Chapter 32: Gastroenterology

Gastrointestinal Disease Risk Factors Excessive alcohol consumption Excessive smoking Increased stress Ingestion of caustic substances Poor bowel habits Types of Gastrointestinal Pain Visceral- dull, poorly located pain that originates in the walls of hollow organs. Somatic- sharp, localized pain that originates in walls of the body such as skeletal muscles. o Peritonitis- inflammation of the peritoneum, which lines the abdominal cavity. Referred- pain that originates in a region other than where it is felt. General Assessment o Scene Size-Up o History Taking Onset of problem Provocation/Palpation Quality Region/radiation Severity Time Associated Symptoms Pertinent Negatives o Physical Exam Signs/Symptoms Allergies Medications Past Medical History Last Oral intake Events leading up to illness/injury o Signs of fluid loss/Internal hemorrhage Cullens sign- Ecchymosis in the periumbilical area. Grey-Turners Sign- Ecchymosis in the flank. -Highest priority when treating a patient w/abdominal pain is to secure and maintain the ABCs -Persistent abdominal pain lasting >6hrs always requires transport. Upper GI Tract

Mouth Esophagus Stomach Duodenum o Ligament of Treitz- ligament that supports the duodeno-jejunal junction. Major Causes of Upper GI Hemorrhage- bleeding in the gastrointestinal tract proximal to the ligament of Treitz Peptic ulcer disease- erosion caused by gastric acid. Accounts for >50% of upper GI bleeds. Gastritis- inflammation of the stomach and intestines, accounts of 25% of upper GI bleeds Varix Rupture- swollen vein of the esophagus, when ruptured and hemorrhage, the mortality rate is >35%. Mallory-Weiss tear- esophageal laceration, usually secondary to vomiting. Esophagitis- inflammation of the esophagus. Duodenitis- inflammation of the duodenum. Upper GI Diseases Esophageal Varices- swollen vein of the esophagus, can ruptured and hemorrhage. Alcohol consumption is the primary cause of esophageal varices. o Cirrhosis- degenerative disease of the liver also associated w/alcohol consumption. Acute Gastroenteritis- sudden onset of inflammation of the stomach and intestines. Chronic Gastroenteritis- non-acute inflammation of the gastrointestinal mucosa. Peptic ulcers- erosion caused by gastric acid. o Zollinger-Ellison syndrome- condition that causes the stomach to secrete excessive amounts of hydrochloric acid and pepsin. Lower GI Tract Jejunum Ileum Large Intestine Rectum Anus Major Causes of Lower GI Hemorrhage- bleeding in the gastrointestinal tract distal to the ligament of Treitz Diverticulosis Colon Lesions Rectal Lesions Inflammatory bowel disorderLower GI Diseases

Ulcerative colitis- idiopathic inflammatory bowel disorder (IBD) o Pancolitis- ulcerative colitis spread throughout the entire colon. o Proctitis- ulcerative colitis limited to the rectum. Colic/Colicky- acute pain associated w/cramping or spasms in the abdominal organs Crohns disease- idiopathic inflammatory bowel disorder associated w/the small intestine. Diverticulitis- inflammation of diverticula o Diverticula- small outpouchings in the musosal lining of the intestinal tract. o Diverticulosis- presence of diverticula, w/or without associated bleeding. Hemorrhoids- small mass of swollen veins in the anus or rectum. Bowel obstruction- blockage of the hollow space within the intestines. o Hernia- protrusion of an organ through its protective sheath. o Intussusception- condition that occurs when part of an intestine slips into the part just distal to itself. o Adhesion- union of normally separate tissue surfaces by a fibrous band of new tissue. o Volvulus- twisting of the intestine on itself. o Infarction- area of dead tissue cased by lack of blood. Accessory Organ Diseases Appendicitis- inflammation of vermiform appendix at the juncture of the large and small intestines. o McBurneys Point- common site of pain from appendicitis, one to two inches above the anterior iliac crest in a direct line w/the umbilicus Cholecystitis- is an inflammation of the gallbladder. o Murphys sign- pain caused when an inflamed gallbladder is palpated by pressing under the right costal margin. Pancreatitis- inflammation of the pancreas. o Causes of acute Pancreatitis Alcohol abuse Gallstones Elevated serum lipids Drug-induced o Signs and symptoms Mild Pancreatitis Epigastric pain Abdominal distention n/v elevated amylase and lipase Severe Pancreatitis

Refractory Hypotensive shock Blood loss Respiratory failure Hepatitis- involves any injury to hepatocytes (liver cells) associated w/an inflammation of infection.