Chap 22

Question 1

Peritoneum

Answer 1

the membrane that lines the abdominal cavity (the parietal peritoneum) and covers the organs within it (visceral peritoneum)

Question 2

Retroperitoneal space

Answer 2

the area between the abdomen and the back

The organs inside the retroperitoneal area, which is technically not part of the abdomen, include the kidneys, the pancreas and the aorta.
The bladder and most of the rectum are inferior to the peritoneum.

Question 3

Extraperitoneal space

Answer 3

area outside the peritoneum

Question 4

Visceral pain

Answer 4

Originates from organs (the viscera) within the abdomen. The organs themselves don’t have a lot of nerve endings to detect pain. so pain is often described as dull, achy or intermittent and may be diffuse or difficult to locate.

Question 5

Hollow organ pain

Answer 5

Intermittent, crampy, or colicky

Question 6

Solid organ pain

Answer 6

dull and persistent

Question 7

Parietal pain

Answer 7

arises from the parietal peritoneum, the lining of the abdominal lining, also known as peritoneal tenderness. Pain described as sharp or constant and localized to a particular area.
Pain direct result of local irritations of the peritoneum such as internal bleeding (ruptured spleen) or infection/inflammation (appendicitis)
Patient may describe this type of pain as worsening when he moves and getting better when he remains still or lies with the knees drawn up

Question 8

Tearing pain

Answer 8

most common type of abdominal pain
Most abdominal structures or organs do not have the ability to detect tearing sensations. The exception is the aorta and stomach. In cases of an expanding abdominal aortic aneurysm (AAA), the inner layer of the aorta is damaged and blood leaks from the inner portions of the vessel to the outer layers. This causes a tearing of the vessel lining and pockets of blood resting in a weak are of the vessel. Creates a tearing pain in back. Ulcers in the stomach can also cause tearing pain as they open or perforate.

Question 9

Referred pain

Answer 9

Pain felt in a place other than where the pain originates. Shares a nerve ending like the gall bladder pain showing in the shoulder. Referred pain into the shoulder is also a common complaint associated with ectopic pregnancies (a pregnancy developing outside of the uterus).

Question 10

Appendicitis

Answer 10

an infection of the appendix.
1 in 15
signs and symptoms, nausea, vomiting, pain in the umbilicus (initially), followed by persistent pain in the RLQ. The bowel contents being let loose into the peritoneal cavity leads to peritonitis

Question 11

Peritonitis

Answer 11

The peritoneum is very sensitive to foreign substances. Ex. gastric juices, bowel contents, and blood. the result is peritonitis.
Abdomen becomes extremely painful and rigid (caused by involuntary response of the muscles over the peritoneum).
-Fever, and other signs of infection

Question 12

Cholecystitis/ Gallstones

Answer 12

Cholecystitis is an inflammation of the gallbladder, often caused by gallstones.
-Severe and sometimes sudden RUQ and/or epigastric pain, which may radiate to the shoulder. Cholecystitis pain may be caused or worsened by ingestion of foods high in fat and can sometimes abruptly end as a stone frees itself and is passed.

Question 13

Pancreatitis

Answer 13

Inflammation of the pancreas, is common with chronic alcohol problems
Because the pancreas is located in the retroperitoneal, behind the stomach, the pain may radiate to the back and/or shoulders.

Question 14

Gastrointestinal (GI) bleeding

Answer 14

GI bleeding may be gradual or sudden and massive.

• Stools- dark black or maroon in color and tarry in appearance.
• Frank blood (red blood) without stool
• Upper GI bleeding exhibit vomiting of frank blood or coffee grounds (partial breakdown by digestive enzymes

Commonly occurs in patients with perforated ulcers in the stomach (gastric ulcers). These lesions are the result of acidic gastric juices wearing a hole in the upper GI system. If the erosion eats into a blood vessel, GI bleeding will result.

• Slow loss of blood in GI- Chronic gastrointestinal hemorrhage.
• Esophageal bleeding- Blood vessels of the esophagus can become vulnerable often due to chronic alcohol ingestion or from hypertension in the liver. If these blood vessels rupture, massive upper GI bleeding can occur. This bleeding, because of its proximity to the pharynx, can threaten the airway and pose a serious life threat

Question 15

AAA

Answer 15

Abdominal aortic aneurysm

Ballooning or weakening in the wall of the aorta as it passes through the abdomen. The weakening results in tearing of the internal layer of the blood vessel, which allows blood to escape into the weaker outer layers.

-Slowly leaking AAA is sharp pain or tearing and may radiate to the back. This is why back pain in older adults is considered a highest priority dispatch.

Question 16

Hernia

Answer 16

Hole in the muscle layers of the abdominal wall, allowing tissue- usually intestine to protrude u against the skin.
-Palpated as a mass or lump on the abdominal wall or in the creases of the groin.

Question 17

Renal colic (Kidney Stone)

Answer 17

Kidneys may form small, hard stones. the stone might descend down the ureter on the way to the bladder. It causes severe flank pain that often radiates anteriorly to the groin area.

Question 18

Cardiac involvement

Answer 18

pain from a heart attack may be felt as abdominal discomfort. This pain is often described as indigestion or digestive discomfort, is commonly felt in the epigastric region. All epigastric abdominal pain should be considered cardiac in nature until proven otherwise.

Question 19

Female abdominal problems

Answer 19

Ectopic pregnancy, ruptured ovarian cysts, pelvic inflammatory disease and menstrual irregularities

Question 20

Female patient questions

Answer 20

Where are you in your menstrual cycle?
Is your period late?
Do you have bleeding from the vagina now that is not menstrual bleeding?
If you are menstruating, is the flow normal?
Have you had this pain before?
If so, when did it happen and what was it like?