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Chapter 16
Gastrointestinal and
Genitourinary
Emergencies
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
16.1 List at least six possible causes of
emergencies involving the gastrointestinal
and genitourinary systems.
16.2 List the signs and symptoms of
emergencies involving the gastrointestinal
and genitourinary systems.
16.3 Compare and contrast visceral pain and
parietal pain.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
16.4 Describe and demonstrate how to assess
the abdomen.
16.5 Describe and demonstrate the
management of a patient with a severe
GI/GU emergency.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Anatomy
and Physiology
 The Acute Abdomen
 Common Gastrointestinal Ailments
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
You are working first-aid duty when a 35-year-old
man walks in complaining of severe abdominal pain.
You assess the patient. Moments later, he vomits.
The vomit is clear and does not appear to contain
blood. He apologizes and states that he started
feeling ill that morning, but decided to ski with his
family. He denies any past medical history, has not
suffered any recent trauma, and is not currently
taking any medications. He states he has never
experienced anything like this before and describes
his abdominal pain as “intense.”
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Abdomen
and pelvis
◦ Hollow organs
◦ Solid organ
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Acute Abdomen
 Causes
◦
◦
◦
◦
◦
◦
of the acute abdomen:
Appendicitis
Pancreatitis
Hepatitis
Cholecystitis
Pyelonephritis
Nephrolithiasis
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Acute Abdomen
 Causes
of the acute abdomen:
◦
◦
◦
◦
Bowel obstruction
Perforated bowel
Peptic ulcerative disease
Esophagitis and gastrointestinal
bleeding
◦ Abdominal aortic aneurysm
◦ OB/GYN-related conditions
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Gastrointestinal
Ailments
 Gastroenteritis
 Indigestion
 Nausea
and vomiting
 Colic
 Diarrhea
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Gastrointestinal
Ailments
 Viruses,
◦
◦
◦
◦
protozoa, and bacteria
Staphylococci
Salmonella
Giardia lamblia and cryptosporidium
Escherichia coli (E coli)
 Constipation
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
Upon examination, you notice that the patient is pale,
sweating, and feels warm to the touch. He relates
that his pain was originally near his belly-button but
has now “moved down and to the right.”
Examination of the abdomen reveals severe
tenderness in the right lower quadrant. He tells you
that every bump on the way to the ski hill felt like
“being stabbed in my gut.”
The patient has a heart rate of 116, blood pressure is
132/88, and respirations are 20 and shallow.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Determine
what is wrong with the
patient:
◦ ABCDs
◦ SAMPLE
◦ OPQRST
 Physical
exam:
◦ Permission
◦ Abdominal palpation
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 In-depth
physical examination:
 ABCDs
 Position
in position of comfort with
knees slightly bent
 Take vital signs frequently
 Supplemental oxygen if needed
 Don’t give anything by mouth
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
Copyright Mike Halloran
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
As you examine the patient and listen to his story,
you are concerned the patient may have a serious
lower abdominal problem. You place the patient on
oxygen, keep him comfortable, and have him
transported to the hospital. A week later the patient’s
wife comes to the patrol room, thanking you and the
patrollers that took such great care of her husband.
She reports that he had surgery for acute
appendicitis and is doing well.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Recognize those patients whose signs and
symptoms suggest the presence of a
potential acute abdomen. Implement lifesaving measures, and rapidly transport the
patient to a definitive care facility.
 By having a fundamental understanding
various abdominal and pelvic structures
and knowing the basic causes of common
GI/GU problems, you will be prepared to
effectively manage most GI/GU-related continued
disorders that you encounter.

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
The abdomen and pelvis contain solid and
hollow organs, major blood vessels, and
nerves.
 The abdomen is divided into four
quadrants.
 Patients with abdominal-pelvic pain may
not present until their signs and symptoms
are unbearable.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Abdominal pain may be the first indication
of a life-threatening emergency.
 Abdominal assessment includes an exam
of all four quadrants.
 All patients with abdominal pain should be
taken seriously and referred either to a
physician or transported to a hospital.
 Do not give a patient complaining of
abdominal pain anything by mouth.
continued

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
A heart attack (AMI) can present with
abdominal pain.
 Acute abdominal pain may be the symptom
of delayed presentation of intra-abdominal
trauma such as a ruptured spleen or renal
injury from the previous day’s fall.
 Do not give a patient complaining of
abdominal pain anything by mouth.

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ