WHAT IS BETWEEN YOUR HEAD AND YOUR ASS?

Presenter: Doug Wildermuth

Abdominal Issues

■ Mostly the result from understanding the digestive process tied to inherent risk factors:– Alcohol consumption

– Excessive smoking

– Increased stress

– Ingestion of caustic substances

– Poor bowel habits

– Poor eating habits

What goes in…

On average…2,500 ml a day

60% by drinking

30% by eating

10% by cellular

metabolism

Must come out…■ 60 % out via urine

■ 28 % out via the lungs & skin

■ 6% out via feces

■ 6% out via sweat

What does water do for you?

• Intracellular Fluid – Fluid inside the cells

• Extracellular fluid:

–Intravascular Fluid – Fluid within the vascular space

–Interstitial Fluid – Fluid outside cells and outside the vascular space

75 % Intracellular 17.5% Interstitial 7.5%Intravascular

■Lack of Glucose

■Lack of Oxygen

■Lack of energy–Sodium/Potassium pump shutdown–Cell membrane rupture–Cellular Death

Abdominal A& P

Solid or Hollow Organs???

Where does it start?

Where does it end?

The DigestiveSystem

Saltine Challenge

Can you eat 6 Saltines crackers in 60 seconds?

Duodenum

The Endocrine System

Function

– To secrete chemicals, such as insulin and adrenalin, responsible for regulating body activities and functions.

Adrenal Glands

– Secrete Epinephrine & Norepinephrine

Insulin allows sugar to

pass from the

bloodstream into the

cells.

The brain needs the

glucose to operate.

The Endocrine System

The Pancreas

Islets of Langerhans

■ Insulin is produced normally by the Beta cells (here).

■ Insulin levels rise while eating as well decrease while resting.

■ Average daily secretion is 0.6 units per kg of insulin to stabilize a glucose level that is typically 70-120.

■ Facilitates glucose metabolism when working properly.

When The Glucose Isn’t Working

■ When glucose can not be used (for whatever reason) cellular starvation begins.

■ Body responds by breaking down stored fats and protein to provide energy.

■ These fatty acids metabolize in the liver and produce ketones.

Pancreatitis■ Inflammation of the pancreas – chronic or acute

cases

■ The digestive enzymes of the pancreas do not reach the duodenum and interact with the pancreatic cells resulting in destruction of the pancreas.

■ Common in alcoholics.

Cholecystitis■ Blockage of the cyst duct…where is the cyst duct?

■ Cyst duct is the gallbladder duct.

AKA – Gallstones!

Cholecystitis

■ Can be inflamed, distended or blocked.

Signs & Symptoms:

■ Upper right quadrant pain.

■ Referral pain to the right shoulder.

■ Acute cases will have nausea and vomiting.

■ Onset could be hours after eating a fatty meal which emulsifies the fats in the duodenum.

■ High risk – women with pregnancy “Fat, Fair, Female & Fertile”, Pima Indians & Hispanics.

Toxic Poisonings■ Methods

– Ingestion – Most common

– Absorption

– Injection

– Inhalation

■ Ingestion – Household products, Petroleum based, cleaning agents, cosmetics, plants, foods, drugs (prescription and illicit)

■ Poison Control Centers?

Poisoning Treatments

■ Decontamination

■ Gastric Lavage

■ Activated Charcoal

■ Whole bowel irrigation

■ Antidotes?

Disorders of the Intestines

■ Gastroenteritis – inflammation of the stomach or intestines due to a pathogen

■ Diverticulitis – abnormal path (or pocket) of the colon (large intestine). More common in people over 50.

■ Inflammatory Bowel Disease (IBS) – inflammation of the inner lining of the digestive tract

– Ulcerative colitis

– Crohn’s disease

Crohn’s Disease■ Idiopathic inflammatory bowel disorder

■ Associated with the small intestine

Gastric Bleeding

■ Upper GI Bleeds– Gastroenteritis may present itself– Type of bleeding noted:

■ Bright red, coffee ground like in nature■ Can be hemodynamically unstable if not noted

■ Lower GI Bleeds– Gastroenteritis may present itself– Type of bleeding noted:

■ Dark Tarry stool in color

Appendicitis■ Inflammation of the appendix

■ Unknown structure

■ Appendectomy?

Hiatal Hernia/Acid Reflux (GERD)

Esophageal Varices■ Distended, varicose veins in the esophagus due to

portal vein hypertension.

■ The portal vein carries blood back from the abdominal organs to the liver.

■ Common untimely death among alcoholics:

– “Drink to Death”

Hepatic Disorders■ Hepatitis – inflammation of the liver

– Types A, B, C, D, E, G

■ Cirrhosis of the liver – scarring of the liver– As tissue is lost, the liver can not metabolize appropriately

resulting in RBC breakdown, ineffective glycogen storage, clotting factor issues.

– Common amongst chronic alcohol abusers

Vascular Issues■ Descending Aortic Aneurism

Vascular Issues

■ Traumatic Tears?

■ Are these operable?

The Renal System

Loop of Henle

Dialysis

• Hemodialysis – shunt, fistula or graft

• BP specific – before and after treatment

Peritoneal Dialysis

An artificial way to remove waste

products and extra fluid from your

blood. With peritoneal dialysis, the network of tiny

blood vessels in your abdomen

(peritoneal cavity) is used to filter

your blood.

Dialysis Emergencies

• Support ABCs

• Stop bleeding from shunt as needed

• Position appropriately

– Flat if Shockey

– Upright if pulmonary edema

Urinary Tract Disorders

■ Acute Urinary Retention:

– Young Waitresses?

– Benign Prostatic Hypertrophy (BPH)

– Exam – Uncomfortable, Nausea, Vomiting

– Require… Foley Catheter to relieve

■ Renal Calculi

– Renal Colic – the pain of a calculi – AKA “Stone”

Renal “A Stone”

Urinary Track Infection■ Common in elderly – may go unnoticed for some

time, can cause sepsis and confusion.

■ If Foley catheter is in, look at urine for appearance.

■ Suspect problems in Foley catheter.

■ Can occur naturally.

Urinary Catheter Management• Why may patients have catheters?

• Issues?

Doug WildermuthNREMT Paramedic

NAEMSE & NAEMT Member

NYS Program Coordinator

NYSDOH-Certified Instructor Coordinator

79 Glenwood AvenueQueensbury, NY 12804Phone: 518-361-0218

Douglas.Wildermuth@E5SupportServices.com