Chapter 22 Abdominal Emergencies Flashcards
Abdomen
Area below the diaphragm above the pelvis
Peritoneum
The membrane that lines the abdominal cavity Organs included are : - stomach - liver - spleen - appendix - small and large colon
In women the uterus, Fallopian tubes, and ovaries are included
Visceral peritoneum
Covers the organs
Parietal peritoneum
Part of the peritoneum that is attached to the wall
Extraperitoneal space
Area outside the peritoneum
Retroperitoneal space
The area between the abdomen and the back
Organs in retroperitoneal space (technically not part of the abdomen) are:
- kidneys
- pancreas
- aorta
What is inferior to the peritoneum
The bladder and most of rectum are inferior
Visceral pain
(originates from the organs)
Pain is often described as - Dull - achy - intermittent * - crampy May be diffused or difficult to locate - from hollow organs
• pain that is dull and persistent often originated from solid organs
Solid organ pain (visceral pain)
Pain that is dull and consistent in abdomen
Parietal Pain (paa-RY-ah-tul)
Arises from parietal peritoneum, lining of abdominal cavity
- referred to peritoneal tenderness (local irritation of peritoneum)
- Because of widespread and efficient nerve endings, Pain can be more easily located and described
- May be caused by internal Bleeding and Infection
Pain is
- sharp or constant and localized -
Patient may describe worsening when moved and better in fetal position
Tearing pain
Not common, most abdominal structures or organs do not have the ability to detect tearing sensations
Exception to this is the
- Aorta (Located in retroperitoneal space) this is why pain is felt in back
- happens from an Aortic Aneurysm causing tearing sound when ruptured
- Stomach (Ulcers can cause tearing pain as they tear open)
Patients often report burning or tearing pain and Frequently Bleed Heavily as a result
Referred Pain
Pain felt in a place other than where the pain originates
- cause by shared pathways in nerves
- Ex: gallbladder is diseased, pain felt not in area of gallbladder but instead, the area of the right shoulder blade.
- also common in ectopic pregnancies
Appendicitis
infection of the appendix
- 1/15 people will develop appendicitis at some time in their life
Signs/Symptoms
- nausea, sometimes vomiting
- pain in area of umbilicus (initially)
- followed by persistent pain in the RLQ
When appendix ruptures, the patient will typically experience a sudden severe increase in pain
- this is a result of bowel contents being let loose in peritoneal cavity causing Peritonitis
Peritonitis
When Peritoneal Cavity comes in contact with an irritant:
- such as Gastric juices
- bowel contents
- and blood
may be result of Medical Condition like a ruptured appendix
or Trauma Condition like a Ruptured Spleen
- Abdomen becomes extremely - Painful and Rigid
- Fever
- Life threatening emergency
- often fixed by Surgery
Cholecystitis /Gallstones
Inflammation of gallbladder - often caused by gallstones
- Sudden RUQ and/or Epigastric (upper central abdomen) Pain
- May Radiate to the shoulder
- cholecystitis pain may be caused or worsened by ingestion of foods high in fat
- Pain May abruptly end as a stone frees itself and is passed
Pancreatitis
an inflammation of the pancreas
- common with chronic alcohol problems
- pain found in epigastric area (upper central abdomen)
- pain might radiate in the back due to pancreas being located in the retroperitoneal (behind the stomach)
- serious condition can be presented with shock
Gastrointestinal Bleeding (GI Bleed)
Bleeding can occur anywhere from Esophagus to Rectum
- Depending on size of blood vessel source may be gradual or sudden and massive
- Occurs usually in lumen of Esophagus, stomach or intestines eventually passes out of mouth or rectum
- Abnormal stools that are dark black or maroon in color
- or Frank Blood instead of stool
- May vomit blood or “coffee grounds” vomit due to blood being broke down by stomach
Abdominal Aortic Aneurysm (AAA)
Tearing of Aorta in abdomen
- High Rate of Death if discovered after they rupture
- Pain radiates to back
- Can also leak slowly
- Association with Back pain and AAA is why back pain in older patients are considered HIGH priority
- Signs: Inequality between femoral and pedal pulses
- Excruciating pain in abdomen and back
Hernia
Hole in muscle layers of Abdominal wall Allowing tissue, usually intestines, to protrude against skin
- Happens when lifting or straining ones self
- followed with sudden onset of pain
- Life threatening condition if causes obstruction or twisting of intestines
- Transported
Renal Colic also known as kidney stones
Kidneys may form small, hard stones
- pain happens when stone descends down ureter
- severe flank pain radiating anteriorly to the groin area
- associated with nausea and vomiting
Cardiac involvement
MI or myocardial infarction may be felt as abdominal discomfort
- often described as indigestion or digestive discomfort
- felt in epigastric region (below xiphoid process, upper center is the abdomen
- abdominal pain should be considered cardiac in nature until proven otherwise
Physical examination of the abdomen
Involves two procedures for EMS:
- Inspection and palpation
- in hospital auscultating Bowel sounds are common. This can be a long process listening three minutes per quadrant
First: Inspect the patient’s abdomen. Look for distention, bloating, discoloration, abnormal protrusions, or other signs that appear abnormal or unusual
Then: palpate the abdominal quadrant. Always palpate the area that has pain or discomfort last!!