Chapter 22 Abdominal Emergencies

Question 1

Abdomen

Answer 1

Area below the diaphragm above the pelvis

Question 2

Peritoneum

Answer 2

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

Question 3

Visceral peritoneum

Answer 3

Covers the organs

Question 4

Parietal peritoneum

Answer 4

Part of the peritoneum that is attached to the wall

Question 5

Extraperitoneal space

Answer 5

Area outside the peritoneum

Question 6

Retroperitoneal space

Answer 6

The area between the abdomen and the back
Organs in retroperitoneal space (technically not part of the abdomen) are:
- kidneys
- pancreas
- aorta

Question 7

What is inferior to the peritoneum

Answer 7

The bladder and most of rectum are inferior

Question 8

Visceral pain

Answer 8

(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

Question 9

Solid organ pain (visceral pain)

Answer 9

Pain that is dull and consistent in abdomen

Question 10

Parietal Pain (paa-RY-ah-tul)

Answer 10

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

Question 11

Tearing pain

Answer 11

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

Question 12

Referred Pain

Answer 12

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

Question 13

Appendicitis

Answer 13

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

Question 14

Peritonitis

Answer 14

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

Question 15

Cholecystitis /Gallstones

Answer 15

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

Question 16

Pancreatitis

Answer 16

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

Question 17

Gastrointestinal Bleeding (GI Bleed)

Answer 17

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

Question 18

Abdominal Aortic Aneurysm (AAA)

Answer 18

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

Question 19

Hernia

Answer 19

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

Question 20

Renal Colic also known as kidney stones

Answer 20

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

Question 21

Cardiac involvement

Answer 21

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

Question 22

Physical examination of the abdomen

Answer 22

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!!