Abdomen Flashcards
What are some common signs and symptoms of acute abdominal pain?
Nausea Vomiting Diarrhoea Constipation Flatulence Fever Bloating
What is in the right upper quadrant?
Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal Hepatic flexure of colon Part of ascending and transverse colon
What is in the Left Upper Quadrant?
Stomach Spleen Left lobe of liver Body of pancreas Left kidney and adrenal Splenic flexure of colon Part of transverse and descending colon
What is in the right lower quadrant?
Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
What is in the left lower quadrant?
Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
What organs are in the midline of the abdomen?
Aorta
Uterus (if enlarged)
Bladder (if distended
What does OLD CARTS stand for?
For abdominal assessment? O- ONSET L – LOCATION D – DURATION C – CHARACTERISTIC A – AGGRAVATING FACTORS R – RELIEVING FACTORS T –TIMING S – SEVERITY
What is the aetiology of Inflammation?
Gastroenteritis Appendicitis Pancreatitis Diverticulitis Cholecystitis
What is the life-threatening effect for Inflammation?
Risk of perforation (peritonitis)
Fluid shifts to area of inflammation
Unable to ingest fluid
What can Inflammation lead to?
Septic shock
Hypovolaemic shock
What is the aetiology for peritonitis?
Perforated peptic ulcers Ruptured peptic ulcers Ruptured diverticula Ruptured appendix Intestinal perforation
What is the life-threatening effect for Peritonitis?
Overwhelming infection
Fluid shifts to area of inflammation
Unable to ingest fluid
What can peritonitis lead to?
Septic shock
Hypovolaemic shock
What is the aetiology for Obstruction?
Bowel obstruction
Biliary obstruction
Mesenteric vascular occlusion
What is the life-threatening effects for obstruction?
Strangulation risk
Fluid trapped in bowel
Fluid shifts to interstitial space
Unable to ingest fluid
What can obstruction lead to?
Septic shock
Hypovolaemic shock
What is the aetiology for Internal Bleeding?
Trauma
Ruptured abdominal aneurysm
GI bleed
What is the life-threatening effects for Internal Bleeding?
Blood lost from vascular space
Unable to ingest fluid
What can Internal Bleeding lead to?
Hypovolaemic shock
What is appendicitis?
Inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum.
What is the most common cause of appendicitis?
Obstruction of the lumen by faeces, foreign body or tumor
What can obstruction of the lumen result in?
Distention
Venous engorgement
Accumulation of mucus and bacteria, which can lead to gangrene and perforation
What are the signs and symptoms of Appendicitis?
Periumbilical pain
Anorexia
Nausea and vomiting
Persistent pain, eventually shifting right lower quadrant and localizing at McBurney’s point
Localized tenderness, rebound tenderness and muscle guarding
Patient may lie still often with the right leg flexed
What is peritonitis?
Localized or generalized inflammatory process of peritoneum which results in massive fluid shifts and adhesions as body attempts to wall off infection
What is the nursing assessment you would undertake of a patient complaining of acute abdominal pain?
Pain Assessment Patient History Vital Signs Family History Diet Medications Constipation Last Bowel Motion Presenting Complaint LOC I/O Skin Color/Temperature Abdominal Assessment (inspection, palpation, percussion, auscultation) ABCD
What are some diagnostic studies and MDT care?
FBC & Lytes, ?X-match urinalysis ?stool spec ECG AXR USS CT scan (+/- contrast)
What are the symptoms of peritonitis?
Abdominal pain Rebound tenderness Muscular rigidity Spasm Patient has shallow respirations Abdominal distension Fever Tachycardia, tachypnoea Nausea and vomiting
What causes Intestinal Obstruction?
Partial/Complete obstruction occurs when intestinal contents cannot pass through the GI tract and it requires URGENT treatment
What are the two types of Intestinal Obstruction?
Mechanical - something obstructing the lumen
Non-mechanical - when muscles/nerves within the intestines do not function properly
What are the symptoms of Small Intestinal Obstruction?
Rapid onset Frequent and copious vomiting Colicky, cramp-like, intermittent pain Feces for a short time Greatly increased abdominal distension
What are the symptoms of Large Intestinal Obstruction
Gradual onset Vomiting is rare Low-grade, cramping abdominal pain Absolute constipation Increased abdominal distention
What is the nursing assessment for Intestinal Obstruction?
Early recognition of deterioration (hypovolemic shock, bowel strangulation) Patient history & physical examination Assessment of vomitus Hydration status Pain Nutritional status Need for surgery Anxiety
What is cholelithiasis?
Stones in gallbladder
What is cholecystitis?
Inflammation of the gallbladder
What is choledocholithiasis?
One or more gallstones in the CBD (common bile duct)
What are the signs and symptoms of Cholelithiasis / acute
Cholecystitis?
Pain Indigestion Fever Jaundice Nausea and Vomiting Restlessness Diaphoresis Inflammation Leukocylosis
What is the nursing plan of care for Cholelithiasis / acute
Cholecystitis?
Pain control Antiemetic Antibiotics Maintain fluid and electrolytes Potentially NBM
What are signs and symptoms of Total Obstruction?
Jaundice Dark amber urine Clay-colored stools Pruritus Intolerance of fatty foods Bleeding tendencies Steatorrhoea
What are the aetiological factors for Acute Pancreatitis?
Alcohol Biliary tract disease Trauma Infection Drugs Postoperative GI surgery
What can Acute Pancreatitis lead to?
Activation of pancreatic enzymes
Injury to pancreatic cells
What are some pancreatic enzymes?
Trypsin Elastase Phospholipase A Lipase Kallikrein
What are the autodigestive effects of trypsin?
Oedema
Necrosis
Haemorrhage
What are the autodigestive effects of elastase?
Haemmorhage
What are the autodigestive effects of Phospholipase A?
Fat necrosis
What are the autodigestive effects of Lipase?
Fat necrosis
What are the autodigestive effects of Kallikrein?
Oedema
Vascular permeability
Smooth muscle contraction
Shock
What are the Signs and Symptoms of Acute Pancreatitis?
Abdominal pain – LUQ radiating to the back Aggravated by eating, relieved by vomiting Abdominal tenderness with muscle guarding Paralytic ileus Greys Turners spots Cullen’s sign Signs of shock Watch for respiratory distress –ARF to ARDS
What is the treatments for Pancreatitis?
Relief and control of pain Prevention of or treating shock Fluid and electrolyte imbalances corrected Nasogastric tube to decompress the stomach NBM (suppresses pancreatic enzymes) w/ NG Antacids, PPI’s to neutralize gastric secretions and decrease hydrochloric acid stimulation Antibiotics to treat infection, antispasmodics Removal of precipitating cause if possible Nutritional therapy – enteral nutrition to parenteral When food allowed small frequent high carbohydrates
How do we manage pancreatitis?
Pain management Manage fluid imbalance Manage nutritional imbalances: maintain caloric needs while NBM Watch electrolytes and blood glucose Assessment: TPR, weight Surgery: pre & post operative care
What are the surgeries for gallstones?
ERCP (Endoscopic Retrograde Cholangio-Pancreatography +/- Sphincterotomy or stenting
ESWL (Extracorporeal Shock Wave Lithotripsy)
