Gastrointestinal And Urologic Emergencies

Front 1

SAMPLE questions for GI and Urologic emergencies

Back 1

Nausea and vomiting. Do you feel nauseous? Have you vomited? How many times? Over what period of time? Was there red blood? Did it look like coffee grounds?
Changes in bowel habits. Has there been any change in your bowel habits? Have you been constipated? Did the stool look dark and tarry?
Have you had diarrhea? Was there any red blood in it? Urination. Have you been urinating more or less often? Is there pain when you urinate? Is the color dark or unusual? Is there an unusual odor? Weight loss. Have you lost weight recently? How many pounds?
Belching or flatulence. Have you experienced belching or flatulence? For how long?
Pain. What does the pain feel like? How long have you had this pain? Is the pain constant or intermittent?
Other. Ask about any other signs or symptoms related to this complaint, such as "Are there any changes you have noted recently that may be contributing to your pain?"
Concurrent chest pain. If the patient reports chest pain, use OPQRST

Front 2

guarding

Back 2

board-like muscle spasm, can be seen with major problems such as a perforated ulcer or pancreatitis.

Front 3

What are the steps for assessing the abdomen? (steps 1-4)

Back 3

1. Explain to the patient what you are going to do in terms of assessing the abdomen.
2. Place the patient in a supine position with the legs drawn up and flexed at the knees to relax the abdominal muscles, unless there is any trauma, in which case the patient will remain supine and stabilized. Determine whether the patient is restless or quiet, and whether motion causes pain.
3. Expose the abdomen and visually assess it. Does the abdomen appear distended (enlarged)? Do you see any pulsating masses (indicates an aortic aneurysm)? Is there bruising to the abdominal wall?
4. Ask the patient where the pain is most intense. Palpate in a clockwise direction beginning with the quadrant after the one the patient indicates is tender or painful; end with the quadrant the patient indicates is tender or painful. If the most painful area is palpated first, the patient may guard against further examination, making your assessment more difficult and less reliable.

Front 4

What are the steps for assessing the abdomen? (steps 5-7)

Back 4

5. Remember to be very gentle when palpating the abdomen. Occasionally, an organ within the abdomen will be enlarged and very fragile and rough palpation could cause further damage. If you see a pulsating mass, do not touch it; doing so could cause the aorta to rupture.
6. Palpate the four quadrants of the abdomen gently to determine whether each quadrant is tense (guarded) or soft when palpatedFigure 16-4.
7. Note whether the pain is localized to a particular quadrant or diffuse (widespread).

Front 5

What are the steps for assessing the abdomen? (steps 8-11)

Back 5

8. Palpate and wait for the patient to respond, looking for a facial grimace or a verbal "ouch." Do not ask the patient, "Does it hurt here?" as you
palpate.
9. Determine whether the patient exhibits rebound tenderness (may be tender when direct pressure is applied, but very painful when pressure is released). This is an indicator of peritonitis. When you are palpating for rebound tenderness, you should use extreme caution.
10. Determine whether the patient can relax the abdominal wall on command.
11. Guarding and rigidity may be detected. Guarding is tensing of the abdominal wall muscles.

Front 6

Localization of Pain: Appendicitis

Back 6

Right lower quadrant (direct);
around navel (referred)
rebounding pain (pain felt on the rebound after palpation)

Front 7

Localization of Pain: Cholecystitis

Back 7

Right upper quadrant (direct);
Right shoulder (referred).

Front 8

Localization of Pain: Ulcer

Back 8

Upper midabdomen or upper part of back

Front 9

Localization of Pain: Diverticulitis

Back 9

Left lower quadrant

Front 10

Localization of Pain: Abdominal aortic aneurysm (ruptured or dissecting)

Back 10

Low part of back and lower quadrants

Front 11

Localization of Pain: Cystitis (inflammation of the bladder)

Back 11

Lower midabdomen (retropubic)

Front 12

Localization of Pain: Kidney infection

Back 12

Costovertebral angle

Front 13

Localization of Pain: Kidney Stone

Back 13

Right or Left Flank, radiating to genitalia

Front 14

Localization of Pain: Pancreatitis

Back 14

Upper abdomen (both quadrants); back

Front 15

Localization of Pain: Pneumonia

Back 15

Referred pain to the upper abdomen

Front 16

Localization of Pain: Hernia

Back 16

Anywhere in the abdominal area

Front 17

Localization of Pain: Peritonitis

Back 17

Anywhere in the abdominal area

Front 18

Back 18

Front 19

cholecystitis

Back 19

Severe inflammation of the gallbladder caused by unpassed gallstones.

Presentation: Constant severe pain in right upper or mid-abdominal region; may refer to upper back and shoulder.

Symptoms: nausea, vomiting, indigestion, gas, bloating. Symptoms typically begin 30 min after a fatty meal.

Front 20

Pancreatitis

Back 20

Inflammation of the pancreas.

Causes: obstructing gallstone, alcohol abuse, other diseases.
Presentation: severe pain in upper left and right quadrants; may radiate to the back.
Symptoms: Pain, nausea, vomiting, abdominal distension, and tenderness.

Front 21

Peptic Ulcer Disease (PUD)

Back 21

Protective layer of stomach and duodenum becomes eroded and acid eats into organ itself over the course of weeks, months or years.

Causes: Heliobactoer pylori, chronic use of NSAIDs. Alcohol and smoking affect severity.

Presentation: Upper abdomen or below the sternum.

Symptoms: burning, nausea, vomiting, belching, and heartburn.

Front 22

Appendicitis

Back 22

Inflammation or infection of the appendix.