The document provides an overview of gastrointestinal, genitourinary, and reproductive system anatomy and emergencies commonly encountered in the prehospital setting. It describes the basic anatomy and components of the gastrointestinal, circulatory, genitourinary, and reproductive systems. It then discusses various gastrointestinal emergencies including esophageal varices, gastritis, peptic ulcer disease, diverticulitis, appendicitis, perforated viscus, bowel obstruction, and gastrointestinal hemorrhage. It also reviews genitourinary emergencies such as kidney stones, urinary tract infections, pyelonephritis, and renal failure. Prehospital treatment focuses on fluid resuscitation, pain management, and rapid transport.

1. Gastrointestinal, Genitourinary,
and Reproductive System
Emergencies
Presented by:
Judy Dyke, RN, NREMT-P
Rogers State University
Paramedic Technology Program

2. Introduction
 Acute abdomen is a sudden onset of
abdominal pain
 Often accompanied by nausea and
vomiting, tenderness, guarding, rigidity
and shock
 In 85-90% of cases, the abdomen is the
site of problem; in 10-15% of cases the
source of the problem lies elsewhere

3. Introduction
 Detection and stabilization are the keys
to coping with cases of acute abdomen
 Acute abdomen accounts for 5% of ED
visits

4. Basic Anatomy
 Abdomen is the largest body cavity
 Bordered by the diaphragm, pelvis,
spine, and abdominal wall
 Divided into four quadrants for reference
purposes

5. Basic Anatomy (cont.)
 Left upper quadrant
– spleen
– tail of pancreas
– stomach
– left kidney
– splenic flexure of colon

6. Basic Anatomy (cont.)
 Right upper quadrant
 liver
 gall bladder
 head of pancreas
 part of duodenum
 right kidney
 hepatic flexure of colon

7. Basic Anatomy (cont.)
 Right lower quadrant
– appendix
– ascending colon
– small intestine
– right ovary
– fallopian tube

8. Basic Anatomy (cont.)
 Left lower quadrant
– small intestine descending colon
– left ovary
– fallopian tube
 Flanks-lateral portion of abdomen
associated with the kidneys
 Epigastrium-portion of abdomen
immediately inferior to the xiphoid
process

9. Basic Anatomy (cont.)
 Peritoneum-membrane serving as
abdominal lining
 Can become inflamed (peritonitis)
 Organs located behind it referred to as
retroperitoneal

10. Basic Anatomy (cont.)
 Solid Organs
 Liver
 Spleen
 Pancreas
 Kidneys
 Adrenals
 Ovaries

11. Basic Anatomy (cont.)
 Hollow Organs
 Stomach
 Intestines
 Gall Bladder
 Urinary Bladder
 Uterus

12. Gastrointestinal System -
Major Components
 Mouth
 Consists of lips, cheeks, gums, tongue,
teeth
 Breaks down food into smaller particles
 Begins digestion through salivary gland
secretions
 Esophagus
 Hollow, muscular tube - transports food
between mouth and stomach

13. Gastrointestinal System -
Major Components
 Stomach
 Hollow organ in the left upper quadrant
 Receives food and continues process of
digestion
 Secrets hydrochloric acid

14. Gastrointestinal System -
Major Components
 Intestines
 Major sites for digestion and absorption
 Digests foods, clears waste products
 Two major divisions
– Small intestines
 Receives food from the stomach
 Divided into duodenum, jejunum, ileum
– Large Intestine
 Divided into cecum, colon, rectum

15. Accessory Organs of Digestion
 Salivary glands - lubricate food passage
and secrete amylase to initiate digestion
 Teeth - process food into usable form
 Liver
 Largest organ in the body
 Secretes bile to digest fats
 Produces proteins
 Detoxifies many substances
 Stores glycogen

16. Accessory Organs of Digestion
 Pancreas
 Secretes digestive enzymes
 Secretes glucagon, insulin, somatostatin
 Appendix
 Hollow, fingerlike organ attached to the
cecum
 Afunctional

17. Circulatory System
 Major blood vessels within the abdomen
 Descending aorta - delivers blood to
abdominal viscera
 Superior and inferior mesenteric arteries -
delivers blood to intestines
 Iliac arteries - supply lower extremities
 Inferior vena cava - Drains lower
extremities and abdominal viscera

18. Circulatory System (cont.)
 Portal System
 Collects blood from parts of the abdominal
viscera
 Transports it to liver for filtration and
processing

19. Genitourinary System
 Kidneys
 Paired organs located in the retroperitoneal
space
 Filter blood and produce urine
 Perform several endocrine functions
 Major regulators of blood pressure
 Help maintain fluid and electrolyte balance

20. Genitourinary System (cont.)
 Ureters
 Tubes connecting kidneys with bladder
 Retroperitoneal
 Urinary bladder
 Located in the pelvis
 Receives and stores urine from the bladder
 Urethra
 Tube connecting the bladder to the outside
 Shorter in females

21. Reproductive System
 Ovaries
 Female gonads
 Small, walnut size organs next to the uterus
 Produce female hormones and the ovum
 Fallopian tubes
 Hollow tubes connecting the ovary to the
uterus, frequent source of infection
 Transport the ovum to the uterus, site of
fertilization

22. Reproductive System (cont.)
 Vagina
 Extends from the uterus to the vulva
 Female organ of copulation
 Birth canal
 Vulva
 External female genitalia
 Made up of the labia majora, labia minora,
introitus, accessory glands

23. Reproductive System (cont.)
 Testes
 Male gonads, lie in the scrotum
 Responsible for production of the male
hormones and sperm
 Epididymus
 Small appendages on the testes
 Reservoir for sperm

24. Reproductive System (cont.)
 Prostate
 Small gland at the base of the bladder
 Responsible for production of seminal fluid
 Can become enlarged in older men and
obstruct urine flow
 Vas deferens
 Small muscular tubes
 Transport sperm from testes to the urethra
for ejaculation

25. Reproductive System (cont.)
 Urethra
 Canal for drainage of urine from bladder to
outside
 Route of sperm discharge
 Penis
 Male organ of copulation
 Covered by loose skin allowing for erection
 Vulnerable to trauma

26. Gastrointestinal System
Emergencies
 Esophageal varices
 Swollen veins in the lower third of
esophagus
 Caused by increased pressure in portal
circulation
 Most common presentation; painless GI
bleeding
 Prehospital treatment is IV fluids

27. Gastrointestinal System
Emergencies (cont.)
 Gastritis
 Stomach lining inflammation
 Caused by increased gastric secretion
associated with alcohol, drugs, stress
 Presents with epigastric pain, belching,
indigestion
 Can lead to gastric ulcer
 Treatment involves administration of
antacids and H2 blocking drugs

28. Gastrointestinal System
Emergencies (cont.)
 Peptic ulcer disease
 Ulcerations in the stomach, esophagus, or
duodenum
 Caused by excess secretion of hydrochloric
acid
 Also caused by breakdown of mucous
lining by drugs or alcohol

29. Gastrointestinal System
Emergencies (cont.)
 Presents with epigastric or upper left
quadrant pain
 Pain often improves following meals or
antacids
 If left untreated, can erode entire lining of
the organ

30. Gastrointestinal System
Emergencies (cont.)
 Diverticulitis
 Diverticula - pouches on the large intestine
 Can become inflamed as with appendicitis
 Presents like a left-sided appendicitis with
abdominal pain, fever, vomiting, anorexia,
tenderness
 Treatment includes antibiotics, diet
modification, and surgery

31. Gastrointestinal System
Emergencies (cont.)
 Bleeding diverticulosis
 Bleeding from diverticuli on the large
intestine
 Presents with painless rectal bleeding or
with some left-side abdominal pain
 Prehospital treatment is prevention of
shock

32. Gastrointestinal System
Emergencies (cont.)
 Carcinoma of the Colon
 Malignant growth in the colon
 Diverse presentation including painless
rectal bleeding, weight loss, or abdominal
pain
 Prehospital treatment is prevent shock

33. Gastrointestinal System
Emergencies (cont.)
 Appendicitis
 Inflammation of the appendix from
obstruction or from undetermined cause
 Patient often complains of acute onset of
right lower quadrant pain beginning around
umbilicus and of nausea, vomiting, fever,
anorexia; can display rebound tenderness
 Rupture can cause peritonitis characterized
by guarding, rebound tenderness, and rigid
abdomen

34. Gastrointestinal System
Emergencies (cont.)
 Appendicitis (cont.)
 Treatment is fluid replacement, prevention
of shock and transport for surgical removal
of appendix

35. Gastrointestinal System
Emergencies (cont.)
 Perforated abdominal viscus
 Perforation of a hollow abdominal organ
causing loss of stomach or intestine
contents into the abdominal cavity
 Produces inflammation and infection of
peritoneum and other organs
 Most common causes are perforated ulcers
or diverticulum

36. Gastrointestinal System
Emergencies (cont.)
 Presents with sudden onset abdominal pain
and generalized tenderness; rebound often
present; abdomen can be rigid
 Prehospital treatment is IV fluids and
prevention of shock

37. Gastrointestinal System
Emergencies (cont.)
 Bowel Obstruction
 Intestinal blockage
 Common causes include tumors, foreign
bodies, prior surgery
 Presents with history of progressive
anorexia, abdominal bloating, diffuse
abdominal pain, nausea, vomiting, fever,
chills
 Prehospital treatment is IV fluid
replacement and prevention of shock

38. Gastrointestinal Hemorrhage
 Upper GI Hemorrhage
 Bleeding from esophagus, stomach,
duodenum
 Common causes include peptic ulcer
disease, gastritis, esophagitis, tumors,
esophageal varices
 S & S include hematemesis, dark stools,
frequent diarrhea, orthostatic vital signs
 Treatment - supplemental O2, fluids and
rapid transport

39. Gastrointestinal Hemorrhage
 Lower GI Hemorrhage
 Bleeding from distal small intestine, colon,
rectum
 common causes include tumors,
diverticulosis, hemorrhoids, rectal fissures
 S & S include rectal bleeding (wine colored
or bright red), increased stool frequency,
crampy diffuse, pain, orthostatic vital signs
 Treatment - O2, fluids and rapid transport

40. Gastrointestinal Emergencies
 Pancreatitis
 Inflammation of the pancreas
 Caused by alcoholism or elevated blood
fats
 Presents with sudden onset of
midabdominal pain that radiates to the back
and shoulders, nausea, and vomiting
 Treatment is IV fluids, analgesics, NG tube
to control vomiting

41. Gastrointestinal Emergencies
(cont.)
 Cholecystitis
 Inflammation of the gall bladder
 Caused by gall stones lodging in duct that
drains the bladder or in bile duct, causing
liver or pancreatic congestion
 Presents with colicky pain in the upper right
quadrant that worsens following meals and
is unrelieved by antacids
 Treatment - surgical removal of gallbladder

42. Gastrointestinal Emergencies
(cont.)
 Hepatitis
 Inflammation or infection of the liver
 Results from viral infections and alcohol or
substance abuse
 Presents with dull right upper quadrant
tenderness unrelated to food digestion and
often with malaise, decreased appetite, clay
colored stools, jaundice
 Protective clothing for paramedics
necessary

43. Gastrointestinal Emergencies
(cont.)
 Hepatitis (cont.)
 Treatment in nonviral cases involves
removing offending agent while in viral
cases patient is observed and treated
symptomatically

44. Gastrointestinal Emergencies
(cont.)
 Aortic aneurysm
 Weakness in the wall of the descending
aorta creates ballooning in wall which can
increase in size and rupture
 Patient complains of diffuse abdominal pain
and severe back pain or tearing sensation if
the artery is dissecting
 Pulsating abd. mass may be seen and felt
 Prehospital treatment - O2, IV fluids,
prevent shock

45. Genitourinary System
Emergencies
 Kidney stones
 Result from crystal aggregation in collecting
system of kidney; crystallized urinary salts
held together by organic matter
 Most common in men 20-50 years old
 Most often seen in spring and fall
 Presenting symptoms can include
excruciating flank pain, difficulty in
urinating, hematuria, nausea and vomiting

46. Genitourinary System
Emergencies (cont.)
 Kidney stones (cont.)
 Predisposing factors
– Urinary tract infections
– Immobilization
– Metabolic disorders (hypercalcemia)
– Gout (increased uric acid)
– Tumors
 Complications
– Inflammation, infection
– Partial or total urinary obstruction

47. Genitourinary System
Emergencies (cont.)
 Urinary tract infections (UTI’s)
 Bladder infection (cystitis) is most common
 Most common in sexually active females
 Can cause kidney infection
 Symptoms include fever, flank pain, chills;
dysruia (painful or burning urination);
discolored urine; and lower abdominal pain
(especially during urination)

48. Genitourinary System
Emergencies (cont.)
 Pyelonephritis
 Kidney infection
 Often from infection ascending from
bladder
 Most common in women
 patients typically febrile, with lower back or
flank pain, chills, possible urinary burning
 No specific prehospital treatment

49. Genitourinary System
Emergencies (cont.)
 Renal Failure
 Acute renal failure - rapid deterioration of
kidney function, potentially reversible
– Causes
 Reduced renal blood flow due to shock, dehydration,
vasopressor agents
 Kidney injury from trauma, nephrotoxic drugs,
infection
 Urine flow obstruction due to enlarged prostate or
tumor
– Metabolic waste products accumulate
– Uremia is present

50. Genitourinary System
Emergencies (cont.)
 Renal Failure
 Chronic renal failure - long standing failure
associated with loss of nephron mass,
usually irreversible
 Complications of renal failure
– Elevated potassium levels
– Uremic pericarditis and encephalopathy
– Pericardial tamponade
– Subject to drug toxicity-failure to eliminate meds
– Fluid overload and noncardiac pulmonary

51. Genitourinary System
Emergencies (cont.)
 Kidney Failure (cont.)
 Presentation with severe renal failure
includes severe dyspnea, JVD, ascites,
rales at lung bases
 Presentation with chronic renal failure
includes wasted appearance, pasty yellow
skin, thin extremities; frostlike appearance
of skin in later stages, edema, jaundice,
oliguria

52. Reproductive System
Emergencies - Female
 Pelvic inflammatory disease (PID)
 Infection of the female reproductive organs
 Presentation includes lower abdominal
pain, pain during movement, vaginal
discharge, fever, chills

53. Reproductive System
Emergencies - Female (cont.)
 Ovarian cyst
 Fluid filled sac which forms on the ovaries;
can rupture causing pain and tenderness
 Often presents with lower abdominal pain -
sudden or graduate onset
 Mittelschmerz
 Abdominal pain accompanying ovulation
 Associated with release of ovum from ovary
 Can cause severe pain

54. Reproductive System
Emergencies - Female (cont.)
 Ectopic pregnancy
 Implantation of a developing fetus outside
of the uterus, most commonly in the
fallopian tube
 If tube ruptures, significant bleeding can
follow
 History of missed menses or irregular
periods

55. Reproductive System
Emergencies - Female (cont.)
 Ectopic pregnancy (cont.)
 Presents with low abdominal pain on either
side, associated with vaginal bleeding and
often pallor and weak pulse
 Prehospital treatment includes
supplemental oxygen, IV fluids, prevention
of shock and rapid transport

56. Reproductive System
Emergencies - Male
 Testicular torsion
 Part of a blood vessel becomes twisted or
rotated stopping blood flow to testicle
 More common in younger males and
children
 Presents with severe testicular pain,
possibly associated lower abdominal pain
and swollen, tender testicle
 Prehospital treatment includes reassurance
and possibly, analgesics

57. Reproductive System
Emergencies - Male (cont.)
 Epididymitis
 Inflammation of the epididymis
 Secondary to gonorrhea, syphilis, TB,
mumps, prostatitis, urethritis, or following
prolonged use of indwelling catheter
 Presents with chills, fever, inguinal pain,
swollen epididymus

58. Reproductive System
Emergencies - Male (cont.)
 Prostatitis
 Infection of the prostate
 Presents with urinary frequency, buring
pain with ejaculation, occasional pain with
defecation, fever and chills, nausea, and
vomiting
 Prehospital treatment primarily supportive

59. Assessment of the Acute
Abdomen
 Primary Assessment
 Ensure ABC’s
 Treat any life threats
 Secondary assessment
 Head to toe survey paying particular
attention to abdomen for
– Obvious asymmetry
– Distention
– Position of patient

60. Assessment of the Acute
Abdomen (cont.)
 Secondary assessment (cont.)
 Gently palpate abdomen
– Begin away from site of pain
– Check each quadrant for tenderness
– Test for rebound tenderness (peritoneal
irritation)
– Be alert to pulsating mass in abdomen, sign of
aneurysm; stop palpation and transport
immediately

61. Assessment of the Acute
Abdomen (cont.)
 Secondary assessment (cont.)
 Vital signs
– Determine pulse, blood pressure, respiration,
temperature
– Perform tilt test
 Obtain history
– OPQRST for pain
– Menstrual activity
– Oral contraceptive use
– Previous illnesses and past surgery

62. Management of the Acute
Abdomen
 With stable patient showing no active
hemorrhage
 Keep patient supine
 Administer O2 via nasal cannula
 Monitor vital signs and cardiac rhythm
 Start IV of NS or RL TKO
 Transport immediately

63. Management of the Acute
Abdomen (cont.)
 With unstable patient exhibiting active
hemorrhage or signs of impending
shock
 Place in shock position
 Administer high flow oxygen
 Start IV(s) of NS or RL wide open
 Position PASG
 Monitor vital signs and cardiac rhythm
 Provide rapid transport

64. Special Patients: Dialysis
 Hemodialysis
 Waste products removed by machine
 Renal failure patients (2-3 times per week)
 Many patients have home dialysis units
 Osmotic mechanism
 Patient’s blood comes in contact with
dialysate which normalizes electrolytes and
eliminates wastes
 Need external AV shunt or internal fistula

65. Special Patients: Dialysis (cont.)
 Peritoneal dialysis
 Uses lining of the peritoneal cavity for
dialysis
 Dialysate is introduced into the peritoneum
 Remains there for 1-2 hours before removal
 Major complication is peritonitis

66. Special Patients: Dialysis (cont.)
 Complications of dialysis
 Hypotension from dehydration, blood loss,
sepsis
 Chest pain/dysrhythmias from
hyperkalemia or ischemia
 Disequilibrium syndrome from rapid
electrolyte and osmotic changes
 Air embolism from tube opening
 Clotting of shunt or fistula
 Hemorrhage from rupture of fistula or shunt

67. Special Patients: Dialysis (cont.)
 Management of dialysis patient
 IV fluid administration should be at direction
of medical control (do not use shunt)
 Monitor cardiac rhythm
 Use arm opposite shunt for blood pressure
 Treat medical emergencies
 Remove patient from dialysis machine by
– Turning off dialysis machine
– Clamping shunt tubing ends
– Controlling shunt hemorrhage

68. Gastrointestinal, Genitourinary,
and Reproductive System
Emergencies
Presented by:
Judy Dyke, RN, NREMT-P
Rogers State University
Paramedic Technology Program