain
Ileus: Paralysis of intestinal muscles
Cystitis: Bladder inflammation
Nephritis: Kidney inflammation
Cholecystitis: Gallbladder inflammation
Diverticulitis: Colon inflammation

Methodology / Instructions for EMS Providers

Scene Size-Up
- Use standard precautions (BSI)
- Ensure scene safety
Primary Assessment
- Assess airway, breathing, circulation
- Check pulses in both feet (for signs of AAA or vascular compromise)
History Taking
- SAMPLE history including bowel and urinary habits
- Ask about bleeding (color and amount)
Physical Exam
- Inspect and gently palpate abdomen in all four quadrants
- Palpate the painful area last
- Look for signs of peritonitis (rigidity, rebound tenderness)
- Assess for pulsatile abdominal mass (do NOT palpate firmly if AAA suspected)
Vital Signs
- Monitor respirations, pulse, blood pressure
- Avoid blood pressure on dialysis shunt arm
Management
- Administer oxygen as needed
- Treat for shock: ABCs, oxygen, position of comfort (usually fetal or knees flexed)
- Control bleeding with direct pressure
- Rapid transport for suspected life-threatening conditions
- Monitor and manage dialysis complications
Patient Comfort
- Show empathy
- Position patient to reduce abdominal strain
Transport
- Transport promptly to appropriate facility
- Reassess frequently

Quiz / Review Points

The pancreas is a retroperitoneal organ.
Gallbladder is a hollow organ, not solid.
Peritonitis causes diffuse abdominal tenderness.
PID causes a characteristic shuffling gait.
Acute abdominal pain patients often prefer side-lying with knees flexed.
Strangulated hernia involves compromised circulation and requires surgery.
Tearing abdominal pain with shock may indicate AAA.
Loss of appetite = anorexia.
Cystitis = bladder inflammation.
Avoid blood pressure on arm with dialysis shunt.

Speakers / Sources

John (primary speaker and instructor throughout the video)
Doctor friend (referenced for clinical advice and anecdotes)
Daughter-in-law and mother (personal examples related to kidney disease and dialysis)

This summary encapsulates the key educational points, clinical signs, and EMS management strategies for gastrointestinal and urologic emergencies as presented in the video.