Abdominal, Gynecological, Genitourinary, and Renal Emergencies Flashcards
Solid organs in abdominal cavity
Spleen, liver, pancreas, kidneys, ovaries
Hollow organs in abdominal cavity
Stomach, gallbladder, duodenum, large intestine, small intestine, bladder, appendix, fallopian tubes, uterus, ureters
Peritoneum (definition and contents)
Lining of abdominal cavity
Visceral peritoneum: covers organs
Parietal peritoneum: Attached directly to abdominal wall
Intraperitoneal space
Space between visceral and parietal peritoneum
Houses the spleen, liver, gallbladder, stomach, pancreas, small intestine, and part of the large intestine
Retroperitoneal space
Space outside the intraperitoneal space
Houses kidneys, pancreas, ureters, and abdominal aorta
Organs located in Right Upper Quadrant of Abdomen
- Majority of liver
- R kidney
- pt Colon
- Part of pancreas
- Gallbladder
- Pt Small intestines
Organs located in Left Upper Quadrant of Abdomen
- Small am’t liver
- Spleen
- L kidney
- Stomach
- Pt Colon
- Most of pancreas
- Pt Small intestines
Organs located in Right Lower Quadrant of Abdomen
- Pt. colon
- Pt. small intestines
- R ureter
- R ovary
- R fallopian tube
- appendix
Organs located in Left Lower Quadrant of Abdomen
- Colon
- Small intestines
- L ureter
- L ovary
- L fallopian tube
Organs located in midline area of abdomone
- Bladder
- Uterus
- Prostate
Types of abdominal pain
- Visceral pain
- Parietal pain (Somatic pain)
- Referred pain
Visceral pain
The visceral peritoneum contains nerves of the autonomic nervous system
- Difficult to pinpoint where the pain is
- Often referred to as a “colicky” pain.
Parietal pain
Parietal peritoneum shares the same nerve path from the spinal cord that is connected to the skin on the abdomen, which means it can perceive much of the same sensations such as pain and pressure.
- Easier to pinpoint particular area in regard to pain.
Referred pain
Pain (from the visceral peritoneum) felt by the patient on areas of the body that appear to have no relation to the abdominal area (such as the back or shoulder)
- Common in cholecystitis, or inflammation of the gall bladder
Peritonitis
Inflammation of the peritoneum that is usually the result of blood, bacteria, or chemical substances that enter the abdominal cavity
-Signs: abdominal pain, abdominal distention, fever, loss of appetite, and a positive Markle Test.
Appendicitis
Inflammation of the appendix due to infection, often from fecal matter
Signs: nausea, vomiting, fever, lack of appetite (anorexia), positive Markel Test, and jaundice (yellowing) of the skin
Pancreatitis
Inflammation of the pancreas, caused by excessive alcohol use, gallstones, pancreatic cancer, trauma
Signs: abdominal pain (which might be severe, radiating from the umbilicus to the back and shoulders), distention, fever, tachycardia and shock
Cholecystis
Inflammation of the gall bladder
Signs: pain in the epigastric area, right upper abdominal pain (which may be referred to the right shoulder), heartburn, belching, nausea, and vomiting (with the vomitus a greenish color [bile] in most cases).
GI bleeding
Bleeding in either esophagus, stomach, or intestines, caused by colon cancer, esophageal varices, ulcers, hemorrhoids, ischemic and/or obstructed bowels, and trauma.
S&S: weakness, abdominal pain, hematemesis (vomiting of blood), vomitus that looks like coffee grounds, (a classic sign of upper GI bleeding) hematochezia (bright red blood in stool), melena (dark tarry stools), syncope, altered mental status, and shock
Esophageal varicies
Varicose veins that develop in the esophagus when the venous blood return to the liver is obstructed, which happens in conditions such as cirrhosis.
S&S: hematemesis (vomiting blood), tachycardia, shortness of breath, jaundice of the skin or sclera of the eyes (a result of the liver disease), and shock.
Gastroenteritis
Inflammation of the lining of the stomach and small and large intestines. Causes may include bacteria, parasites, food poisoning, and viruses.
S&S: severe diarrhea and vomiting, dehydration, abdominal pain/cramping (commonly described as “colicky”-type discomfort), headache, fever, tachycardia, and shock. Severe cases may include hematemesis, hematochezia, and melena.
Ulcers
“Sores” that can form in various areas of the GI tract
S&S: heartburn, epigastric pain, nausea, vomiting, hematemesis (bright-red blood if acute; if blood has been in the digestive system for a longer period of time it will look like coffee grounds), hematochezia, melena (black, “tarry” feces), and shock.
Intestinal obstruction
Obstruction within the intestines that prevents contents such as gas, food, and fluids from moving forward. Obstructions can be caused by tumors, hernias, twisting or kinking of the bowel, scar tissue from surgeries, and adhesions (the intestinal walls sticking together). Fecal impaction (constipation) is also a common cause of an obstruction.
S&S: abdominal pain/cramping, abdominal distention, nausea, vomiting, constipation (diarrhea occurs when partially blocked), and, if perforation has occurred, peritonitis and sepsis
Hernia
Protrusion of part of an organ through a muscular wall. The wall is weakened usually during activities such as heavy lifting, excessive and violent vomiting, and/or violent coughing.
S&S: Sudden onset of abdominal pain during heavy lifting or straining, nausea, vomiting, tachycardia, and tenderness at the hernia site
Abdominal Aortic Aneurysm (AAA)
A weakened, ballooned, and enlarged area of the wall of the abdominal aorta. abdominal cavity the space located below the diaphragm that extends to the pelvis. Causes life-threatening hemorrhaging when ruptured.
S&S: Slow symptoms; patinet feelspulsation over the abdomen, tenderness, and back pain, to abrupt rupture of the aneurysm, which leads to death. The pain may radiate into the lower back, flank, and/or midthoracic area.
Other signs and symptoms may include gradual onset of pain that may become severe, with the patient describing it as a “tearing” sensation, testicular pain in the male patient, nausea, vomiting, mottled abdominal skin, absent or decreased femoral or pedal pulses, and signs of shock
Dysmenhorrea
Severe pain or cramps during menstruation
Mittelschmerz
Abdominopelvic pain during the middle of a menstrual cycle that is associated with ovulation.
Often caused by fluid and/or blood released from the rupture of the ovarian tissue which may cause irritation to the peritoneum.
Ovarian cysts
Small fluid-filled sacs that develop on ovaries. These cysts are harmless unless they rupture, which will cause bleeding and pain.
S&S: Abdominopelvic pain radiating to the back and vaginal bleeding, painful intercourse and pain while having a bowel movement.
Endometritis
Inflammation or irritation of the lining of the uterus (endometrium)
Can be caused by sexual transmitted diseases (STDs; chlamydia, gonorrhea), intrauterine device (IUD), or any surgical procedure that enters the uterus through the cervix.
S&S: Abdominopelvic pain, abdominal distention, vaginal bleeding, vaginal discharge that may present as an unusual color or odor, pain during a bowel movement, intercourse, exercise, and fever.
Endometriosis
Occurs when endometrial tissue that grows inside the uterus grows outside the uterus elsewhere in the body. The endometrial tissue breaks down, causing bleeding and then forms scar tissue called lesions.
S&S: Pelvic pain, vaginal bleeding, dysmenorrheal, painful intercourse and post intercourse, pain during a bowel movement, and pain to the lower back.
Pelvic Inflammatory Disease
Infection of the uterus, fallopian tubes, ovaries, and cervix (the female reproductive tract)
Due to STDs, bacteria/viruses/fungi; occur in those who have undergone recent gynecological procedures, and who use an intrauterine device (or IUD)
S&S: Abdominopelvic pain, fever, nausea, vomiting, vaginal discharge that has a foul odor, painful intercourse, painful urination, and irregular menstrual cycles
Common signs of STDs
Abdominopelvic pain, vaginal discharge that has a foul odor, fever, nausea, vomiting, irregular menstrual cycles, painful intercourse, painful urination, genital problems (itching, redness, swelling), and lesions
Other signs: PID, inflammation of the urethra (urethritis), inflammation of the cervix (cervicitis), inflammation of the prostrate (prostatitis), and fertility problems in both males and females.
Urinary Tract Infection
Infection of the urinary system that may involve one or all parts of the urinary system (kidneys, ureters, bladder, and urethra)
S&S: abdominopelvic pain; increased frequency or urge to urinate; painful, burning sensation when urinating (when urination does occur, it is usually in small amounts); cloudy, dark urine that has a foul or strong odor; pain to the pelvic area in women, with men often reporting pain in the rectal area and pain to the flank area; and blood in the urine (hematuria).
Kidney stones
Small, hard deposits of substances such as calcium and uric acid (minerals and acid salts).
Can block ureter and cause inflammation and pain.
S&S: Signs and symptoms associated with kidney stones may include abdominopelvic pain, pain radiating from the flank that moves toward the groin area as the stone moves through the ureter, nausea, vomiting, hematuria, fever, and pain with urination.
Kidney failure
Kidneys fail to function adequately due to injuries, poisons, and diseases (hypertension and diabetes are the most common).
S&S: abdominopelvic pain, hematuria, altered level of consciousness, decreased or in some cases no urine output, hypertension, and tachycardia. Patients in renal failure usually have other medical conditions associated with the renal insufficiency, such as pulmonary edema, metabolic disorders, hypertension, liver failure, seizure, and uremia.
Hemodialysis
Uses a machine to filter the blood. This machine essentially acts as a kidney. This machine has dialysate within it that cleans the blood. Blood is on one side of a semipermeable membrane and dialysate is on the other. As the blood crosses this membrane to the side containing the dialysate, the waste products are removed. The access site may be a shunt, fistula, port, or graft.
Peritoneal dialysis
The peritoneal membrane (the lining of the abdomen) is used to filter the blood. Dialysate is run through a tube into the patient’s abdomen. The dialysate remains in the abdomen for several hours so the blood may circulate and be cleaned by the dialysate. When finished, another tube drains the waste out of the body through a different tube
Signs of complications due to dialysis
hypotension, muscle cramps, peritonitis, nausea, vomiting, hemorrhage/infection at the site of the shunt, and SOB.
S&S of Internal Bleeding
- Injuries to the surface of the body
- Bruising, swelling, pain over vital organs
- Painful, swollen, deformed extremities
- Bleeding from a bodily orifice
- Tender, rigid, or distended abdomen
- Bright red substance in vomitus or vomitus that looks like coffee grounds
- Dark, tarry stools OR bright red blood in stool
- S&S of shock
S&S of Shock (Hypoperfusion)
- Altered mental status
- Pale, cool, clammy skin
- Nausea & vomiting
- Vital sign changes (Pulse, RR go up then down, BP goes down)
- Thirst
- Dilated pupils
- Cyanosis
- Diminished or absent peripheral pulses
Abdominal aorta
The portion of the descending aorta that extends from the
thoracic portion of the aorta proximally to the distal point
where the aorta divides into the iliac arteries; arteries
branching from the abdominal aorta supply the abdominal
organs.
Guarded position
The position in which a patient with severe abdominal pain
usually assumes, with knees drawn up and hands clenched
over the abdominal area.
Hematemesis
Vomiting of blood.
Hematochezia
Bright-red blood in the stool.
Hematuria
Blood in the urine.
Involuntary guarding
Abdominal wall muscle contraction caused by inflammation of
the peritoneum that the patient cannot control; also called
“rigidity”.
Markle Test
A test for the presence of peritonitis during which the patient
stands on the toes, then drops to the heels, or during which
the heels are struck together or struck on the bottom; jarring of
the torso will elicit pain when peritoneal linings are inflamed;
also called the “heel drop test”.
Melena
Dark, tarry stools containing decomposing blood normally from
the upper gastrointestinal (GI) system.
Voluntary guarding
Contraction of the abdominal muscles by the patient in
anticipation of pain or when an unpleasant feeling occurs; the
abdomen is rigid upon palpation.
Renal calculi
Kidney stones.
