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61 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
What behaviors predispose patients to GI disorders?
Smoking, ingestion of caustic agents, low-fiber diet, alcohol, stress, along with certain medications like NSAIDS, acetyislicylic acid, and anticoagulants.
31.5
Table 31-2
portal veins
Veins of the stomach which transport venous blood from the GI tract directly to the liver for the processing of the nutrients that have been absorbed.
31.6
peristalsis
Rhythmic contractions of the esophagus and intestines to push food along for absorption though the intestines.
31.6
chyme
The partially digested food that exits the stomach entering the duodenum.
31.27
Where is one place where the liver, pancreas, and gall bladder connect to the digestive system?
The duodenum.
31.6
Where is the bile in the gall bladder made?
Within the liver, which helps to dissolve fats.
31.6
Functions of the liver
Convert glycogen into glucose
Detoxifies drugs
Completes breake down of dead WBC and RBC
Stores vitamins and minerals
31.7
90% of absorptions occurs in the __________.
intestines
31.7
What is the primary role of the large intestine?
reabsorption of water
31.7
The appedix is attach to the...
beginning of the ascending colon, at the cecum.
31.7
What happens when the large instestine does not work?
Leads to soft stool or diarrhea
31.8
The entire digestion process normally takes _______ hours.
8 to 72
31.8
What are the three major pathologic conditions are responsible for diseases of GI tract?
Hypovolemia, infection, and inflammation.
31.8
Hypovolemia is either caused by...
dehydration or hemorrhage.
31.8
What are a couple main causes of dehydration?
Vomiting and diarrhea.
31.9
Infection within the GI system typically occurs by...
either ingestion of severely infectious food or a rupture in of the system.
31.9
The process of inflammation
In the area under "attack" the body will vasodilate, mobilization of WBC, and changes within cellular metabolic process occur. All of this to allow cells to move from normal operation mode into a state of being under siege. Inflammation assists WBC in either destroying or at least walling off the invading agents.
31.9-10
Basic s/s of inflammation
redness, swelling, and tenderness
31.10
Notes on GI Bleeding
It is a symptom of another disease, not a disease itself. Common causes of are inflammation, varices, tear, cancer, dilated veins, ulcers, infections, and hemmorrhods (lower).
31.10-11
Esophageal varices
Occur when the amount of prssure within the blood vessels surrounding the esophagus increases. The esophageal blood vessels eventually deposit their blood into the portal system. If the liver is back up, it will dilate the vessels until it leaks into the esophagus.
31.10
What is the main cause of portal hypertension (thus leading to varices)?
In industrialized countries chronic alcohol consumption which damages the interior of the liver, leading to slower blood flow.
In developing countries, viral hepatitis is the main culprit causing liver damage.
31.10-11
Mallory Weiss Syndrom
The junction between the esophagus and the stomach tears, causing severe bleeding and potentially death. Vomiting increases the pressure and can increase the tearing. More prevalent in older adults and older children.
31.11
Hemmorrhods
Created by swelling and inflammation of the blood vessels surround the rectum. Often cause by increase pressure on the rectum, ie prenancy, straining at the stool, and chronic constipation.
31.11
Peptic Ulcer Disease
When the protective layer erodes within the stomach and duodenum allowing acid to eat into the organ itself over the course of weeks, months, or even years. Cause by infections, and NSAIDs. Alcohol and smoking increase gastric acidity. Occurs more often in elderly.
31.11
Cholecystits
Caused by an obstruction of the cystic duct leading from the gallbladder to the duodenum, usually by gallstones. S/s are sever RUQ pain, radiating to the right shoulder, positive Murphy's sign (hint), N/V, fever, jaundice, and tachycardia.

Females have it two to three times more often than males, while older patiens are more prone than younger adults.
More prevalence in Caucasians than in African Americans. People who or overweight or a recent extreme weight loss. Thus the classic profile is: fair, fat, female, and fifty.
31.11-12
Wikipedia
Murphy's sign is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers), the test is considered positive. A positive test also requires no pain on performing the maneuver on the patient's left hand side.
Appendicitis
Infection of the appendix. Often caused by accumulation of feces, within the appendix. If left uncheck can rupture, causing peritonitis, sepsis, and death.

Occcurs more often in adolescents. more deadly in elderly. Males are slighty more prone to developing appendicits than females.
31.12
Diverticulitis
Buldges within the intestinal wall, which turn into pouches called diverticula. Feces may get caught in the diverticula and cause localized inflammation and infection.

Cause by lack of fiber. As stool is more solid it takes more contractions and subsequently increase pressure within the colon to move.

Typical in adults over 40 with low fiber diet.
31.12
Pancreatits
When the tube from the pancreas to the intestines becomes blocked and the enzymes becom activated and begin to do their job within the tube.

Factors that contribute include alcohol consumption and gallstones. Other causes include medication reactions, truama, cancer, and very high triglyceride levels.

More common in males, especially African Americans aged 35 to 64 years old.
31.13
Ulcerative colitis
Generalize inflammation of the colon, which causes a thinning in the linning of the intestines. This results in a weakened, dilated colon, prone to infection by bacteria and bleeding.

Unknown cause.
Disease of the young with most patients between 15 and 30 years of age. Equal between men and women. 20% of patients with this disease have family members with the disease.
31.13
Crohn Disease
Believe to be an autoimmune condition where the immune system attacks the entire immune system.

Most patients are between 20 and 30 years old. More prevalent in men than women. Very uncommon in African Americans however Jewish descent have increase incidence.
31.13
Gastroenteritis
A family of conditions revolving around a central theme of diarrhea, hausea, and vomiting.

Consider acute when it is an infection caused by a bacterial or viral organism rather than medications, toxins, or chemo.
31.13
Hepatitis A and E transmit by
fecal to oral route

At high risk when you travel to countries where food and water is not cleaned.
31.13
Hepatitis B, C, and D transmit by
person to person, typically by sexually or blood to blood.

IV drug users and prostitutes are at high risk.
31.13
Bowel obstruction
Decrease motility or the bowel either by paralysis of the intestines or a change in the diameter of their lumen.

Paralysis can be causes by infection kidney disease, impaired blood flow, narcotics and anesthetics.

Intestinal lumen can be compromise be neoplasm (ie. tumors), objects patients have swallowed, strictures (narrowing of the lumen due to damage in the intestinal wall), hernia, or twisting intestines (intussusceptions).
31.13
Remain alert to the four causes of acute abdominal pain that are immediate life threats:
acute myocardial infarction (AMI), ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy, and a rupture viscus (any hollow organ).
31.14
How can recent foot intake play a role?
Fatty foods cause the gallbladder to contract, releasing bile, which may lead to pain especially in patients with gallbladder disease. Spicy foods act as a direct irritant on the GI tract. Milk products contain surar lactose which is intolerable by some, which will caused bloating, pain, and often violent diarrhea within minutes of ingestion of dairy products.
31.15
Orthostatic VS
Take BP and HR laying down, than stand pt. After a minute or two take BP and HR. If HR increase by = or >10bpm and BP decrease = or >10 mm Hg than orthostatic VS are positive for changes. Patient has probably loss a lot of blood, dehydrated, etc.
31.15
striae
Stretch marks on the abdomen cause by size change.
31.27
protuberant
A convex or distended shape of the abdomen. This can be caused by edema, pregnancy, and organ enlargement.
31.27 and 16
scaphoid
A concave shape of the abdomen. This can be caused by evisceration.
31.27
Normal bowels sounds
Gurgles and clicks occur 5 to 30 times per minute.
31.16
Abnormal bowel sounds
Borborygmi "stomach growling" indicates strong contractions of the intestines, often present with diarrhea.

Hyperperistalisis or hypo hint the name.

Hypo is when you don't hear anything for 15 to 20 seconds. For a true indication, you would have to listen for 2 minutes.
31.16
A rigid abdomen may indicate...
hemorrhage or infection.

Try and make sure it is not just because the patient is tensing up. Have the pt breathe with an open mouth. It is more difficult for the stomach to contract during mouth breathing.
31.17
What is your key component in a physical exam of a GI Bleed?
How much blood have they lost. Focus your assessment on evaluation for shock. Determine whether the patient is compensating for fluid loss. Orthostatic vital signss are the key to gauging the degree of fluid loss in the prehospital setting.
31.19
S/s of Esophageal Varicies
Initially the patient will show signs of liver disease including fatigue, weight loss, jaundice, anorexia, edema in the abdomen, pruritus, abdominal pain, and N/V. A very gradual disease that may take months to years to reach extremes. The rupture varices brings about sudden severe problems including severe dysphagia, vomiting of bright red blood, hypotension, and signs of shock.
31.20
Mallory Weiss Syndrome is often linked to what?
Vomiting, especially in women dealing with hyperemesis gravidarum (severe vomiting related to pregnancy).
31.20
S/s of hemorrhoids
Bright red blood during defecation. Additionally the patient may experience itching and a small mass on the rectum.
31.20
S/s of Peptic Ulcer Disease
Classic s/s include burning or gnawing pain in the stomach that subsides or diminishes immediately after eating and than reemerges 2 to 3 hours later. N/V, belching, and heartburn are common as well. GI bleeding may occur as the erosion becomes severe.
31.20
S/s Cholecystitis
After patient eats a fatty meal, about 2 or 3 hours latter they develop severe uppper right quadrant abdominal pain.
31.20
S/s of Appendicitis
Classic presentation is pain periumbilical (around the navel) that migrates to the right lower quadrant. The duration of the pain is usually less than 48 hours. As the condition progresses, the pain will change characteristics. Rebound tenderness is a sign of perforation of the appendix with resultnat peritonitis. Additionally patient may develop N/V and a fever.

Symptoms are atypical in the young elderly, and pregnant patients.
31.21
S/s of Diverticulitis
Typically they will have abdominal pain localized to the left lower quadrant. If it becomes infected it will bring along fever, malaise, body aches, chills, nausea, and vomiting. May also causes constipation and bowel obtruction as the infection cases narrowing.
31.21
S/s of pancreatitis
Pain tends to localize to the epigastic area in the RUQ. Often describe as sharp. May radiate to the back. Patients may also experience N/V, fever, tachycardia, hypotension, and muscle spasms in the extremities as a result of hypocalcemia.

Most severe cases will cauese severe and uncontrolled internal hemorrage as the blood vessels of the pancreas are destroyed.
31.21
What two signs are classic of retroperitoneal bleeding?
Grey Turner's Sign, bruising in the flanks, and Cullen's sign, bruising around the umbilicus.
31.21
S/s of ulcerative colitis
Gradual onset of bloody diarrhea and abdominal pain, which can range from mild to severe. Other s/s include joint pain, skin lesions, fever, fatigues, loss of appetite.
31.21
S/s of Crohn Disease
Chronic complaint of abdominal pain often in the RLQ. Additionally patient may experience rectal bleeding, weight loss, diarrhea, arthritis, skin problems, and fevers.
31.21
S/s of gastroenteritis
Abdominal pain, often describe as cramping, N/V/D and fever.
31.21
S/s of hepatis
All hepaitis are associated with the same s/s. The first phase includes aching joints, weakness, fatigue, nausea, vomiting, anorexia, urticaria, and pruritus (itching).
The second phase includes more damage to the liver that result in liver failure. It is characterized by acholic stools (Light, clay colored), darkening of the urine, jaudice, and ictericsclera (yellow sclera).
31.21
S/s of bowel obstruction
Abdominal pain and fullness. Initially diarrhea may occur. Decrease bowel sounds. N/V are common in later stages, with emesis and the patient's breath having a feculent odor. Eventually, infection may occur, leading to sepsis.
31.21
What is the only true contraindication to pain management in the prehospital setting for the GI patient?
Hypotension
31.22
Does dried blood pose an infectious threat?
Yes, for example Hepititis B can remain infectious even in dried blood for more than a week.
31.23
Notes on pain medications with Cholecystitis
Morphine is believed to cause contractions of the bile movement out of the gallbladder, thus increasing the pain.
31.24