Abdominal Emergencies Flashcards
Abdomen
Region between the diaphragm and pelvis
Which organ systems are found in the abdomen
– Digestive
– Reproductive
– Endocrine
– Regulatory
What are the solid organs of the abdomen
Spleen
Liver
Pancreas
Kidneys
What are the Hollow organs of the stomach
Stomach Gallbladder Duodenum Large Intestine Small Intestine
Peritoneum
thin membrane lining the abdominal cavity and covering each organ.
These organs include the stomach, liver, spleen, appendix, sm & lg intestine and in women the uterus, fallopian tubes & ovaries.
Parietal peritoneum
lines abdominal cavity
Visceral peritoneum
covers each organ
Which organs are found in the extra-peritoneal space, behind the peritoneum
Kidneys
Pancreas
Portion of the Aorta
Which organs lie inferior the the peritoneum
bladder
part of the rectum
Which organs are found in within the peritoneal cavity
Spleen (behind the liver) Liver Gallbladder Stomach Transverse Colon (and ascending & descending colon) Small Bowel (intestine)
Which organs are within the retroperitoneal cavity
Kidney ( and ureters)
Pancreas
Duodenum
Abdominal Aorta
Inferior vena cava Fallopian tube (and ovaries) Sigmoid colon Uterus Rectum Urinary Bladder
Abdomen divided into what regions
RUQ, LUQ, RLQ, LLQ Epigastric region
Visceral Pain
- Originates from the visceral peritoneum
- Fewer nerve endings allow for only diffuse sensations of pain
- Frequently described as “dull” or “achy”
- Colic (intermittent pain) may result from distention and/or contraction of hollow organs
- Persistent or constant pain often originates from solid organs
Parietal Pain
- Originates from the parietal peritoneum - parietal tenderness
- Many nerve endings allow for specific, efficient sensations of pain
- Frequently described as “sharp”
- Pain is often severe, constant, and localized to a specific area
- The pt will describe this kind of pain as worsening upon movement or getting better when still or lies with knees drawn up
Referred Pain
• Perception of pain in skin or muscles at distant locations
– Abdomen has many nerves from different parts of the nervous system
– Nerve pathways overlap as they return to the spinal cord
– Pain sensation is transmitted from one system to another
Tearing Pain
- Originates in the aorta
- Separation of layers of this large blood vessel caused by aneurysm
- Retroperitoneal location of aorta causes pain to be referred to back as that it is located
Appendicitis: What is it Signs & Symptoms
• Infection of appendix • Appendectomy is usually indicated • Signs and symptoms – Persistent RLQ pain – Pain often initially referred to umbilical region – Rupture of appendix • Sudden, severe increase in pain • Contents released into abdomen causes severe peritonitis
Peritonitis: What is it Signs & Symptoms
• Irritation of peritoneum, usually caused by foreign material in peritoneal space
• Parietal peritoneum is sensitive, especially to acidic substances
• Irritation causes involuntary contraction of abdominal muscles
• Signs and symptoms
– Abdominal pain and rigidity
Cholecystitis: What is it Signs & Symptoms
• Inflammation of the gallbladder
• Often caused by blockage of its outlet by gall stones (cholecystolithiasis)
• Symptoms often worsened by ingestion of fatty foods
• Signs and symptoms
– Sharp RUQ or epigastric pain
– Pain often referred to shoulder
Pancreatitis: What is it Signs & Symptoms
• Inflammation of the pancreas • Common with chronic alcohol abuse • Signs and symptoms – Epigastric pain – Often referred to back or shoulder – pain is referred as the organ is retroperitoneal
Gastrointestinal (GI) Bleeding: What is it Signs & Symptoms
- Hemorrhage within the lumen of the GI tract
- May be minor to severe
- Blood eventually exits (mouth or rectum)
- Often painless
- Gastric ulcers (holes in GI system from highly acidic gastric juices) can cause severe pain and peritonitis
• Signs and symptoms
– Dark-colored stool (maroon to black), often “tarry” (Melena)
– Frank blood from rectum (hemorrhoid)
– Vomiting “coffee ground” appearing blood
– Vomiting frank blood
– Pain: absent to severe
Abdominal Aortic Aneurysm (AAA): What is it Signs & Symptoms
- Weakening of inner wall of the aorta
- Tears and separates from outer layers (dissection)
- Weakened vessel bulges, may continue to grow
- May eventually rupture
• Signs and symptoms
– Progressive (often “tearing”) abdominal pain
– Frequently radiates to back (lumbar)
– Palpable abdominal mass, possibly pulsating
– Possible inequality in pedal pulses
• Signs and symptoms
– Sudden, severe increase in pain may indicate
rupture
• High aortic pressure causes rapid internal bleeding
• Sudden progression of shock
• Likely exsanguination (fatal hemorrhage)
Hernia: What is it Signs & Symptoms
- Hole in the abdominal wall, allowing tissue or parts of organs (commonly intestines) to protrude under skin
- May be precipitated by heavy lifting
- May cause strangulation of tissue or bowel obstruction
- May require surgical repair
• Signs and symptoms
– Sudden onset of abdominal pain, often following exertion
– Palpable mass or lump on abdominal wall or crease of groin (inguinal hernia)
Renal Colic: What is it signs & symptoms
• Severe pain caused by kidney stones traveling down the ureter
• Signs and symptoms
– Severe, cramping, intermittent pain in flank or back
– Frequently referred to groin
– Nausea, vomiting
Cardiac Involvement: What is it signs & symptoms
• Pain of myocardial infarction can produce
– Nausea or vomiting
– Epigastric pain
– Indigestion
• Always consider the possibility of a cardiac emergency as a cause of abdominal symptoms
Assessment and Care of Abdominal Pain or Discomfort
• Many potential causes of abdominal pain
• Role of EMT is not to diagnose
• Focus efforts
– Perform thorough history and physical exam
– Identify serious or life-threatening conditions
Scene Size-Up: What should you think of
- Protect self from blood-borne pathogens
- Be aware of odors
- Determine if patient’s condition is medical, trauma, or both
Primary Assessment: Steps and what are yo thinking of for the abdominal patient
- General impression
- ABC’s
- Level of consciousness
All pt’s with abdominal pain should be given O2 immediately.
History of Present Illness: what kind of questions
- O: “When did it begin? What were you doing?”
- P: “What makes it better or worse? Movement? Position?”
- Q: “Describe your discomfort.”
- R: “Point to its location. Does it radiate or move?”
- S: “How bad is the pain on a scale of 1–10?”
- T: “Do you have pain all the time? Is it intermittent? Has it changed?”
History of the Present Illness: Other that OPQRST what kinds of questions would you ask a Female patient.
• Female patients – “Where in your cycle are you?” – “Is your period late?” – “Are you experiencing vaginal bleeding?” – “Is your flow normal?” – “Have you experienced this pain before?” – “Is it possible you are pregnant?” – “Are you using birth control?”
What nemonic do you use for Past Medical History
- S: Symptoms
- A: Allergies
- M: Medications
- P: Pertinent past history
- L: Last oral intake
- E: Events leading to emergency
Geriatric Note: Assessment of Abdominal Issues
- Decreased ability to perceive pain
- More serious causes of abdominal pain
- More likely to be life-threatening
- May be complicated by medications
Elements of the physical exam for an abdominal issue?
• Inspection – Distention – Discoloration – Protrusions • Palpation (use fingertips; painful area last) – Rigidity – Pain – Guarding
How often do you reassess vital signs for the abdominal patient?
• Baseline, then every 5 minutes – Pulse – Blood pressure – Respirations – Skin condition, color, temperature – Mental status
Patient Care for the Abdominal Patient
• Maintain airway – Be prepared to suction • Administer oxygen – 15 LPM via NRB • Position of comfort – LLR for airway protection • Transport to appropriate facility
Think About It:
• An 89-year-old female with a history of diabetes, hypertension, and gallstones is complaining of nausea and dizziness about 20 minutes after eating.
• What are the concerns with this patient?
• Is this an abdominal emergency, a diabetic
emergency, or a cardiac emergency?
• How will you know?
• What will your treatment be?
Chapter Review: Abdominal
- Abdominal complaints must be treated as serious emergencies requiring transport.
- Diagnosis is difficult; your responsibility is to assess the patient and report findings.
- Assessment should include thorough history, physical exam, and vital signs.
Chapter Review: Abdominal
- Quickly identify life-threateningemergencies: aneurysms, internal bleeding, shock.
- Care consists of airway management, oxygen, positioning, transport.
- Use standard precautions, including disinfecting equipment.
Remember: Abdominal
- Abdominal organs provide a variety of important functions to the body.
- The abdomen can be divided into four quadrants, with reference to the midline and umbilicus.
- Classifications of pain can help identify specific abdominal dysfunctions.
Remember: Abdominal
- Assessment and management always take a higher priority than determining the exact cause of abdominal pain.
- Knowledge of the characteristics of specific abdominal disorders can aid differential diagnosis when assessing a patient with abdominal pain.
Remember: Abdominal
• Care for a patient with abdominal pain
should include treatment of immediate life
threats, administration of oxygen, placing
patient in a position of comfort, and
appropriate transport.
Questions to consider: What are five signs and symptoms of abdominal distress?
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Questions to consider: Describe the difference between visceral and parietal pain. Describe a condition that may be responsible for each.
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Questions to consider: What is the emergency care for a patient experiencing abdominal pain or distress?
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Questions to consider: Name the four abdominal quadrants. How are the quadrants determined?
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Questions to consider: You are called to a patient with abdominal pain. He describes the pain as severe and says it has been “on and off” over the past several days, becoming severe within the last hour.
- What additional questions would you ask the patient?
- In what position would he likely be most comfortable?
.
Retroperitoneal Space
the area posterior to the peritoneum between the peritoneum and the back
Tell me about your abdominal pain - what does it feel like
could you possibly be pregnant
triple a
Do a thorough assessment
.
What cells produce insulin
beta cell in the islets of langerhans produce insulin.
spleen tucked up under the stomach
.
solid organs - rupture one of these causes bleeding
. this is the more immediate concern
hollow organs rupture - dumps contents into sterile abdominal cavity - causes peritonitis - severe infection
.
parietal and visceral - boundary of the lining parietal peritoneal
outside in first lining - parietal move in farther on top of the organs themselves visceral pluera
some organs outside the peritoneum - retroperitoneal space
kidney
a portion of the aorta
serous membrane that covers the abdomen
.
umbillicus divides the four quadrants of the abdomen
.
bleeding from the inside - start to stretch the receptors on the visceral peritoneum - hurts all over - dull achy - can’t pinpoint -
.
parietal receptors they know exactly where it hurts
.
know the difference betwn visceral and parietal pain pg 574
.
referred pain
perception of pain in skin or muscle at distant locations
pain into the right shoulder with gall bladder attacks
referred pain
tearing pain (pg 754)
generally originates in the aorta
has three different linings
- weakened area starts to have blood between the
intima, and the media, and adventitia
burning or tearing sensation in the abdomen
aaa
sometimes complain of unequal pulses in the feet
appendix - RLQ pain push in doesn’t hurt - let go it hurts - rebound pain - ruptures get peritonitis - have very rigid abdomen
.
cholicystitis - stores bile to digest fat - referred pain to the right shoulder
.
pancreatitis
common bile duct - gallstones can also block the pancreas and can also get pancreatitis
go bleed - BP low pulse high
.
with abdominal pain could have cardiac involvment
.
Esophagus
hollow digestive organ structure to carry food from the mouth and pharynx to the stomach
Stomach
hollow digestive organ, expandable, located below the diaphragm & connected to the esophagus & small intestine, begins the breakdown of food
Small Intestine
hollow digestive organ consisting of the duodenum, jejunum, and ileum, takes stomach contents and remove nutrients as it passes contents onto the lg intestine
Large Intestine (colon)
hollow digestive organ, The lg intestine absorbs fluid from it’s contents, creating fecal waste for excretion through the rectum and anus
Appendix
hollow lymphatic organ, this dead-end sac of bowel rich material in lymphatic tissue has no function in digestion. It may become infected (appendicitis) causing pain & requiring surgery.
Liver
solid digestive (other functions with regulation of the blood & detoxification) . This organ is involved in regulating levels of carbohydrate & other substances in the blood. It is involved in bile secretion for the digestion of fats, and many other functions including detoxification of the blood.
Gallbladder
hollow digestive organ, which stores bile before its release into the intestine.
Spleen
solid lymphatic tissue, which removes abnormal blood cells & is involved in the immune response.
Pancreas
a solid digestive organ, which releases enzymes that assist in breaking down food in the small intestine into absorbable molecules. In also secretes hormones into the blood that regulate blood sugar levels.
Kidneys
a solid urinary organ that filters and excretes waste. They also regulate water, blood, and electrolyte levels and assists the liver with detoxification.
Bladder
hollow urinary organ, that collects urine from the kidneys prior to excretion (urination).
What defines the abdominal quadrants
the umbilicus
visceral pain
visceral pain is organ pain and is diffuse
intermittent, crampy, or colicky pain often comes from the hollow organs
pain that is dull & persistent often originates from the solid organs
