Assessment For Learning (A4L) and Summary Abdominal Pain / GI Issues
Instructions to the learner: Without using any references, quickly answer the questions in the “Assessment For Learning (A4L)” section below. Then, use the resources listed in the “Lesson Sequence” section to help you fill in any missing answers or verify items where you were uncertain. Finally, complete these same questions again at the end of this document as another assessment of your learning. There is a section at the end of this document with suggested answers and notes for the A4L questions—-use this as a guide. The A4L questions are for your use—-your learning is assessed in the classroom or proctored testing environment.
If you are a BCFPD member and desire CEUs for this learning activity, you may schedule a proctored written learning assessment at Fire District Headquarters by contacting
Bryant Gladney at . This activity is worth 3 CEUs in Medical for BLS and 3 CEUs in Medical for ALS.
If you want a digital copy of this document, go to: http://wp.me/P2bOOm-r1 or scan:
Objectives / Learning Targets: The learner who successfully completes this course will be able to demonstrate understanding of the following concepts:
• General pathophysiology of gastrointestinal issues that may produce emergency requests for assistance from patients.
• Field assessment and management of common GI system issues.
Answer these questions without using a reference to test your prior knowledge (these questions are the “Assessment For Learning (A4L)”:
1. Define peritonitis.
2. List some signs and symptoms of peritonitis.
3. Describe bowel obstruction.
4. Describe abdominal aortic aneurysm.
5. Describe gall stones / “gall bladder attack”.
6. Describe diverticulitis.
7. Describe appendicitis.
8. Describe gastroenteritis.
9. Describe kidney stones.
10. Describe peptic ulcers.
11. Describe GERD.
12. What is a hiatal hernia?
13. Describe a UTI.
14. Describe irritable bowel syndrome (IBS).
15. Describe inflammatory bowel disease (IBD).
16. What does “coffee grounds emesis” indicate?
17. What do “dark, tarry stools” indicate?
18. Describe esophageal varices.
19. What is meant by the term “referred pain”?
20. Regardless of the exact cause of abdominal pain, describe your field management.
Lesson Sequence / Steps
Step One: Complete the A4L to determine what material you already understand.
Step Two: Review the summary and video links below. These specific videos have been chosen to reinforce key points and provide some visuals to deepen your understanding. Many of them are aimed at the general public but were included here due to the clarity of their content. Go back to the A4L and fill in any gaps in your understanding.
Step Three: (for students in initial EMT or Paramedic classes): Review your textbook materials and take the associated quizzes in the publisher’s online package.
• EMT Chapter 28 (AAOS Emerg. Care and Transport. of the Sick and Injured)
• Paramedic Chapters 2.19, 2.20 (Beebe & Myers Professional Paramedic)
Summary and Lesson Sequence From BCFPD EMS Education:
• The acute abdomen is a medical emergency, requiring prompt but gentle transport.
• The pain, tenderness, and abdominal distention associated with an acute abdomen may be signs of peritonitis, which may be caused by any condition that allows pus, blood, feces, urine, gastric juice, intestinal contents, bile, pancreatic juice, amniotic fluid, or other foreign material to lie within or adjacent to the peritoneum. Watch this short video lesson on peritonitis: http://www.youtube.com/watch?v=1MX9XxQGvOU
• Review this summary of ascites: http://www.medicinenet.com/ascites/article.htm#ascites_facts
• Signs and symptoms of acute abdomen include pain, nausea, vomiting, and a tense, distended abdomen.
• Describe the location of pain using abdominal quadrants. Watch this video on landmarks and locations in the abdomen: http://www.youtube.com/watch?v=AjQliCj2yLg
• In addition to abdominal disease or injury, problems in the gastrointestinal, genital, and urinary systems may also cause peritonitis.
• Watch this video on acute abdomen: http://www.youtube.com/watch?v=LwDph5rqtcw
• Then watch this follow up video on causes and types of abdominal pain / acute abdomen: http://www.youtube.com/watch?v=z-vaUwZIu7A
• Bowel obstruction: http://www.youtube.com/watch?v=_uckguNXlc4
• Abdominal Aortic Aneurysm (AAA): http://www.youtube.com/watch?v=Of6NEJ3FtQM
• Gall bladder / Biliary colic: http://www.youtube.com/watch?v=yFO1RXt8_w4
• Pancreatitis: http://www.youtube.com/watch?v=3Aqu9o356DA
• Diverticulitis : http://www.youtube.com/watch?v=DwAUJJUvdVM
• Appendicitis: http://www.youtube.com/watch?v=4VVbOjBX5ew
• Gastroenteritis: http://www.youtube.com/watch?v=LCTEERyEr0g (although aimed at pediatric patients, the information applies to adults equally well)
• Kidney Stones: http://www.youtube.com/watch?v=LngbrHJkXoE
• Ulcers
• Ulcers can bleed significantly resulting in blood collecting in the stomach and resulting in emesis that looks like coffee grounds (partially digested blood).
• Ulcer bleeding can work through the bowels and present as dark stools with the appearance of tar. (dark tarry stools also known as melana). Watch this short animation on peptic ulcers: http://youtu.be/LKuNokt9B1Q
• GERD and hiatal hernia: http://www.youtube.com/watch?v=TdK0jRFpWPQ
• UTI: http://www.youtube.com/watch?v=koc6Trz6vdE
• IBS: http://www.youtube.com/watch?v=eKLqFnAmK6c
• IBD (Crohn’s or Ulcerative Colitis): http://www.youtube.com/watch?v=Keqzt83KMVA
• Pain is common directly over the inflamed area of the peritoneum, or it may be referred to another part of the body. Referred pain occurs because of the connections between the two different nervous systems supplying the parietal peritoneum and the visceral peritoneum.
• In contrast to cardiac patients with pain, the abdominal pain patient’s pain level is more frequently related to the severity of their condition.
• Patients with abdominal pain want that pain controlled. Many ALS protocols do not include standing orders for pain control in abdominal pain patients and many online medical control physicians in our system will not routinely give orders for pain medication. Therefore, EMTs should be cautious about promising patients pain control from the paramedics.
• Do not give the patient with an acute abdomen anything by mouth.
• A patient in shock or with any life-threatening condition should be transported without delay. Call for advanced life support assistance if your patient’s condition deteriorates during transport.
• Patients with vomiting and diarrhea can become hypovolemic.
• Patients with vomiting and diarrhea can have electrolyte disturbances that may impact their cardiac conduction system.
• GI system bleeding (these patients can have life threatening shock—-particularly if they also take “blood thinners” such as Coumadin / warfarin). Watch this short video summary of GI bleeding: http://www.youtube.com/watch?v=0CmrS1v8oM8
• Esophageal
• Varices are varicose veins (superficial) on the inner wall of the esophagus that can bleed profusely when damaged or if they rupture. Liver disease is a key risk factor. Watch this video for a view of a varix (plural is varices) that is not actively bleeding.
• http://www.youtube.com/watch?v=24slqqkwOFg
• Hematemesis is the term for bloody emesis.
• Stomach (ulcers)
• Bowels
• Bleeding in the bowels may present as blood in the feces (bloody stools) also known as hematochezia.
• Abdominal wall hernia: http://www.youtube.com/watch?v=zZA0QhSvrUU
Answer the same questions again to test your current knowledge. If you are applying for CEUs for this learning activity, you can anticipate that the material contained in these questions is key information that will be assessed on the proctored written learning assessment that you will take.
1. Define peritonitis.
2. List some signs and symptoms of peritonitis.
3. Describe bowel obstruction.
4. Describe abdominal aortic aneurysm.
5. Describe gall stones / “gall bladder attack”.
6. Describe diverticulitis.
7. Describe appendicitis.
8. Describe gastroenteritis.
9. Describe kidney stones.
10. Describe peptic ulcers.
11. Describe GERD.
12. What is a hiatal hernia?
13. Describe a UTI.
14. Describe irritable bowel syndrome (IBS).
15. Describe inflammatory bowel disease (IBD).
16. What does “coffee grounds emesis” indicate?
17. What do “dark, tarry stools” indicate?
18. Describe esophageal varices.
19. What is meant by the term “referred pain”?
20. Regardless of the exact cause of abdominal pain, describe your field management.
Suggested Answers: “ABDOMINAL PAIN / GI ISSUES”
1. Define peritonitis. Irritated peritoneal lining due to free fluid / blood / pus in the abdomen.
2. List some signs and symptoms of peritonitis. pain, nausea / vomiting, tense / rigid abdominal muscles, distention of the abdomen, bleeding (in the stool or from the rectum or in emesis)
3. Describe bowel obstruction. cessation of bowel movement from mechanical or physiological cause
4. Describe abdominal aortic aneurysm. a weakened, distended “false lumen” in the aortic wall in the abdominal section of the descending aorta
5. Describe gall stones / “gall bladder attack”. sharp, colic-type pain in the RUQ related to obstruction of the bile duct by stones or “sludge” that has formed in the gall bladder—-usually brought on by meal of fatty or fried foods—-may last a few minutes to hours
6. Describe diverticulitis. Small pouches form in bowel tissue (usually in the colon) and then become clogged with stool or undigested food particles which produces inflammation followed by pain and small amounts of bleeding.
7. Describe appendicitis. Inflammation (and possible rupture) of the appendix. RLQ pain, nausea / vomiting and probably a fever.
8. Describe gastroenteritis. Common (usually viral) illness producing stomach cramping, nausea, vomiting and frequently diarrhea.
9. Describe kidney stones. Crystals that form in the urinary system that may form stones that block urine flow from the kidney producing significant flank pain and possibly an infection.
10. Describe peptic ulcers. Areas of stomach lining that have been damaged by gastric acid thus producing pain and potential bleeding.
11. Describe GERD. Gastric juices (highly acidic) flow or splash into the esophagus due to a poorly functioning gastro-esophageal sphincter (valve-like structure between esophagus and stomach).
12. What is a hiatal hernia? Protrusion of the superior part of the stomach through the esophageal opening in the diaphragm. This usually causes GERD.
13. Describe a UTI. Infection in the bladder, ureters or kidneys producing fever, pain and dysuria (burning during urination).
14. Describe irritable bowel syndrome (IBS). Abnormal contractions of the bowel that move food either too quickly or too slowly producing either diarrhea or constipation along with cramping and bloating.
15. Describe inflammatory bowel disease (IBD). Ulcerative colitis or Crohn’s disease producing inflammation of the bowel lining usually with pain, urgent need to defecate or diarrhea and maybe blood in the stool.
16. What does “coffee grounds emesis” indicate? Blood usually from esophageal or peptic ulcers.
17. What do “dark, tarry stools” indicate? Blood usually from lower bowel sources.
18. Describe esophageal varices. Superficial veins in the esophagus that can become irritated or ruptured producing significant bleeding.
19. What is meant by the term “referred pain”? Pain that is felt in areas that are not where the issue that causes the pain.
20. Regardless of the exact cause of abdominal pain, describe your field management. Control nausea (usually with Zofran or Phergan), replace fluid loss from vomiting or diarrhea, assess for electrolyte disturbances with severe diarrhea or vomiting, assess for GI bleeding and manage shock from those. Control of pain in these patients is frequently their first priority yet not commonly addressed in the field prior to an ED / Surgical evaluation.
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